Search Results (5)

Background: Transforaminal spinal endoscopy is a minimally invasive technique used to treat several spinal conditions. Thanks to its minimally invasive approach, it offers numerous advantages over traditional open surgery, including reduced blood loss, faster post-operative hospital discharge, quicker recovery, and lower complications. This study aims to evaluate the efficacy and safety of transforaminal spinal endoscopy on a large cohort of patients. Methods: We conducted a retrospective study of 1000 patients who underwent transforaminal spinal endoscopy between January 2015 and December 2023. All patients were treated by a single surgeon in a single hospital. The patients presented with persistent symptoms of radicular pain, neurological deficits related to herniated discs, and foraminal stenosis. All patients underwent transforaminal spinal endoscopy using a transforaminal approach. Clinical outcomes were evaluated using the VAS (Visual Analogue Scale) for pain, the ODI (Oswestry Disability Index) for functional disability, and patient satisfaction. Perioperative complications were recorded and analyzed. Results: Reduction in Pain: The mean VAS score decreased significantly from 8.2 ± 1.3 pre-operatively to 2.1 ± 1.5 at 12 months post-operatively (p < 0.001). Functional Improvement: The mean ODI improved from 56% ± 12% pre-operatively to 18% ± 9% at 12 months post-operatively (p < 0.001) Patient Satisfaction: 92% of patients reported a high level of satisfaction with their treatment results. Complications: Perioperative complications were minimal, with an overall common complication rate of 4%. No major complications or functional impairments were observed. Conclusions: Transforaminal spinal endoscopy is associated with good clinical outcomes and a low complication rate in patients with spinal pathologies. This study supports the adoption of this technique as a first-line treatment for selected patients, offering a less invasive and equally effective option compared to traditional surgery. Full article

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical technique for the treatment of lumbar disc herniation. Despite its growing popularity, limited research has explored the influence of patient characteristics and the choice of technique on post-operative outcomes and patient satisfaction. Objective: To investigate the impact of patient characteristics and surgical technique (interlaminar vs. transforaminal) on the surgical outcomes and patient satisfaction following PELD. Methods: A retrospective analysis was conducted on 177 patients who underwent PELD (53.1% males, age = 46.11 ± 14.2 years), including 147 patients with the interlaminar approach and 30 with the transforaminal approach. Demographic data, pre-operative clinical features, surgical technique, intra-operative and post-operative complications and complaints, patient-reported outcomes (disability, quality of life, satisfaction), and revision surgery rates were documented and analyzed. The mean follow-up duration was 5.55 years ± 2.73 years. Results: No significant differences were observed in demographics, pre-operative status, or post-operative complaints and complication rates between two surgical techniques, except that transforaminal technique showed a higher incidence for dural tear and persistent muscle weakness (p = 0.028 and p = 0.046, respectively). Both techniques led to excellent patient-reported outcomes with no significant differences. Total patient satisfaction with PELD was 93.8%, which correlated positively with the absence of complications and complaints and negatively with persistent back pain, recurrent herniation and revision surgery. Conclusions: Interlaminar and transforaminal PELD are both effective and safe minimally invasive surgical techniques for the treatment of lumbar disc herniation with a high patient satisfaction rate. Further prospective studies are warranted to confirm these findings. Full article

Background: Lumbar spinal stenosis (LSS) remains a predominant cause of debilitating back and leg pain, affecting many aging populations. Traditional decompression surgeries can be invasive and pose significant risks and recovery time. This study elucidates the techniques and preliminary outcomes of endoscopic transfacet decompression in treating severe LSS. Methods: A retrospective review was performed on 65 patients with severe LSS who underwent endoscopic transfacet decompression. The patient outcomes were analyzed using the VAS for leg pain and the modified Macnab criteria. Pre-operative and post-operative scores were compared, and any complications were analyzed. An online survey was administered to 868 surgeons using Likert-scale ratings to evaluate surgeons’ experience with endoscopic decompression in patients with painful spondylolisthesis. The survey responses were analyzed using descriptive statistics and Polytomous Rasch analysis to evaluate surgeon endorsement. Results: The study included 65 patients, of which 29 (44.6%) were female and 36 (55.4%) were male, with a mean age of 65.79 ranging from 38 to 84 years. The available mean post-operative follow-up period was 31.44 months, ranging from 24 to 39 months. The VAS score for leg pain reduced significantly from pre-operative 7.54 ± 1.67 to 2.20 ± 1.45 by 5.34 ± 2.03 (p < 0.001) with a large effect size (Cohen’s d = 2.626). At the final follow-up, functional Macnab outcomes were reported as excellent by 20 (30.8%), good by 37 (56.9%), fair by 5 (7.7%), and poor by 3 (4.6%) of patients. There were no incidental durotomies, nerve root injuries, wound complications, or instances of post-operative instability. Only five patients (7.7%) developed post-operative dysesthesia. Incomplete decompression led to fair and poor outcomes in 8 (12.3%) patients. No revision surgeries were performed. post-operative instability was not observed. The surgeon survey corroborated these observations, where the polytomous Rasch analysis showed consensus on the effectiveness of the percutaneous endoscopic decompression of low-grade spondylolisthesis. Differential item functioning (DIF) analysis showed no significant bias in item responses between orthopaedic and neurosurgeons. Conclusions: The endoscopic transfacet decompression technique delineated herein showcased excellent Macnab outcomes in managing severe LSS, with a combined success rate of 87.7%. Patients also experienced a statistically significant reduction in leg pain. Dysesthesia rates were lower than with the transforaminal approach, likely because of limited exiting and traversing nerve root manipulation. This technique might represent a viable, less invasive alternative to open microsurgical dissection and decompression for patients with severe LSS, where fusion may be required. This approach was found to be highly accepted among endoscopic spine surgeons. Full article

The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged ≥ 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. Therefore, less invasive surgical alternatives are required for the elderly or medically handicapped patients. Transforaminal endoscopic lumbar lateral recess decompression (TELLRD) may be helpful for those patients. This study aimed to demonstrate the efficacy of TELLRD for treating radiculopathy in octogenarian patients. A total of 21 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELLRD between January 2017 and January 2021. The inclusion criterion was unilateral radiculopathy, which stemmed from lumbar lateral recess stenosis. The pain source was verified using imaging studies and selective nerve blocks. Full-scale lateral canal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. We found the pain scores and functional status improved significantly during the 24-month follow-up period. The clinical improvement rate was 95.24% (20 of 21 patients) with no systemic complication. In conclusion, endoscopic lateral recess decompression via the transforaminal approach is practical for octogenarian patients. Full article

Objective: To define the characteristics of Mini LDH, develop new diagnostic references and examine the clinical efficacy of percutaneous endoscopic lumbar discectomy via a transforaminal approach (TF-PELD) for it. Methods: A total of 72 patients who underwent TF-PELD with Mini LDH from September 2019 to October 2022 were enrolled in this retrospective study. The patients’ basic information, symptoms, number of outpatient visits, duration of conservative treatment, physical examination findings and so on were obtained from the medical records. Clinical effects of TF-PELD for Mini LDH were assessed by means of the following: the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain, Oswestry Disability Index (ODI) for functional status assessment and Modified Mac Nab criteria for patient satisfaction. Results: Mini LDH have specific clinical characteristics and imaging features. All included patients achieved obvious pain relief after TF-PELD surgery. Pain scores were repeated at postoperative day 1 and 1, 3, 6, 12 and 24 months later. Results were statistically analyzed. The average VAS-Back, VAS-Leg and ODI scores were all significantly reduced at the first postoperative day and gradually decreased with the follow-up time continuing. In total, 66 out of 72 patients received an excellent or good recovery and no poor result was reported according to the Modified Mac Nab criteria. Conclusions: Mini LDH is a type of LDH with special characteristics and in need of correct diagnosis and active treatment in clinical work. TF-PELD was also found to be an effective procedure for the treatment of Mini LDH. Full article