Dataset Information

Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation.

ABSTRACT:

Objective

Full-endoscopic spine surgery (FESS) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the optimal operative route of the posterolateral approach (PLA) of FESS for the treatment of L5/S1 LDH.

Methods

Between June 2016 and November 2018, a total of 21 patients with leg pain due to L5/S1 LDH underwent PLA of FESS. According to the partial removal of the superior articular process (SAP) of the L5/S1 facet joint (FJ), we categorized these patients into 2 groups. LDH type, anatomical configurations (FJ, sacral ala [SA], and iliac crest [IC]), the presence or absence of spondylolysis, operation time, and operative outcome were compared between these 2 groups.

Results

Although the anatomical configuration of the FJ was the most important factor for the necessity of SAP removal, the configuration of the SA and IC did not restrict endoscope insertion and subsequent LDH removal. Even in intracanal LDH, the removal of SAP was not absolutely required depending on the FJ configuration. Furthermore, the presence of spondylolysis was a factor associated with the unnecessity of SAP removal.

Conclusion

Detailed radiological examination of the FJ configuration is an important preoperative investigation to determine the optimal operative route for PLA of FESS.

SUBMITTER: Fujita M

PROVIDER: S-EPMC6449817 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation.

Fujita Muneyoshi M Kawano Hirotaka H Kitagawa Tomoaki T Iwai Hiroki H Takano Yuichi Y Inanami Hirohiko H Koga Hisashi H

Neurospine 20190331 1

<h4>Objective</h4>Full-endoscopic spine surgery (FESS) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the optimal operative route of the posterolateral approach (PLA) of FESS for the treatment of L5/S1 LDH.<h4>Methods</h4>Between June 2016 and November 2018, a total of 21 patients with leg pain due to L5/S1 LDH underwent PLA of FESS. According to the partial removal of the superior articular process (SAP) of the L5/S1 facet joint (FJ), we catego ...[more]

PMID: 30943712

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Project description:This was a retrospective study. The present study investigates whether Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach(PELD) is no less effective than posterior lumbar interbody fusion(PLIF) in the treatment of L4/5 and L5/S1 two-level disc herniation. In this retrospective study, we included 40 patients with L4/5 and L5/S1 two-level lumbar disc herniation (LDH) who received PELD (n = 18) or PLIF (n = 22). The two groups are divided into a united group(PELD) and a fusion group(PLIF). In the united group, the transforaminal approach was adopted for L4/5 level disc herniation, and the interlaminar approach was adopted for L5/S1 level disc herniation. The degree of nerve root and dural compression determined by MRI was taken preoperatively. The clinical outcomes which preoperative 1 week, 3 months,6 months,12 months, 24 months, 36months and final follow-up after surgery between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), the Japanese Orthopaedic Association (JOA) and the modified MacNab criteria. In both groups, the VAS, ODI and JOA scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05). According to the modified MacNab criteria, the excellent or good outcome rate was 94.44% in the united group and 90.91% in the fusion group. Within 1 week after the operation, there was a significant difference in the improvement of clinical symptoms between the combination group and the fusion group (P < 0.05), and the combination group was better than the fusion group. Additionally, within three months postoperatively, the combination group exhibited significantly better functional improvements compared to the fusion group .With the gradual recovery of patients, there was no significant difference in the improvement of clinical symptoms between the two groups (P > 0.05). To sum up, This study aimed to compare the efficacy of PELD and PLIF in the treatment of dual-segmental lumbar disc herniation of L4/5 and L5/S1. Compared with PLIF, PELD has advantages in less intraoperative bleeding, shorter operation time and non-general anesthesia. However, the possibility of postoperative recurrence of PLIF is lower. In short, both methods can bring satisfactory results to patients. Clinically, surgeons should carefully weigh the advantages and disadvantages of the two operations and choose the operation method suitable for patients. At the same time, in future studies, we should further extend the follow-up time to observe whether vertebral fusion has more advantages in preventing postoperative recurrence.

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Dataset Information

Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation.

Objective

Methods

Results

Conclusion

Publications

Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation.

Similar Datasets

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