Effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Hu ¹ ,  LI Pengfei ¹ , JIA Nan ¹ , JIN Xianhui ¹ , DING Wenyuan ² , ZHANG Wei ²

1. Department of Orthopaedics, Harrison International Peace Hospital, Hengshui Hebei, 053000, P.R.China;
2. Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China;

Corresponding author：

LI Pengfei, Email: pengflyl@163.com

Keywords：

Discectomy; transforaminal endoscope; minimally invasive surgery; lumbar disc herniation

DOI：

10.7507/1002-1892.201711039

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ObjectiveTo investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus.MethodsBetween August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung’s technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups (P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height.ResultsThe discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm³ in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups (P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups (P<0.05); no significant difference was found between groups A and B (P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups (P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group (P<0.05), but no significant difference of above scores and recovery values was found among 4 groups (P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups (P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant (P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups (P>0.05).ConclusionThe ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.

Citation： YANG Hu, LI Pengfei, JIA Nan, JIN Xianhui, DING Wenyuan, ZHANG Wei. Effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 933-940. doi: 10.7507/1002-1892.201711039 Copy

1.	白一冰, 徐岭, 隰建成, 等. 椎间孔镜联合椎间盘造影诊治腰椎间盘突出症. 中华医学杂志, 2012, 92(47): 3350-3353.
2.	Xin G, Shi-Sheng H, Hai-Long Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy. Clin Anat, 2013, 26(6): 728-734.
3.	李振宙, 吴闻文, 侯树勋, 等. 经皮侧后路腰椎间孔成形手术器械的设计及临床应用. 中华骨科杂志, 2011, 31(10): 1026-1032.
4.	白一冰, 李嵩鹏, 简伟, 等. 椎间孔镜下侧隐窝减压治疗腰椎管狭窄的疗效分析. 中国疼痛医学杂志, 2014, 20(12): 919-921.
5.	Hirano Y, Mizuno J, Takeda M, et al. Percutaneous endoscopic lumbar discectomy-early clinical experience. Neurol Med Chir (Tokyo), 2012, 52(9): 625-630.
6.	Choi G, Lee SH, Lokhande P, et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976), 2008, 33(15): E508-E515.
7.	Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976), 2013, 38(7): 617-625.
8.	Kapetanakis S, Charitoudis G, Thomaidis T, et al. Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation. J Craniovertebr Junction Spine, 2017, 8(1): 44-49.
9.	Choi G, Kim JS, Lokhande P, et al. Percutaneous endoscopic lumbar discectomy by transiliac approach: a case report. Spine (Phila Pa 1976), 2009, 34(12): E443-E446.
10.	Choi G, Prada N, Modi HN, et al. Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L₄-L₅ disc through an L₅-S₁ interlaminar approach: a technical note. Minim Invasive Neurosurg, 2010, 53(3): 147-152.
11.	Gupta RS, Wu XT, Hong X, et al. Technique of percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation. Open J Orthop, 2015, (5): 208-216.
12.	Ying J, Huang K, Zhu M, et al. The effect and feasibility study of transforaminal percutaneous endoscopic lumbar discectomy via superior border of inferior pedicle approach for down-migrated intracanal disc herniations. Medicine (Baltimore), 2016, 95(8): e2899.
13.	Mahesha K. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases. Indian J Orthop, 2017, 51(1): 36-42.
14.	Kafadar A, Kahraman S, Akbörü M. Percutaneous endoscopic transforaminal lumbar discectomy: a critical appraisal. Minim Invasive Neurosurg, 2006, 49(2): 74-79.
15.	Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery, 2006, 58(1 Suppl): O59-O68.
16.	Choi I, Ahn JO, So WS, et al. Exiting root injury in transforaminal endoscopic discectomy: Preoperative image considerations for safety. Eur Spine J, 2013, 22(11): 2481-2487.
17.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
18.	Ahn Y, Lee SH, Lee JH, et al. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien), 2009, 151(3): 199-206.
19.	Kim JS, Choi G, Lee SH. Percutaneous endoscopic lumbar discectomy via contralateral approach: a technical case report. Spine (Phila Pa 1976), 2011, 36(17): E1173-1178.
20.	Ditsworth DA. Endoscopic transforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canal. Surg Neurol, 1998, 49(6): 588-598.
21.	Cho JY, Lee SH, Lee HY. Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation: floating retraction technique. Minim Invasive Neurosurg, 2011, 54(5-6): 214-218.
22.	Yeom KS, Choi YS. Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation. J Orthop Sci, 2011, 16(3): 263-269.

1. 白一冰, 徐岭, 隰建成, 等. 椎间孔镜联合椎间盘造影诊治腰椎间盘突出症. 中华医学杂志, 2012, 92(47): 3350-3353.
2. Xin G, Shi-Sheng H, Hai-Long Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy. Clin Anat, 2013, 26(6): 728-734.
3. 李振宙, 吴闻文, 侯树勋, 等. 经皮侧后路腰椎间孔成形手术器械的设计及临床应用. 中华骨科杂志, 2011, 31(10): 1026-1032.
4. 白一冰, 李嵩鹏, 简伟, 等. 椎间孔镜下侧隐窝减压治疗腰椎管狭窄的疗效分析. 中国疼痛医学杂志, 2014, 20(12): 919-921.
5. Hirano Y, Mizuno J, Takeda M, et al. Percutaneous endoscopic lumbar discectomy-early clinical experience. Neurol Med Chir (Tokyo), 2012, 52(9): 625-630.
6. Choi G, Lee SH, Lokhande P, et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976), 2008, 33(15): E508-E515.
7. Ahn Y, Kim CH, Lee JH, et al. Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine (Phila Pa 1976), 2013, 38(7): 617-625.
8. Kapetanakis S, Charitoudis G, Thomaidis T, et al. Health-related quality of life after transforaminal percutaneous endoscopic discectomy: An analysis according to the level of operation. J Craniovertebr Junction Spine, 2017, 8(1): 44-49.
9. Choi G, Kim JS, Lokhande P, et al. Percutaneous endoscopic lumbar discectomy by transiliac approach: a case report. Spine (Phila Pa 1976), 2009, 34(12): E443-E446.
10. Choi G, Prada N, Modi HN, et al. Percutaneous endoscopic lumbar herniectomy for high-grade down-migrated L₄-L₅ disc through an L₅-S₁ interlaminar approach: a technical note. Minim Invasive Neurosurg, 2010, 53(3): 147-152.
11. Gupta RS, Wu XT, Hong X, et al. Technique of percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation. Open J Orthop, 2015, (5): 208-216.
12. Ying J, Huang K, Zhu M, et al. The effect and feasibility study of transforaminal percutaneous endoscopic lumbar discectomy via superior border of inferior pedicle approach for down-migrated intracanal disc herniations. Medicine (Baltimore), 2016, 95(8): e2899.
13. Mahesha K. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases. Indian J Orthop, 2017, 51(1): 36-42.
14. Kafadar A, Kahraman S, Akbörü M. Percutaneous endoscopic transforaminal lumbar discectomy: a critical appraisal. Minim Invasive Neurosurg, 2006, 49(2): 74-79.
15. Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery, 2006, 58(1 Suppl): O59-O68.
16. Choi I, Ahn JO, So WS, et al. Exiting root injury in transforaminal endoscopic discectomy: Preoperative image considerations for safety. Eur Spine J, 2013, 22(11): 2481-2487.
17. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
18. Ahn Y, Lee SH, Lee JH, et al. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien), 2009, 151(3): 199-206.
19. Kim JS, Choi G, Lee SH. Percutaneous endoscopic lumbar discectomy via contralateral approach: a technical case report. Spine (Phila Pa 1976), 2011, 36(17): E1173-1178.
20. Ditsworth DA. Endoscopic transforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canal. Surg Neurol, 1998, 49(6): 588-598.
21. Cho JY, Lee SH, Lee HY. Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation: floating retraction technique. Minim Invasive Neurosurg, 2011, 54(5-6): 214-218.
22. Yeom KS, Choi YS. Full endoscopic contralateral transforaminal discectomy for distally migrated lumbar disc herniation. J Orthop Sci, 2011, 16(3): 263-269.

Chinese Journal of Reparative and Reconstructive Surgery

Effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus

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