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Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors.

ABSTRACT: Full endoscopic surgery including discectomy (FED) and ventral facetectomy (FEVF) is a minimally invasive lumbar decompression surgery that only requires an 8 mm skin incision and can be done under the local anesthesia and sedation. Six male medical doctors underwent the endoscopic decompression (FED/FEVF) for common degenerative lumbar spine problems. Their age ranged from 27 to 63 years of age with a mean of 40 years. Five doctors underwent FED surgery for herniated nucleus pulposus (HNP), and the remaining one physician had FEVF for lumbar lateral recess stenosis. There were no surgery related complications. Postoperatively, 5 out of the 6 physician patients returned the original job within a week because they had clinical duties. The shortest duration to return to work was reported by a 63-year-old orthopedic surgeon resumed working in his clinic 2 days after the FEVF surgery. The longest duration to return to work occurred in general medicine resident who took almost 2 weeks for the sick leave because he did not have clinical duties. The mean duration for the returning to work was 5.8 days after the surgery. At final follow-up ranging from 6 to 30 months, all physician patients were working without any residual pain. In the hands of the authors, the full endoscopic transforaminal decompression surgery is the preferred surgical option and allowed early return to work-an observation that is not the norm in Japan.

SUBMITTER: Fujii Y

PROVIDER: S-EPMC7063313 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors.

Fujii Yugen Y Yamashita Kazuta K Sugiura Kosuke K Ishihama Yoshihiro Y Manabe Hiroaki H Tezuka Fumitake F Takata Yoichiro Y Sakai Toshinori T Maeda Toru T Sairyo Koichi K

Journal of spine surgery (Hong Kong) 20200101 Suppl 1

Full endoscopic surgery including discectomy (FED) and ventral facetectomy (FEVF) is a minimally invasive lumbar decompression surgery that only requires an 8 mm skin incision and can be done under the local anesthesia and sedation. Six male medical doctors underwent the endoscopic decompression (FED/FEVF) for common degenerative lumbar spine problems. Their age ranged from 27 to 63 years of age with a mean of 40 years. Five doctors underwent FED surgery for herniated nucleus pulposus (HNP), and ...[more]

PMID: 32195436

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Project description:Background:This study aimed to analyze the return to work (RTW) and recovery time (RT) to narcotic independence following outpatient endoscopic decompression for contained lumbar herniated disc causing sciatica-type low back and leg pain. Methods:A retrospective study of 442 patients with symptomatic contained lumbar herniated disc was treated with the transforaminal endoscopic decompression surgery. The mean follow-up was 33.5 months, ranging from 24 to 85 months. The patients' age ranged from 30 to 85 years, with a mean age of 40.9 years. Statistical analysis of pre- and postoperative VAS, Macnab outcomes, improvement of postoperative walking endurance was performed. RTW rates were correlated with the type of work as classified according to energy consumption per minute (Kcal/min) as Light, Medium, and Heavy using guidelines adopted from the U.S. Department of Labor. Kaplan-Meier (KM) survival tables were calculated, and curves were plotted using IBM SPSS 25.0 to graphically illustrate the diverse RTW and RT dynamic when analyzed by the clinical outcome and the type of work performed by the patient preoperatively. Results:Excellent (237/442) and Good (133/442) results were obtained in 83.7% (370/442) of patients. Fair results were reported by 43 patients (9.7%), and Poor results by 29 (6.6%), respectively. The mean preoperative VAS was 8.08. The mean postoperative VAS was significantly reduced to 2.55 (P<0.0001). The overall RTW rate was 92.5% (409/442). Patients performing Heavy (RTW rate =87.5%) and Medium (RTW rate =86.0%) work had a lower RTW rate than patients who were performing Light jobs (370/442; RTW rate =95.8%). Preoperatively, only 31.7% (140/442) had unlimited walking endurance. Postoperative walking endurance was unlimited in 77.4% (342/442; P<0.0001). Another 20.4% (90/442) of patients had pain-free walking endurance up to one mile. K-M analysis showed an estimated median RTW of 6 days for Excellent, 9 days for Good, 17 days for Fair, and 18 days for Poor Macnab outcomes. RTW analysis by the type of work showed estimated median RTW of 20 days for patients in the Heavy, 13 days in the Medium, and 6 days in the Light workgroup. The mean RT was 33.52 days in the Heavy, 19.17 days in the Medium, and 9.86 days in the Light workgroup (P<0.0001). The mean RTW was 22.27 days (P=0.008) in the Heavy, 13.97 days (P=0.004) in the Medium, and 7.58 days (P=0.004) in the Light workgroup. Postoperative irritation of the dorsal root ganglion (DRG) occurred in 68 of the 442 study patients (15.38%). DRG irritation delayed RTW to a mean of 18.94 days (P<0.0001) and RT to 15.31 days (P<0.001). Conclusions:Patient RTW and RT data are "real-world" economic indicators of successful clinical outcomes with the lumbar endoscopic transforaminal decompression procedure and compare favorably to previously reported benchmarks for other types of translaminar surgeries. These median postoperative RTW and RT times with narcotic independence were on the order of 10 days or less in the vast majority of patients Excellent and Good outcomes (83.7%). The most relevant surgical predictor of delayed RTW and RT is a postoperative DRG irritation which predominantly affected patients adversely in the Medium and Heavy workgroups. These RTW and RT data may assist in the management of return-to-work expectations with the spinal endoscopy procedure.

Project description:BackgroundMinimally-invasive (MIS) mitral valve (MV) surgery has become standard therapy in many cardiac surgery centers. While femoral arterial perfusion is the preferred cannulation strategy in MIS mitral valve surgery, retrograde arterial perfusion is known to be associated with an increased risk for cerebral atheroembolism, particularly in atherosclerosis patients. Therefore, antegrade perfusion may be beneficial in such cases. This analysis aimed to compare outcomes of antegrade axillary vs. retrograde femoral perfusion in the MIS mitral valve surgery.MethodsThis analysis includes 50 consecutive patients who underwent MIS between 2016 and 2020 using arterial cannulation of right axillary artery (Group A) due to severe aortic arteriosclerosis. Perioperative outcomes of the study group were compared with a historical control group of retrograde femoral perfusion (Group F) which was adjusted for age and gender (n = 50). Primary endpoint of the study was in-hospital mortality and perioperative cerebrovascular events.ResultsPatients in group A had a significantly higher perioperative risk as compared to Group F (EuroSCORE II: 3.9 ± 2.5 vs. 1.6 ± 1.5; p = 0.001; STS-Score: 2.1 ± 1.4 vs. 1.3 ± 0.6; p = 0.023). Cardiopulmonary bypass time (group A: 172 ± 46; group F: 178 ± 51 min; p = 0.627) and duration of surgery (group A: 260 ± 65; group F: 257 ± 69 min; p = 0.870) were similar. However, aortic cross clamp time was significantly shorter in group A as compared to group F (86 ± 20 vs. 111 ± 29 min, p < 0.001). There was no perioperative stroke in either groups. In-hospital mortality was similar in both groups (group A: 1 patient; group F: 0 patients; p = 0.289). In group A, one patient required central aortic repair due to intraoperative aortic dissection. No further cardiovascular events occurred in Group A patients.ConclusionSelective use of antegrade axillary artery perfusion in patients with systemic atherosclerosis shows similar in-hospital outcomes as compared to lower risk patients undergoing retrograde femoral perfusion. Patients with higher perioperative risk and severe atherosclerosis can be safely treated via the minimally invasive approach with antegrade axillary perfusion.

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Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors.

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Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors.

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