Full-Endoscopic Lumbar Discectomy: Tips & Tricks for New Users Based on a Retrospective Observational Study of the First 100 Patients.

Konstantinos Panagiotopoulos, Roberto Gazzeri, Santo R Princiotto, Giovanni Pennisi, Umberto Agrillo
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Abstract

Aim: To report our institutional experience with full-endoscopic lumbar discectomy (FELD) and analyzed the pertinent literature.

Material and methods: We retrospectively enrolled 100 patients who had undergone full-endoscopic discectomy for lumbar disc herniation using either an interlaminar (IL) or transforaminal (TF) approach. All patients underwent pre-operative imaging. Before and after surgery, patients' pain and disability levels were measured using visual analog scale (VAS) and Oswestry disability index (ODI) respectively. Clinical outcomes were assessed using the modified MacNab criteria. Patients were divided into two groups, Group 1 (cases 1-50) and Group 2 (cases 51-100), and their learning curve factors were compared using a Student's t-test.

Results: Sixtynine cases were operated via an IL approach and the remaining 31 cases using a TF approach. There were 4 early conversions in microdiscectomy. The mean operative time of the 96 procedures was 57 min. In Group 1, the mean operative time was 61.7 minutes (range: 35-110); in Group 2, it was 52.3 minutes (range: 25-75). The difference between the two groups was statistically significant (p=0.009). No significant differences were found in conversions, early operations, and recurrences between Groups 1 and 2. Both groups experienced a significant reduction in postoperative VAS and ODI compared to preoperative scores.

Conclusion: The findings support previously reported information on the safety and effectiveness of the FELD. Herein, we share some practical tips and tricks based on our initial experience and on the review of the available literature, which could facilitate new users. In experienced hands endoscopic techniques make treatment of herniated discs feasible independently of patient age, anatomy, and/or targeted pathology features. Conversely, thoughtful patient selection and careful preoperative planning are highly recommended for new users.

全内窥镜腰椎间盘切除术。基于对前100名患者的回顾性观察研究,为新用户提供的技巧和窍门。
目的:全内窥镜腰椎间盘切除术(FELD)是治疗腰椎间盘突出症的一种成功手术方法。我们报告了本机构使用全内镜腰椎间盘切除术的经验,并分析了相关文献:我们回顾性地选取了100名接受过全内窥镜椎间盘切除术的腰椎间盘突出症患者,采用的是层间(IL)或经穿孔(TF)方法。所有患者均接受了术前影像学检查。手术前后,分别使用视觉模拟量表(VAS)和Oswestry残疾指数(ODI)测量患者的疼痛和残疾程度。临床结果采用改良的 MacNab 标准进行评估。患者被分为两组,第一组(病例数1-50)和第二组(病例数51-100),采用Student's t检验比较他们的学习曲线因素:69例采用IL方法,其余31例采用TF方法。显微椎间盘切除术中有 4 例早期转归。96例手术的平均手术时间为57分钟。第一组的平均手术时间为61.7分钟(范围:35-110);第二组为52.3分钟(范围:25-75)。两组之间的差异具有统计学意义(P=0.009)。第一组和第二组在转院、提前手术和复发方面没有发现明显差异。与术前评分相比,两组患者的术后 VAS 和 ODI 均明显下降:我们的研究结果支持之前报道的有关 FELD 安全性和有效性的信息。在此,我们根据自己的初步经验和对现有文献的回顾,与大家分享一些实用技巧和窍门,以方便新用户使用。在经验丰富的医生手中,内窥镜技术使腰椎间盘突出症的治疗变得可行,不受患者年龄、解剖结构和/或目标病理特征的影响。相反,我们强烈建议新用户在选择患者时要深思熟虑,并在术前制定周密的计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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