nach oben

European Spine Journal

Erschienen in:

16.11.2019 | Original Article

Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study

verfasst von: Kang Li, Kai Gao, Tao Zhang, Chao-liang Lv

Erschienen in: European Spine Journal | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

In this study, the authors described the technical notes of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) through unilateral approach and compared PTELD through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms.

Methods

A prospective randomized clinical study was performed from June 2014 to October 2016. A total of 71 patients with lumbar disc herniation (L3/4 or L4/5) and bilateral symptoms were divided randomly into Unilateral-Approach group (n = 35) or Bilateral-Approach group (n = 36). Operation time, blood loss, intraoperative fluoroscopy and recurrences were recorded and analyzed statistically. Visual Analogue Scale scores, Oswestry Disability Index and the MacNab standard were used to analyze the clinical outcomes of the two groups.

Results

The baseline data of the two groups were statistically similar. There was significant postoperative improvement in VAS and ODI scores in both the groups, and clinical outcomes are comparable according to the MacNab standard. However, VAS score of back pain at 1 day after surgery in Unilateral-Approach group was significantly lower than that in Bilateral-Approach group (P < 0.05). Moreover, operation time and cumulative time of intraoperative fluoroscopy of Unilateral-Approach group were significantly shorter than that of Bilateral-Approach group (P < 0.05).

Conclusion

For L3/4 or L4/5 LDH with bilateral symptoms, PTELD through unilateral approach is effective, with advantage of shorter operation time, shorter cumulative time of intraoperative fluoroscopy and milder postoperative short-term back pain compared to bilateral approach.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Nur mit Berechtigung zugänglich

Yeung AT, Yeung CA (2007) Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am 38 (3):363–372; abstract vi. https://doi.org/10.1016/j.ocl.2007.04.005

Tsou PM, Alan Yeung C, Yeung AT (2004) Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J 4(5):564–573. https://doi.org/10.1016/j.spinee.2004.01.014 CrossRefPubMed

Tsou PM, Yeung AT (2002) Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J 2(1):41–48CrossRef

Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27(7):722–731CrossRef

Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY (2004) Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine 29(16):E326–332CrossRef

Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33(9):931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7 CrossRefPubMed

Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS (2008) Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 33(15):E508–515. https://doi.org/10.1097/BRS.0b013e31817bfa1a CrossRefPubMed

Ahn Y, Jang IT, Kim WK (2016) Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clin Neurol Neurosurg 147:11–17. https://doi.org/10.1016/j.clineuro.2016.05.016 CrossRefPubMed

Kim HS, Paudel B, Jang JS, Lee K, Oh SH, Jang IT (2018) Percutaneous endoscopic lumbar discectomy for all types of lumbar disc herniations (LDH) including severely difficult and extremely difficult LDH cases. Pain Physician 21(4):E401–E408PubMed

10.

Ren C, Li Y, Qin R, Sun P, Wang P (2017) Transforaminal endoscopic lumbar discectomy for lumbar disc herniation causing bilateral symptoms. World Neurosurg 106:413–421. https://doi.org/10.1016/j.wneu.2017.06.191 CrossRefPubMed

11.

Gu J, Guan F, Zhu L, Guan G, Chi Z, Wang H, Yu Z (2016) Risk factors of postoperative low back pain for lumbar spine disease. World Neurosurg 94:248–254. https://doi.org/10.1016/j.wneu.2016.07.010 CrossRefPubMed

12.

Choi SH, Adsul NM, Kim HS, Kim KJ, Kim JH, Chung SK, Choi JH, Jang JS, Jang IT, Oh SH (2018) Percutaneous endoscopic interlaminar unilateral ventral dural approach for symptomatic bilateral L5-S1 herniated nucleus pulposus: technical note. J Neurol Surg Part A Cent Eur Neurosurg 79(6):518–523. https://doi.org/10.1055/s-0038-1639505 CrossRef

Titel: Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study
verfasst von: Kang Li
Kai Gao
Tao Zhang
Chao-liang Lv
Publikationsdatum: 16.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 7/2020
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06210-y

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Graphic abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2020

Is Cutibacterium acnes early surgical site infection rate related to the duration of antibiotic prophylaxis in adolescent idiopathic scoliosis surgery?

Staged surgical treatment for infection of total disc arthroplasty: three cases and a narrative review of the literature

Augmented reality and artificial intelligence-based navigation during percutaneous vertebroplasty: a pilot randomised clinical trial

Expert’s comment concerning Grand Rounds case entitled “Staged surgical treatment for infection of total disc arthroplasty: three cases and a narrative review of the literature” by Christoph-Heinrich Hoffmann, Jens Castein, Frank Kandziora (Eur Spine J; 2018: doi:10.1007/s00586-018-5648-3)

The factors related to the poor ADL in the patients with osteoporotic vertebral fracture after instrumentation surgery

Correction to: Revision surgery in thoracic disc herniation