OUTCOMES OF TRANSFORAMINAL ENDOSCOPIC DISCECTOMY FOR LUMBOSACRAL DISC HERNIATION

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Abstract

Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.

The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in comparison with microdiscectomy (MD) and to specify factors determining complications and failures.

Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.

Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9%) which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.

Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic procedure are associated with technique drawbacks as well as with mistakes in planning and performing the approach. Congenital alignment of lumbar spine with specific patterns of facets and foramina anatomy dictate technical difficulties with transforaminal approach. 

About the authors

I. V. Volkov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Nikiforov Russian Center of Emergency and Radiation Medicine

Author for correspondence.
Email: ivanvolkov@yandex.ru

Ivan V. Volkov — Cand. Sci. (Med.), Senior Researcher, Vreden Russian Research Institute of Traumatology and Orthopedics; Neurosurgeon, Nikiforov Russian Center of Emergency and Radiation Medicine

8, ul. Akad. Baykova, St. Petersburg, 195427

Россия

I. Sh. Karabaev

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: fake@neicon.ru

Igor Sh. Karabaev — Cand. Sci. (Med.), Head of Neurosurgery Department 

54, ul. Optikov, St. Petersburg, 19734

Россия

D. A. Ptashnikov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Dmitry A. Ptashnikov — Dr. Sci. (Med.), professor, Head of Spine Surgery and Oncology Department, Vreden Russian Research Institute of Traumatology and Orthopedics; Head of Traumatology and Orthopedics Department, Mechnikov North Western State Medical University 

St. Petersburg

Россия

N. A. Konovalov

Burdenko National Scientific and Practical Centre for Neurosurgery

Email: fake@neicon.ru

Nikolai A. Konovalov — Dr. Sci. (Med.), professor, Head of Spinal Neurosurgery Department 

41, Kirochnaya ul., St. Petersburg, 191015

Россия

K. A. Poyarkov

Nikiforov Russian Center of Emergency and Radiation Medicine

Email: fake@neicon.ru

Konstantin A. Poyarkov — Neurosurgeon 

54, ul. Optikov, St. Petersburg, 19734

Россия

References

  1. Kambin P. History of Surgical Management of Herniated Lumbar Discs from Cauterization to Arthroscopic and Endoscopic Spinal Surgery. In: Arthroscopic and endoscopic spinal surgery: text and atlas. Totowa, NJ: Humana Press; 2005. рp. 1-29.
  2. Foley K.T., Smith M.M. Microendoscopic discectomy. Tech Neurosurg. 1997;3(4):301-307.
  3. Savitz M.N. Same-day microsurgical arthroscopic lateralapproach laser-assisted (SMALL) fluoroscopic discectomy. J Neurosurg. 1994;80(6):1039-1045. doi: 10.3171/jns.1994.80.6.1039.
  4. Ruetten S., Komp M., Merk H., Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521-530. doi: 10.3171/spi.2007.6.6.521.
  5. Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Res. 1999;21(1):39-42. doi: 10.1080/01616412.1999.11740889.
  6. Ahn Y., Lee S., Shin S. Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg. 2005;23(4):362-368. doi: 10.1089/pho.2005.23.362.
  7. Obenchain T.G. Laparoscopic lumbar discectomy: case report. J Laparoendosc Surg. 1991;1(3):145-149.
  8. Connolly P.J., Yuan H.A., Kolata R.J., Clem M.F. Endoscopic approach to the lumbar spine using the insufflation technique. In Atlas of endoscopic spine surgery (Regan, McAffe, Mack, eds.). St. Louis: Quality Medical Publishing; 1995. p. 345-349.
  9. Mack M.J., Regan J.J., Bobechko W.P., Acuff T.E. Application of thoracoscopy for disease of the spine. Ann Thorc Surg. 1993;56(3):736-738.
  10. Борщенко И.А., Мигачев С.Л., Древаль О.Н., Басков А.В. Опыт чрескожной эндоскопической поясничной дискэктомии. Результаты и перспективы. Нейрохирургия. 2009;(4):25-34. Borshchenko I.A., Migachev S.L., Dreval’ O.N., Baskov A.V. [Our experience in transcutaneous endoscopic lumbar diskectomia. Results and possibilities]. Neirokhirurgiya [The Russian Journal of Neurosurgery]. 2009;(4):25-34. (in Russian).
  11. Гуща А.О., Арестов С.О. Эндоскопическая спинальная хирургия. М. : ГЭОТАР-Медиа, 2010. 96 с. Gushcha A.O., Arestov S.O. Endoskopicheskaya spinal’naya khirurgiya [Endoscopic spinal Surgery]. Moscow: GEOTAR-Media; 2010. 96 p.
  12. Гуща А.О., Шевелев И.Н., Арестов С.О. Опыт эндоскопических вмешательств при патологии позвоночника. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко. 2007;(2):26-32. Gushcha A.O., Shevelev I.N., Arestov S.O. [Experience of endoscopic interventions in the pathology of the spine]. Zhurnal “Voprosy nejrokhirurgii” imeni N.N. Burdenko [Burdenko Journal of Neurosurgery]. 2007;(2):26-32. (in Russian).
  13. Худяев А.Т., Люлин С.В., Щурова Е.Н. Mетод чрекожной эндоскопической дискэктомии при лечении больных с дегенеративно-дистрофическими поражениями поясничного отдела позвоночника. Хирургия позвоночника. 2006;(2):16-21. Khudyaev A.T., Lyulin S.V., Shchurova E.N. [Percutaneous endoscopic discectomy for degenerative-dystrophic disease of the lumbar spine]. Khirurgiya pozvonochnika [Spine Surgery]. 2006;(2):16-21. (in Russian).
  14. Шевелев И.Н., Гуща А.О., Коновалов Н.А., Арестов С.О. Использование эндоскопической дискэктомии по дестандо при лечении грыж межпозвонковых дисков поясничного отдела позвоночника. Хирургия позвоночника. 2008;(1):51-57. Shevelev I.N., Gushcha A.O., Konovalov N.A., Arestov S.O. [Destandau endoscopic discectomy in patients with lumbar intervertebral disc hernia]. Khirurgiya pozvonochnika [Spine Surgery]. 2008;(1):51-57. (in Russian).
  15. Борщенко И.А., Басков А.В. Минимально инвазивная хирургия дегенеративного поражения поясничных межпозвонковых дисков. Нейрохирургия. 2010;(1):65-71. Borshchenko I.A., Baskov A.V. [Minimally invasive surgery of patients with degenerative disease of lumbar intervertebral disks]. Neirokhirurgiya [The Russian Journal of Neurosurgery]. 2010;(1):65-71. (in Russian).
  16. Kambin P., Gennarelli T., Hermantin F., Minimally invasive techniques in spinal surgery: current practice. Neurosurg focus. 1998:4(2):1-10. doi: 10.3171/foc.1998.4.2.11.
  17. Yeung A.T., Tsou P.M. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27(7):722-731. doi: 10.1097/00007632-200204010-00009.
  18. Мержоев А.М., Гуляев Д.А., Давыдов Е.А., Сингаевский С.Б., Пришвин А.П. Перкутанная эндоскопическая поясничная дискэктомия — интерламинарный доступ. Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2017;(1):48-56. Merzhoev A.M., Gulyaev D.A., Davydov E.A., Singaevskii S.B., Prishvin A.P. [Percutaneous endoscopic lumbar discectomy — interlaminar approach]. Rossiiskii neirokhirurgicheskii zhurnal im. professora A.L. Polenova [Russian Neurosurgical Journal named after professor A.L. Polenov]. 2017;(1):48-56. (in Russian).
  19. Sairyo K., Higashino K., Yamashita K., Hayashi F., Wada K., Sakai T., Takata Y., Tezuka F., Morimoto M., Terai T., Chikawa T., Yonezu H., Nagamachi A., Fukui Y. A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review. J Med Invest. 2017;64(1.2):1-6. doi: 10.2152/jmi.64.1.
  20. Коновалов Н.А., Назаренко А.Г., Асютин Д.С., Зеленков П.В., Оноприенко Р.А., Королишин В.А., Черкиев И. У., Мартынова М.А., Закиров Б.А., Тимонин С.Ю., Косырькова А.В., Пименова Л.Ф., Погосян А.Л., Батыров А.А. Современные методы лечения дегенеративных заболеваний межпозвонкового диска. Обзор литературы. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко. 2016;(4):102-108. Konovalov N.A., Nazarenko A.G., Asyutin D.S., Zelenkov P.V., Onoprienko R.A., Korolishin V.A., Cherkiev I.U., Martynova M.A., Zakirov B.A., Timonin S.Yu., Kosyr’kova A.V., Pimenova L.F., Pogosyan A.L., Batyrov A.A. [Modern treatments for degenerative disc diseases of the lumbosacral spine. A literature review]. Zhurnal “Voprosy nejrokhirurgii” im. N.N. Burdenko [Burdenko Journal of Neurosurgery]. 2016;(4):102-108. doi: 10.17116/neiro2016804102-108. (in Russian).
  21. Tsou P.M., Yeung A.T. Transforaminal endoscopic decompression for radiculopathy secondary to intracanal noncontained lumbar disc herniations: outcome and technique. Spine J. 2002;2(1):41-48. doi: 10.1016/s1529-9430(01)00153-x.
  22. Savitz M.N., Doughty H., R.N., Burns P. Percutaneous lumbar discectomy with a working endoscope and laser assistance. Neurosurg focus. 1998:4(2):E11. doi: 10.3171/foc.1998.4.2.12.
  23. Yeung A.T. Minimally invasive disc surgery with the yeung endoscopic spine system (YESS). Surg Technol Int. 2000;8:267-277.
  24. Schubert M., Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol. 2005;17(6):641-661.
  25. Milette P.C. Reporting lumbar disk abnormalities: at last, consensus! AJNR Amer. J Neuroradiol. 2001;22(3):429-430.
  26. Pfirrmann C.W. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26(17): 1873-1878. doi: 10.1097/00007632-200109010-00011.
  27. Modic M.T. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1):193-199.
  28. Lee S., Lee J.W., Yeom J.S., Kim K.J., Kim H.J., Chung S.K., Kang H.S. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol. 2010;194(4): 1095-1098. doi: 10.2214/AJR.09.2772.
  29. Roussouly P., Gollogly S., Berthonnaud E., Dimnet J. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine. 2005;30(3):346-353. doi: 10.1097/01.brs.0000152379.54463.65.
  30. Ahn Y., Lee S.H., Lee J.H., Kim J.U., Liu W.C. 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. doi: 10.1007/s00701-009-0457-4.
  31. Birkenmaier C., Komp M., Leu H.F., Wegener B., Ruetten S. The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician. 2013;16(4):335-344. doi: 10.15674/0030-59872014241-50.
  32. Ruetten S. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33(9):931-939. doi: 10.1097/brs.0b013e31816c8af7.
  33. Morgenstern R., Morgenstern C., Yeung A.T. The Learning Curve in Foraminal Endoscopic Discectomy: Experience Needed to Achieve a 90% Success Rate. SAS Journal. 2007;1(3):100-107. doi: 10.1016/SASJ-2007-0005-RR.
  34. Wu X.B., Fan G.X., Gu X., Shen T.G., Guan X.F., Hu A.N. Zhang H.L., He S.S. Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study. J Zhejiang Univ Sci B. 2016;17(7):553-560. doi: 10.1631/jzus.B1600002.
  35. Smith N., Masters J., Jensen C., Khan A., Sprowson A. Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J. 2013;22(11): 2458-2465. doi: 10.1007/s00586-013-2848-8.
  36. Борщенко И.А. Чрескожная эндоскопическая поясничная дискэктомия: современные возможности и результаты. Нейрохирургия. 2016;(1):105. Borshchenko I.A. [Percutaneous endoscopic lumbar discectomy: modern possibilities and results]. Neirokhirurgiya [The Russian Journal of Neurosurgery]. 2016;(1):105. (in Russian).
  37. Mahesha K. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases. Indian J Orthop. 2017;51(1): 36-42. doi: 10.4103/0019-5413.197520.
  38. Kamson S., Trescot A.M., Sampson P.D., Zhang Y. Fullendoscopic assisted lumbar decompressive surgery performed in an outpatient, ambulatory facility: report of 5 years of complications and risk factors. Pain Physician. 2017;20(2):E221-E231.
  39. Bai J., Zhang W., Wang Y., An J., Zhang J., Sun Y., et al. Application of transiliac approach to intervertebral endoscopic discectomy in L5/S1 intervertebral disc herniation. Eur J Med Res. 2017;22(1):14. doi: 10.1186/s40001-017-0254-0.
  40. Kim H.S., Yudoyono F., Paudel B., Jang J.S., Choi J.H., Chung S.K. Kim J.H., Jang I.T., Oh S.H., Park J.E., Lee S. Analysis of clinical results of three different routes of percutaneous endoscopic transforaminal lumbar discectomy for lumbar herniated disk. World Neurosurg. 2017;103:442-448. doi: 10.1016/j.wneu.2017.04.008.

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