Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has bee...Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.展开更多
Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20...Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.展开更多
Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar...Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.展开更多
Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar interver...Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.展开更多
BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial ...BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis,imaging,and treatment of this condition.Total endoscopic discectomy is an alternative surgical technique that is less invasive.AIM To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.METHODS This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021.All patients were randomly divided into the following two groups:The observation group,comprising 62 patients who underwent surgery using the interlaminar approach,and the control group,comprising 58 patients who were operated through the foramina approach.The treatment effects,perioperative indicators,functional recovery,pain,and quality of life were compared between the two groups.RESULTS The treatment effect in the observation group(93.55%)was significantly better than that in the control group(77.59%).There was no difference in the operative time and intraoperative blood loss amount between the two groups(P>0.05).The hospitalization time of the observation group(4.34±1.33 d)was significantly shorter than that of the control group(5.38±1.57 days)(P<0.05).The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment,but the scores were lower in the observation group than in the control group.The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment,but scores were lower in the observation group(2.18±0.88 in the lower back and 1.42±0.50 in the leg)than in the control group(3.53±0.50 in the lower back and 2.21±0.52 in the leg).A short form of the Arthritis Impact Measurement Scales 2 measurement scale(AIMS2-SF)score and Barthel index of the lower back of the two groups increased significantly after treatment,with the observation group having a significantly higher AIMS2-SF score(95.16±1.74)and Barthel index(97.29±1.75)than the control group(84.95±2.14 and 89.16±2.71,respectively)(P<0.05).CONCLUSION Through total endoscopic discectomy with the interlaminar approach,the degree of pain in the waist and leg was reduced,and the lumbar function considerably recovered.展开更多
Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation w...Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital between January 2013 and January 2017 were selected and randomly divided into two groups: Percutaneous transforaminal endoscope discectomy (PTED) group and control group. Patients in PTED group received percutaneous transforaminal endoscope discectomy, while control group received open fenestration discectomy. Serum levels of pain substances SP, NPY, PGE2 and NGF, inflammatory mediators IFN-γ, TNF-α, IL-17 and MMP3 as well as stress response substances Cor, NE, OH-, O2- and MDA of two groups of patients were determined the same day after surgery and 3 days after surgery.Results: The same day after surgery and 3 d after surgery, serum SP, NPY, PGE2, NGF, IFN-γ, TNF-α, IL-17, MMP3, Cor, NE, OH-, O2- and MDA levels of PTED group were significantly lower than those of control group. Conclusion: Percutaneous transforaminal endoscope discectomy for lumbar intervertebral disc herniation causes less postoperative pain and inflammatory stress than open fenestration discectomy.展开更多
Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatm...Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.展开更多
Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the f...Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the first 60 cases at the L4/5 level （Group I） and the first 60 cases at the L5/S1 level （Group II） of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C （Group I： A cases 1-20, B cases 21-40, C cases 41-60; Group I1： A cases 1-20, B cases 21-40, C cases 41-60）. Operation time was thoroughly analyzed. Results： Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were （88.75±17.02）, （67.75±6.16）, and （64.85±7.82） min, respectively. There was a significant difference between Groups A and B （P〈0.05）, but no significant difference between Groups B and C （P=-0.20）. The mean operation times of Groups IIA, liB, and IIC were （117.25±13.62）, （109.50±11.20）, and （92.15±11.94） rain, respectively. There was no significant difference between Groups A and B （P=0.06）, but there was a significant difference between Groups B and C （P〈0.05）. There were 6 cases of postoperative dysesthesia （POD） in Group I and 2 cases in Group IIA （P=-0.27）. There were 2 cases of residual disc in Group I, and 4 cases in Group II （P=0.67）. There were 3 cases of recurrence in Group I, and 2 cases in Group II （P〉0.05）. Conclusions： Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.展开更多
文摘Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.
文摘Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.
文摘Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.
基金Research Project of Sichuan Provincial Health Department(No:130914).
文摘Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.
基金Science and Technology Support Plan of Guizhou Science and Technology Department,No.[2019]2812and National Natural Science Foundation of China,No.82060415.
文摘BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis,imaging,and treatment of this condition.Total endoscopic discectomy is an alternative surgical technique that is less invasive.AIM To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.METHODS This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021.All patients were randomly divided into the following two groups:The observation group,comprising 62 patients who underwent surgery using the interlaminar approach,and the control group,comprising 58 patients who were operated through the foramina approach.The treatment effects,perioperative indicators,functional recovery,pain,and quality of life were compared between the two groups.RESULTS The treatment effect in the observation group(93.55%)was significantly better than that in the control group(77.59%).There was no difference in the operative time and intraoperative blood loss amount between the two groups(P>0.05).The hospitalization time of the observation group(4.34±1.33 d)was significantly shorter than that of the control group(5.38±1.57 days)(P<0.05).The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment,but the scores were lower in the observation group than in the control group.The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment,but scores were lower in the observation group(2.18±0.88 in the lower back and 1.42±0.50 in the leg)than in the control group(3.53±0.50 in the lower back and 2.21±0.52 in the leg).A short form of the Arthritis Impact Measurement Scales 2 measurement scale(AIMS2-SF)score and Barthel index of the lower back of the two groups increased significantly after treatment,with the observation group having a significantly higher AIMS2-SF score(95.16±1.74)and Barthel index(97.29±1.75)than the control group(84.95±2.14 and 89.16±2.71,respectively)(P<0.05).CONCLUSION Through total endoscopic discectomy with the interlaminar approach,the degree of pain in the waist and leg was reduced,and the lumbar function considerably recovered.
文摘Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital between January 2013 and January 2017 were selected and randomly divided into two groups: Percutaneous transforaminal endoscope discectomy (PTED) group and control group. Patients in PTED group received percutaneous transforaminal endoscope discectomy, while control group received open fenestration discectomy. Serum levels of pain substances SP, NPY, PGE2 and NGF, inflammatory mediators IFN-γ, TNF-α, IL-17 and MMP3 as well as stress response substances Cor, NE, OH-, O2- and MDA of two groups of patients were determined the same day after surgery and 3 days after surgery.Results: The same day after surgery and 3 d after surgery, serum SP, NPY, PGE2, NGF, IFN-γ, TNF-α, IL-17, MMP3, Cor, NE, OH-, O2- and MDA levels of PTED group were significantly lower than those of control group. Conclusion: Percutaneous transforaminal endoscope discectomy for lumbar intervertebral disc herniation causes less postoperative pain and inflammatory stress than open fenestration discectomy.
文摘Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.
文摘Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the first 60 cases at the L4/5 level （Group I） and the first 60 cases at the L5/S1 level （Group II） of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C （Group I： A cases 1-20, B cases 21-40, C cases 41-60; Group I1： A cases 1-20, B cases 21-40, C cases 41-60）. Operation time was thoroughly analyzed. Results： Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were （88.75±17.02）, （67.75±6.16）, and （64.85±7.82） min, respectively. There was a significant difference between Groups A and B （P〈0.05）, but no significant difference between Groups B and C （P=-0.20）. The mean operation times of Groups IIA, liB, and IIC were （117.25±13.62）, （109.50±11.20）, and （92.15±11.94） rain, respectively. There was no significant difference between Groups A and B （P=0.06）, but there was a significant difference between Groups B and C （P〈0.05）. There were 6 cases of postoperative dysesthesia （POD） in Group I and 2 cases in Group IIA （P=-0.27）. There were 2 cases of residual disc in Group I, and 4 cases in Group II （P=0.67）. There were 3 cases of recurrence in Group I, and 2 cases in Group II （P〉0.05）. Conclusions： Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.
