Translaminar Full Endoscopic Technique with Tom Shidi Needles for Highly- and Dorsally-Migrated Lumbar Disc Herniations.

BACKGROUND: Thirty years have passed since Kambin's first clinical series of lumbar disc herniations (LDH) treated by arthroscopic microdiscectomy. Despite several advances in this interim, sequestrated LDHs over the dorsal aspect of the dura, and high-grade up- or downward disc migration have been a relative limitation of the transforaminal endoscopic technique. The interlaminar window was the next step to deal with such highly migrated LDHs. Favorable outcomes were obtained in 70-90% of the patients in the long-term, but recurrence rates remained high (approximately 12%), and the approach could be limited by the size of the interlaminar window. Few relevant studies have addressed the role of translaminar full endoscopic technique for migrated LDHs. To describe an innovative modification of the translaminar full endoscopic approach with Tom Shidi needles. METHODS: This technical modification is presented in a detailed fashion for treating these challenging LDHs and illustrated through a clinical case. RESULTS: The patient underwent successful translaminar full endoscopic technique with complete pain resolution postoperatively. The postprocedural course was uneventful. A follow-up imaging showed no evidence of residual LDHs fragments. CONCLUSIONS: Translaminar full endoscopic technique with Tom Shidi needles is a promising modification of the previously presented interlaminar and translaminar endoscopic routes in the treatment of migrated LDHs to fasten surgical procedures and increase the safety of spinal canal manipulation.

Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes.

INTRODUCTION: Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates. METHODS: Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed. RESULTS: We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)-dural tear (1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%); epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI 0.1-3.4%). CONCLUSION: Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.

Pain intensity and functionality after percutaneous endoscopic discectomy: a retrospective cohort study / Intensidade de dor e funcionalidade após discectomia endoscópica percutânea: estudo de coorte retrospectivo / Intensidad del dolor y funcionalidad después de la discectomía endoscópica percutánea: un estudio de cohorte retrospectivo

ABSTRACT Objectives To evaluate pain intensity and functional status before and 30 days following percutaneous lumbar endoscopic discectomy. Methods A retrospective cohort study that included patients who underwent percutaneous endoscopic discectomy from January 2019 to October 2020 at the Irmandade Santa Casa de Misericórdia Hospital, in Porto Alegre. The data were collected from the electronic medical records of the patients by two independent physicians. Clinical outcomes were assessed using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results Forty-six patients with a mean age of 52.6 ± 15.8 years, 27 of whom (58.7%) were male, were evaluated. Regarding clinical outcomes, a statistically significant improvement was observed in the comparison between the pre- and 30-day postoperative VAS and ODI scores, with no significant difference in relation to sex. No peri- or postoperative complications were observed. All patients successfully completed surgery and were discharged after recovery from anesthesia. Conclusion There was a significant improvement in pain and functional status 30 days after percutaneous endoscopic discectomy performed to correct lumbar disc herniation, with no difference in relation to sex. In addition, no peri- or postoperative complications were observed. Future studies, with longer follow-up times, comparing clinical outcomes from the various techniques of percutaneous endoscopic discectomy are necessary. Level of evidence III; Retrospective comparative study.

RESUMO Objetivos Avaliar a intensidade da dor e o estado funcional antes da cirurgia e em 30 dias de pós-operatório de discectomia endoscópica lombar percutânea. Métodos Estudo de coorte retrospectivo. Foram incluídos pacientes tratados com discectomia endoscópica percutânea, de janeiro de 2019 a outubro de 2020, no complexo hospitalar Irmandade Santa Casa de Misericórdia de Porto Alegre. Os dados foram coletados do prontuário eletrônico dos pacientes por dois médicos independentes. Os desfechos clínicos foram avaliados pela pontuação da Escala Visual Analógica (EVA) e do Índice de Incapacidade Oswestry (ODI). Resultados Foram incluídos 46 pacientes no estudo, com média de idade de 52,6 ± 15,8 anos, sendo 27 (58,7%), do sexo masculino. Quanto aos desfechos clínicos, observou-se melhora estatisticamente significativa com relação às escalas de EVA e ODI na comparação entre pré-operatório e 30 dias depois da cirurgia, sem diferença significativa com relação ao sexo. Não foram observadas complicações peri e pós-operatórias. Todos os pacientes completaram a cirurgia com sucesso e receberam alta após recuperação da anestesia. Conclusão Observou-se melhora significativa da dor e do estado funcional 30 dias depois da discectomia endoscópica percutânea realizada para correção da hérnia de disco lombar, sem diferença com relação ao sexo. Além disso, não foram observadas complicações peri e pós-operatórias, assim como não houve necessidade de internação hospitalar. Futuros estudos, com maior tempo de seguimento, que comparem os desfechos clínicos através das diversas técnicas de discectomia endoscópica percutânea fazem-se necessários. Nível de evidência III; Estudo retrospectivo comparativo

RESUMEN Objetivo Evaluar la intensidad del dolor y el estado funcional antes de la cirugía y 30 días después de la discectomía endoscópica lumbar percutánea. Métodos Estudio de cohorte retrospectivo. Se incluyeron pacientes tratados mediante discectomía endoscópica percutánea, de enero de 2019 a octubre de 2020, en el complejo hospitalario Hermandad Santa Casa de Misericordia de Porto Alegre. Los datos fueron recolectados de los registros médicos electrónicos de los pacientes por dos médicos independientes. Los resultados clínicos se evaluaron mediante la puntuación de la Escala Visual Analógica (EVA) y del Índice de Discapacidad de Oswestry (ODI). Resultados Se incluyeron 46 pacientes en el estudio, con una edad promedio de 52,6 ± 15,8 años, de los cuales 27 (58,7%) eran del sexo masculino. En cuanto a los resultados clínicos, hubo una mejoría estadísticamente significativa en relación a las escalas EVA y ODI al comparar el preoperatorio y 30 días después de la cirugía sin diferencia significativa en cuanto al sexo. No se observaron complicaciones perioperatorias y postoperatorias. Todos los pacientes completaron con éxito la cirugía e fueron dados de alta después de recuperarse de la anestesia, sin casos de reingreso hospitalario. Conclusión Hubo una mejoría significativa del dolor y del estado funcional luego de 30 días de discectomía endoscópica percutánea, realizada para corregir la hernia de disco lumbar, sin diferencias en cuanto al sexo. Además, no hubo complicaciones perioperatorias y postoperatorias, así como tampoco hubo necesidad de hospitalización. Son necesarios estudios futuros, con un período de seguimiento más largo, que comparen los resultados clínicos a través de las diferentes técnicas de discectomía endoscópica percutánea. Nivel de evidencia III; Estudio comparativo retrospectivo.

Comparison of two endoscopic spine surgical techniques.

OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.

Comparison of two endoscopic spine surgical techniques

SUMMARY OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.

Transforaminal Endoscopic Lumbar Discectomy: Clinical Outcomes and Complications / Discectomia endoscópica transforaminal lombar: Resultados clínicos e complicações

Abstract Objective To evaluate the clinical and functional results of transforaminal endoscopic lumbar discectomy. Materials and Methods From August 2015 to January 2017, 101 patients with lumbar disc hernia refractory to clinical treatment underwent endoscopic discectomy. Through clinical evaluation by the Visual Analogue Scale and functional evaluation by the Oswestry Disability Index questionnaire, the patients were analyzed in the preoperative period, the immediate postoperative period, at 1 month, 3 months, 6 months and 1 year after surgery. Results The mean age of the participants was 48.1 years. The most affected disc levels were L4-L5 and L5-S1. A total of 29 patients were treated at 2 disc levels. After 1 month of postoperative follow-up, the mean scores on the questionnaires (VAS and ODI) decreased significantly (p < 0.001). Conclusion Transforaminal endoscopic Lumbar discectomy has been shown to be a safe, effective and minimally-invasive alternative for the treatment of lumbar disc herniation. The procedure has advantages, such as short hospital stay, surgery performed under local anesthesia and sedation, early return to daily activities, and low rate of complications.

Resumo Objetivo Avaliar os resultados clínicos e funcionais da discectomia endoscópica transforaminal lombar. Materiais e Métodos De agosto de 2015 a janeiro de 2017, 101 pacientes portadores de hérnia de disco lombar refratária ao tratamento clínico foram submetidos a discectomia endoscópica. Por meio de avaliação clínica pela Escala Visual Analógica e análise funcional pelo questionário Oswestry Disability Index, os pacientes foram analisados no período pré-operatório, no pós-operatório imediato, com 1 mês, 3 meses, 6 meses e 1 ano após a cirurgia. Resultados A média de idade dos participantes foi de 48.1 anos. Os níveis discais mais acometidos foram L4-L5, seguidos de L5-S1. Um total de 29 pacientes foram abordados em 2 níveis discais. Após 1 mês de seguimento pós-operatório, a média das pontuações nos questionários (EVA e ODI) diminuiu significativamente (p < 0.001). Conclusão A discectomia endoscópica transforaminal lombar mostrou ser uma alternativa segura, eficaz e minimamente invasiva para o tratamento de hérnia de disco lombar. O procedimento tem vantagens, como curto período de internação hospitalar, cirurgia realizada sob anestesia local e sedação, retorno precoce às atividades diárias, e baixa taxa de complicações.

A Novel, Minimally Invasive Hybrid Technique to Approach Intracanal Herniated Thoracic Discs.

BACKGROUND: Multiple options exist for thoracic disc herniation (TDH). However, when a specific technique is chosen, the goal is to avoid the manipulation of the spinal cord, which is already compressed. OBJECTIVE: To describe a hybrid endoscopic technique for intracanal TDH by combining an oblique paraspinal approach (OPA) and transforaminal full-endoscopic discectomy. METHODS: We describe the step-by-step operative technique and present the clinical and radiological outcomes of a case series of hybrid endoscopic thoracic discectomy. RESULTS: A total of 3 patients were treated. We observed the usefulness of an OPA to enlarge the intervertebral foramen through the rigid tubular retractor and the feasibility of a full-endoscopic transforaminal approach to reach intracanal TDHs. CONCLUSION: Early experience with the hybrid endoscopic technique for TDHs demonstrated acceptable clinical and radiological outcomes in the 3 patients treated; however, a larger sample size and a methodologically advantageous study to compare this procedure with conventional options are necessary to probe the full benefits of the hybrid technique.

Comparative results between open and minimally invasive fusion in lumbar degenerative disease / Resultados comparativos entre a fusão aberta e minimamente invasiva na doença degenerativa lombar / Resultados comparativos entre fusión abierta y mínimamente invasiva en enfermedad degenerativa lumbar

ABSTRACT Objective: Lumbar spine fusion is indicated in patients who are refractory to traditional treatment for degenerative disc disease. The aim of this study was to compare the perioperative and postoperative results of conventional open surgery versus minimally invasive surgery (MIS) in posterior 360° lumbar fusion with pedicle screw instrumentation. Methods: A total of 25 patients underwent MIS and 40 underwent open surgery between 2015 and 2017. Perioperative variables and lumbar and radicular pain values were compared using a visual analogue scale (VAS) and the Oswestry disability index (ODI) until 12 months after surgery. Results: The MIS cohort presented less blood loss (140 vs 345 ml; p=0.001), shorter hospital stay (1.1 vs 2.2 days; p=0.001), longer operative time (113 vs 94 minutes; p=0.001) and greater X-ray exposure (80 vs 6 seconds; p=0.001), compared to the open surgery group. The MIS cohort showed better results in the ODI and lumbar VAS scores. No significant differences were observed in radicular VAS. Conclusion: MIS surgery showed advantages over the open surgery technique; however, the learning curve should be improved in order to reduce operative time. Level of Evidence III; Retrospective descriptive observational study.

RESUMO Objetivo: A fusão espinhal lombar é indicada para pacientes refratários ao tratamento tradicional da doença degenerativa do disco. O objetivo do presente estudo consistia em comparar os resultados peri- e pós-operatórios da cirurgia aberta convencional versus a cirurgia minimamente invasiva (MIS) na fusão lombar de 360º por via posterior com instrumentação de parafuso pedicular. Métodos: Foram estudados 25 pacientes submetidos à técnica de MIS e 40 submetidos à cirurgia aberta entre 2015 e 2017. As variáveis perioperatórias e os valores da dor lombar e dor radicular foram comparados com a escala visual analógica (EVA) e Oswestry Disability Index (ODI) até 12 meses após a cirurgia. Resultados: O grupo MIS apresentou menores índices de perda sanguínea (140 vs 345 ml; p = 0,001) e menor permanência hospitalar (1,1 vs. 2,2 dias; p = 0,001), maior tempo de cirurgia (113 vs. 94 minutos; p = 0,001) e maior exposição às radiografias (80 vs 6 seg; p = 0,001) em relação ao grupo de cirurgia aberta. O grupo MIS apresentou melhores resultados nos escores de ODI e EVA lombar. Na EVA radicular não foram observadas diferenças significativas. Conclusão: A cirurgia minimamente invasiva apresentou vantagens em relação à técnica da cirurgia aberta, embora a curva de aprendizagem deva ser otimizada para reduzir o tempo de cirurgia. Nível de Evidência III; Estudo retrospectivo descritivo observacional.

RESUMEN Objetivo: La fusión espinal lumbar es indicada para pacientes refractarios al tratamiento tradicional de la enfermedad degenerativa del disco. El objetivo del presente estudio consistía en comparar los resultados peri y postoperatorios de la cirugía abierta convencional versus la cirugía mínimamente invasiva (MIS) en la fusión lumbar de 360º por vía posterior con instrumentación de tornillo pedicular. Métodos: Se estudiaron 25 pacientes sometidos a la técnica MIS y 40 sometidos a la cirugía abierta entre 2015 y 2017. Se compararon las variables perioperatorias y los valores del dolor lumbar y dolor radicular con la escala visual analógica (EVA) e índice de incapacidad de Oswestry (ODI) hasta los 12 meses post cirugía. Resultados: El grupo MIS presentó menores índices de pérdida sanguínea (140 vs 345 ml; p=0,001) y menor permanencia hospitalaria (1,1 vs 2,2 días; p=0,001), mayor tiempo de cirugía (113 vs 94 minutos; p=0,001) y exposición a las radiografías (80 vs 6 seg; p=0,001) con relación al grupo de cirugía abierta. El grupo MIS presentó mejores resultados en las puntuaciones de ODI y EVA lumbar. En la EVA radicular no se observaron diferencias significativas. Conclusión: La cirugía mínimamente invasiva presentó ventajas con relación a la técnica de la cirugía abierta, aunque la curva de aprendizaje deba ser optimizada para reducir el tiempo de cirugía. Nivel de Evidencia III; Estudio retrospectivo descriptivo observacional.

Lumbar endoscopic discectomy in obese patients / Discectomia endoscópica lombar em pacientes obesos / Discectomía endoscópica lumbar en pacientes obesos

ABSTRACT Objective The aim of this study was to evaluate the clinical and functional results of endoscopic lumbar discectomy in obese patients. Methods We selected 56 patients with lumbar disc hernia refractory to clinical treatment that underwent endoscopic discectomy. Twenty-five patients with a body mass index (BMI) greater than or equal to 30 kg/m 2 were analyzed through the Visual Analogue Scale and functional evaluation using the Oswestry Disability Index questionnaire and compared to 31 patients in the control group (BMI between 18.5 and 24.9 kg/m 2 ). These data were obtained in the preoperative period, in the immediate postoperative period, at 1 month, 3 months, 6 months and one year after surgery. Results The mean BMI in the control group was 22.1 kg/m 2 , and in the obese group, 33.6 kg/m 2 . In both groups there was a statistically significant improvement in clinical and functional analyzes. There was no statistical difference between the groups. Conclusions Lumbar transforaminal endoscopic discectomy has been shown to be a safe, effective and minimally invasive alternative for the treatment of lumbar disc herniation in obese patients. Level of Evidence III; Retrospective and Comparative Study.

RESUMO Objetivo A meta do estudo foi avaliar os resultados clínicos e funcionais da discectomia endoscópica lombar nos pacientes obesos. Métodos Foram selecionados 56 pacientes portadores de hérnia de disco lombar refratário ao tratamento clínico submetidos à discectomia endoscópica. Através de avaliação clínica - pela Escala Visual Analógica - e funcional - pelo questionário de Oswestry Disability Index. Foram analisados 25 pacientes com índice de massa corpórea (IMC) maior ou igual de 30 kg/m 2 e comparados com 31 pacientes do grupo controle (IMC entre 18,5 e 24,9 kg/m 2 ). Esses dados foram obtidos no período pré-operatório, no pós-operatório imediato, com 1 mês, 3 meses, 6 meses e um ano após a cirurgia. Resultados O IMC médio no grupo controle foi de 22,1 kg/m 2 , e no grupo obeso de 33,6 kg/m 2 . Em ambos os grupos houve melhora estatisticamente significativa nas análises clínicas e funcionais. Não se observou diferença estatística entre os grupos. Conclusão A discectomia endoscópica transforaminal lombar mostrou ser uma alternativa segura, efetiva e minimamente invasiva para o tratamento de hérnia de disco lombar em pacientes obesos. Nível de Evidência III; Estudo Retrospectivo, Comparativo.

RESUMEN Objetivo El objetivo de este estudio fue evaluar los resultados clínicos y funcionales de la discectomía lumbar endoscópica en pacientes obesos. Métodos Se seleccionaron 56 pacientes portadores de hernia discal lumbar refractaria al tratamiento clínico, sometidos a discectomía endoscópica. Se analizaron 25 pacientes con índice de masa corporal (IMC) mayor o igual a 30 kg/m 2 ) por medio de la Escala Visual Analógica y evaluación funcional mediante el cuestionario Índice de Discapacidad de Oswestry y se compararon a 31 pacientes del grupo control (IMC entre 18,5 kg/m 2 y 24,9 kg/m 2 ). Estos datos fueron obtenidos en el preoperatorio, en el postoperatorio inmediato, al mes, a los 3 meses, 6 meses y un año después de la cirugía. Resultados El IMC promedio en el grupo control fue de 22,1 kg/m 2 y en el grupo obeso, de 33,6 kg/m 2 . En ambos grupos hubo una mejoría estadísticamente significativa en los análisis clínicos y funcionales. No hubo diferencia estadística entre los grupos. Conclusiones La discectomía endoscópica transforaminal lumbar se ha mostrado una alternativa segura, eficaz y mínimamente invasiva para el tratamiento de hernia discal lumbar en pacientes obesos. Nivel de Evidencia III; Estudio Retrospectivo y Comparativo.

Efficacy and safety of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar spinal stenosis combined with osteoporosis.

OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.

Efficacy and safety of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar spinal stenosis combined with osteoporosis

SUMMARY OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.

RESUMO: OBJETIVO: Investigar a eficácia e segurança da discectomia endoscópica percutânea transforaminal (DEPT) no tratamento da estenose lombar (EL) combinada à osteoporose. MÉTODOS: Oitenta pacientes com EL combinada à osteoporose foram divididos entre um grupo de controle e um grupo de DEPT, que receberam tratamento convencional com fusão intersomática lombar transforaminal e DEPT, respectivamente. As indicações cirúrgicas, a escala analógica visual (VAS) da incisão e de dor lombar e nas pernas, os escores lombares de acordo com a Associação Ortopédica Japonesa (JOA) e o Oswestry Disability Index (ODI), a densidade mineral óssea (DMO) e possíveis reações adversas foram observados. RESULTADOS: Em comparação com o grupo de controle, no grupo de DEPT o tempo de operação, a perda de sangue e duração de internação, os escores VAS da incisão no pós-operatório após 12, 24 e 48 h, o VAS para dor lombar e nas pernas e os escores ODI lombares após 6 meses de pós-operatório foram significativamente menores (P < 0,01); já o escore JOA lombar após 6 meses de pós-operatório foi significativamente maior (P < 0,05). Não houve diferença significativa na densidade mineral óssea entre os dois grupos (P > 0,05). Em comparação com o grupo de controle, o grupo de DEPT teve uma taxa efetiva total significativamente maior (P < 0,05), e a incidência de reações adversas foi significativamente menor (P < 0,05). CONCLUSÕES: A discectomia endoscópica percutânea transforaminal é segura e eficaz no tratamento de EL combinada à osteoporose.

Radiation Exposure during Percutaneous Endoscopic Lumbar Discectomy: Interlaminar versus Transforaminal

Objective Percutaneous endoscopic lumbar discectomy (PELD) relies heavily on fluoroscopy guidance; therefore, medical staff exposure to radiation has become an important issue. The purpose of this study was to determine the radiation dose and the amount of time to which the surgeons are exposed during PELD and to compare both parameters in the transforaminal (TF) and interlaminar (IL) approaches. Although they are considerably different, they may be wrongly considered together. Methods A retrospective evaluation of the last 20 PELD performed by the authors is presented. Patients were distributed in 2 groups. Six (1F, 5M) patients were submitted to IL-PELD and 14 (6F, 8M) to TF-PELD. Fluoroscopy reports were obtained from patients' records, all performed with the same C-Arm device and software mode. Groups were compared using unpaired t-test. Results The IL group showed an average radiation exposure of 8.37 4.21 mGy and duration of 11.1 5.45 seconds, while the TF group showed an average radiation exposure of 28.92 7.56 mGy and duration of 42 16.64 seconds. The p-value for radiation was 0.0000036, and for time it was 0.00027. Conclusions Interlaminar PELD requires a lower radiation dose and a shorter amount of exposure than TF-PELD. Studies that concern radiation required for minimallyinvasive spine surgeries should consider the PELD approaches separately.

Experimental model for transforaminal endoscopic spine

Abstract Purpose: To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP). Methods: TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described. Results: This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers. Conclusion: This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.

Discectomía Endoscópica Lumbar Percutánea (DELP): presentación de 60 casos intervenidos en Argentina con pacientes despiertos / Percutaneous Lumbar Endoscopic Discectomy (PRS): presentation of 60 cases operated in Argentina with awake patients

Introducción: La DELP es una técnica mínimamente invasiva que se usa en distintos países desde finales de los años ochenta para el tratamiento de las hernias discales. Nuestro objetivo es describir los resultados de las DELP en una serie de pacientes despiertos, con anestesia peridural y sedación. Materiales y Métodos: En un grupo de 60 pacientes y 77 hernias de discos operados entre abril de 2016 y marzo de 2018, se recogieron datos como la edad, el sexo, la imagen clínica y las anomalías de imágenes mediante MRI. El resultado principal fue la diferencia en los puntajes de Oswestry (ODI) pre y postquirúrgico a las 8 semanas del procedimiento. También se evaluaron los criterios de Macnab, la duración de la operación, el tiempo de hospitalización, las complicaciones quirúrgicas y la necesidad de reintervención. Los pacientes recibieron anestesia peridural y sedación. Resultados: Se operaron 60 pacientes y 77 hernias discales. El promedio de reducción en ODI a las 8 semanas fue 48 puntos (SD=5), representando un porcentaje medio de reducción de 85%(SD=8). Según los criterios de Macnab, tuvieron excelente o buena evolución el 85% de los pacientes, regular 10% y mala evolución 5%. El tiempo de cirugía promedio fue de 50 minutos y el de hospitalización 8,6 horas. Conclusiones: En nuestra serie de pacientes quirúrgicos con hernias discales lumbares la DELP resultó ser una técnica con muy buenos resultados en la reducción del dolor, de corta duración quirúrgica, sin complicaciones y breve estadía hospitalaria. La opción del paciente despierto y la modalidad ambulatoria fueron muy aceptadas por los pacientes y resultaron de factible ejecución.

Introduction: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally-invasive technique that has been used in different countries since the late eighties for the treatment of herniated discs. Objective: To describe the results of PELD in a series of awake patients, treated with epidural anesthesia and mild sedation. Methods and Materials: In a group of 60 patients, who together had 77 discs operated upon between April 2016 and March 2018, data were collected on patient age and gender, clinical presentation, and MRI abnormalities. The main outcome of interest was the difference between preoperative and postoperative Oswestry (ODI) scores eight weeks after the procedure. Macnab criteria, operation duration, length of hospitalization, surgical complications, and the need for reoperation were other outcomes evaluated. All patients received epidural anesthesia and mild sedation. Results: The average reduction in ODI at 8 weeks was 48 points (SD = 5), representing an average percentage reduction of 85% (SD = 8). By Macnab's criteria, 85% of patients experienced either an excellent or good result, while 10% and 5% had a fair and poor result, respectively. Average surgery time was 50 minutes and in-hospitalization stay 8.6 hours. Conclusions: In our series of surgical patients with lumbar disc herniations, PELD yielded very good results, manifest as significantly reduced pain, brief procedural durations, no complications, and short hospital stays. Patients accepted the option of being awake and immediately ambulatory, and the approach proved highly feasible to execute.

Lumbar herniated disc - endoscopic discectomy treatment.

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Lumbar herniated disc treatment with percutaneous hydrodiscectomy

SUMMARY Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.

RESUMO Hérnias discais lombares são manifestações comuns das doenças degenerativas da coluna, sendo a principal causa de dor lombar irradiada. Esta diretriz seguiu padrão de uma revisão sistemática com recuperação de evidências com base no movimento da Medicina Baseada em Evidências. Utilizamos a forma estruturada de formular a pergunta sintetizada pelo acrônimo P.I.C.O., em que o P corresponde à Hérnia de disco lombar, I à intervenção Tratamento com hidrodiscectomia percutânea, C comparando com Outras modalidades de tratamento, O de desfecho de Evolução clínica e complicações. A partir da pergunta estruturada, identificamos os descritores que constituíram a base da busca da evidência nas bases de dados Medline-PubMed (636 trabalhos) e, assim, após os critérios de elegibilidade (inclusão e exclusão), oito trabalhos foram selecionados para responder à dúvida clínica. Os detalhes da metodologia e dos resultados desta diretriz estão expostos no Anexo I.

Delayed Infected Pseudomeningocele After Percutaneous Endoscopic Lumbar Diskectomy.

BACKGROUND: Percutaneous endoscopic lumbar diskectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disk herniations. However, while its use increases, newer complications have been discovered. CASE DESCRIPTION: We present the unique case of a woman who underwent PELD/foraminotomy to treat right-side foraminal disk herniations on L4-5 and L5-S1 in the same procedure. Ten days after surgery, the patient developed fever and severe low back pain radiated down her right leg. Magnetic resonance imaging showed a right pseudomeningocele arising from L4-5 and a nerve root herniated through the dural sac at the same lumbar segment. Blood cultures and fluid culture obtained from pseudomeningocele drainage depicted infection. Specific antibiotics were administrated, direct dura repair under the microscope was performed, and the patient improved symptomatically. CONCLUSIONS: PELD combined with foraminotomy is a relatively new and skill-demanding surgery which is indicated only in cases where foraminal disk herniation is combined with foraminal stenosis. This surgical strategy requires experience by the endoscopic surgeon to prevent procedure-related complications. Although rare, these complications can lead to increased morbidity.