Short- and long-term results of percutaneous full-endoscopic and microsurgical lumbar discectomy: prospective cohort study
https://doi.org/10.14531/ss2019.2.27-34
Abstract
Objective. To analyze immediate and long-term results of percutaneous endoscopic and microsurgical discectomy.
Material and Methods. A prospective cohort study in two groups of patients was conducted in 2015–2018. The observation period was 6–42 months. Group 1 included 110 patients who underwent percutaneous endoscopic lumbar discectomy, and Group 2 – 331 patients who underwent microdiscectomy. Efficiency was assessed using NRS-11, ODI, SF-36, and MacNab questionnaires.
Results. The operating time, bed day number, and disability period were shorter in Group 1 (p < 0.001). The average effective dose of radiation exposure to the patient was 4.4 mSv in transforaminal endoscopy, and 0.8 mSv in interlaminar and microsurgical discectomy. There were no significant intergroup differences in frequency and types of complications and reoperations. The portion of symptomatic hernia recurrence in Group 1 was 10 %, in Group 2 – 4.8 %. Significant differences in neurological outcomes and quality of life were not revealed. Good and excellent outcomes according to MacNab criteria were noted in 78.2 % and 84.9 %, in Groups 1 and 2, respectively.
Conclusion. The percutaneous endoscopic discectomy allows reducing hospital stay length and disability period, while having clinical efficacy equal to that of other disectomy methods. A statistically insignificant increase in the risk of hernia recurrence after percutaneous endoscopic discectomy was noted.
About the Authors
M. N. Kravtsov
S.M. Kirov Military Medical Academy
Russian Federation
Maksim Nikolayevich Kravtsov, MD, PhD, doctoral student in the Neurosurgical Department, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
Russian Federation
Maksim Nikolayevich Kravtsov, MD, PhD, doctoral student in the Neurosurgical Department, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
S. D. Mirzametov
S.M. Kirov Military Medical Academy
Russian Federation
Saidmirze Dzhamirzoevich Mirzametov, neurosurgeon in the Clinic of Neurosurgery, postgraduate student in the Department of Neurosurgery, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
Russian Federation
Saidmirze Dzhamirzoevich Mirzametov, neurosurgeon in the Clinic of Neurosurgery, postgraduate student in the Department of Neurosurgery, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
V. N. Malakhovskiy
S.M. Kirov Military Medical Academy
Russian Federation
Vladimir Nikolayevich Malakhovskiy, DMSc, Prof., teaching assistant in the Department of Roentgenology and Radiology, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
Russian Federation
Vladimir Nikolayevich Malakhovskiy, DMSc, Prof., teaching assistant in the Department of Roentgenology and Radiology, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
N. P. Alekseyeva
St. Petersburg State University; Pavlov First St. Petersburg State Medical University
Russian Federation
Russian Federation
Nina Petrovna Alekseyeva, PhD in Physics and Mathematics, Associate Professor, Faculty of Mathematics and Mechanics, Universitetskaya
Emb., 7–9, St. Petersburg, 199034, Russia;
Lev Tolstoy str., 6–8, St. Petersburg, 197022, Russia
B. V. Gaidar
S.M. Kirov Military Medical Academy
Russian Federation
Boris Vsevolodovich Gaidar, DMSc, Prof., Professor of the Department of Neurosurgery, Academician of the RAS, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
Russian Federation
Boris Vsevolodovich Gaidar, DMSc, Prof., Professor of the Department of Neurosurgery, Academician of the RAS, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
D. V. Svistov
S.M. Kirov Military Medical Academy
Russian Federation
Dmitry Vladimirovich Svistov, MD, PhD, associate professor, Head of the Department of Neurosurgery, chief neurosurgeon of the Ministry of Defence of the Russian Federation, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
Russian Federation
Dmitry Vladimirovich Svistov, MD, PhD, associate professor, Head of the Department of Neurosurgery, chief neurosurgeon of the Ministry of Defence of the Russian Federation, Academician Lebedev str., 6, St. Petersburg, 194044, Russia
References
1. Hijikata S, Yamagishi M, Nakayma T. Percutaneous discectomy: a new treatment method for lumbar disc herniation. J Tokyo Den-Ryoku Hosp. 1975;39:39–44.
2. Kambin P, ed. Arthroscopic Microdiscectomy: Minimal Intervention in Spinal Surgery. Baltimore, 1991.
3. Schreiber A, Suezawa Y, Leu H. Does percutaneous nucleotomy with discoscopy replace conventional discectomy? Eight years of experience and results in treatment of herniated lumbar disc. Clin Orthop Relat Res. 1989;238:35–42.
4. Suezawa Y, Jacob HAC. Percutaneous nucleotomy. Arch Orthop Tauma Surg. 1986;105:287–295. DOI: 10.1007/BF00449928.
5. 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;6:521–530. DOI: 10.3171/spi.2007.6.6.2.
6. Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol. 2005;17:641–661. DOI: 10.1007/s00064-005-1156-9.
7. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27:722–731.
8. Iprenburg M. Transforaminal endoscopic surgery – technique and provisional results in primary disc herniation. Eur Musculoskelet Rev. 2007;2:73–76.
9. Krzok G, Telfeian AE, Wagner R, Iprenburg M. Transpedicular lumbar endoscopic surgery for highly migrated disk extrusions: preliminary series and surgical technique. World Neurosurg. 2016;95:299–303. DOI: 10.1016/j.wneu.2016.08.018.
10. Dezawa A, Mikami H, Sairyo K. Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine. Asian J Endosc Surg. 2012;5:200–203. DOI: 10.1111/j.1758-5910.2012.00142.x.
11. Zorin NA, Kirpa YuI, Zorin NN. The comparative assessment of efficacy of endoscopic transforaminal microdiscectomy and open microdiscectomy in treatment of lumbar discs herniation. Ukr Neyrokhіr Zh. 2014;3:61–65. In Russian.
12. Volkov IV, Karabaev ISh, Ptashnikov DA, Konovalov NA, Poyarkov KA. Outcomes of transforaminal endoscopic discectomy for lumbosacral disc herniation. Travmatologiya i ortopediya Rossii. 2017;23(3):32–42. In Russian. DOI: 10.21823/2311-2905-2017-23-3-32-42.
13. Wang H, Song Y, Cai L. Effect of percutaneous transforaminal lumbar spine endoscopic discectomy on lumbar disc herniation and its influence on indexes of oxidative stress. Biomed Res. 2017;28:9464–9469.
14. Gibson JNA, Subramanian AS, Scott CEH. A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Eur Spine J. 2017;26:847–856. DOI: 10.1007/s00586-016-4885-6.
15. Chen Z, Zhang L, Dong J, Xie P, Liu B, Wang Q, Chen R, Feng F, Yang B, Shu T, Li S, Yang Y, He L, Pang M, Rong L. Percutaneous transforaminal endoscopic discectomy compared with microendoscopic discectomy for lumbar disc herniation: 1-year results of an ongoing randomized controlled trial. J Neurosurg Spine. 2018;28:300–310. DOI: 10.3171/2017.7.SPINE161434.
16. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine. 2008;33:931–939. DOI: 10.1097/BRS.0b013e31816c8af7.
17. Control of the patient effective doses from medical X-ray examinations. Guidelines MU 2.6.1.2944-11. Moscow: Rospotrebnadzor, 2011:32. In Russian.
18. Lee YS, Lee HK, Cho JH, Kim HG. Analysis of radiation risk to patients from intraoperative use of the mobile X-ray system (C-arm). J Res Med Sci. 2015;20:7–12.
19. Alexeyeva NP, Tatarinova AA, Gurschenkov AV, Kutuzova AE, Belyakova LA, Gracheva PV, Bondarenko BB. Analysis of repeated measures with missing data on the basis of ergodic model centralization in cardiology. Byulleten’ Federal’nogo Centra serdca, krovi i ehndokrinologii im. V.A. Almazova. 2011;8(3):59–63. In Russian.
20. Alexeyeva NP. Dual balance correction in repeated measures ANOVA with missing data. Electron J Appl Stat Anal. 2017;10:146–159. DOI: 10.1285/i20705948v10n1p146.
21. Zloba E, Yackiv I. Statistical methods for recovering missing data. Computer Modelling & New Technologies. 2002;6(1):51–61. In Russian.
22. Liu X, Yuan S, Tian Y, Wang L, Gong L, Zheng Y, Li J. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results. J Neurosurg Spine. 2018;28:317–325. DOI: 10.3171/2017.6.SPINE172.
23. Kim MA, Lee S, Kim HS, Park S, Shim SY, Lim DJ. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for lumbar disc herniation in the Korean: a meta-analysis. BioMed Res Int. 2018;2018:9073460. DOI: 10.1155/2018/9073460.
24. Iprenburg M, Wagner R, Godschalx A, Telfeian AE. Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study. Neurosurg Focus. 2016;40:E7. DOI: 10.3171/2015.11.FOCUS15485.
25. McGirt MJ, Ambrossi GLG, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery. 2009;64:338–345. DOI: 10.1227/01.NEU.0000337574.58662.
26. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine. 2006;31:653–657. DOI: 10.1097/01.brs.0000203714.76250.68.
27. Kahanovitz N, Viola K, Muculloch J. Limited surgical discectomy and microdiscectomy. A clinical comparison. Spine. 1989;14:79–81.
Review
For citations:
Kravtsov M.N., Mirzametov S.D., Malakhovskiy V.N., Alekseyeva N.P., Gaidar B.V., Svistov D.V. Short- and long-term results of percutaneous full-endoscopic and microsurgical lumbar discectomy: prospective cohort study. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2019;16(2):27-34. https://doi.org/10.14531/ss2019.2.27-34
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