Background This study aims to assess the clinical and radiographic outcomes of biportal endoscopic lumbar discectomy compared to microscopic lumbar discectomy in obese patients with lumbar herniated discs. Previous research has established a positive correlation between operation time and estimated blood loss in obese patients undergoing microscopic lumbar discectomy, based on an increase in body mass index. However, no studies have specifically examined the outcomes of biportal endoscopic lumbar discectomy in this patient population. Therefore, this study seeks to fill this research gap and provide valuable insights into the effectiveness of these two surgical approaches for obese patients with lumbar herniated discs.
Methods This retrospective multicenter study analyzed and compared clinical and radiological data from 48 obese patients with a body mass index (BMI) greater than 30 kg/m2 who underwent either microscopic or biportal endoscopic lumbar discectomy. The study assessed clinical outcomes using the visual analog scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D) scores. Radiological data were obtained through magnetic resonance imaging (MRI) scans.
Results The study included a total of 48 patients, with 31 patients undergoing microscopic discectomy and 17 patients undergoing biportal endoscopic discectomy. Both groups showed improvements in VAS, ODI, and EQ-5D scores following surgery compared to preoperative scores. However, there was no significant difference in these outcome measures between the two surgical techniques. Although there was a no significant difference in the occurrence of recurrent disc herniation confirmed by postoperative MRI, there was significant difference in the number of patients requiring additional surgery between the two groups.
Conclusions For obese patients with lumbar disc herniation that did not respond to conservative treatment, this study found no significant differences in clinical or radiological outcomes between microscopic and biportal endoscopic surgery methods. However, it is worth noting that the biportal group had a lower incidence of reoperation compared to the microscopic group.
Background When obese patients underwent lumbar discectomy using a microscope, a correlation was found between the operation time and an increase in estimated blood loss according to the increase in body mass index.
However, except for minor complications, there was no difference in postoperative outcomes between obese and normal-weight patients. These are the results of microscopic lumbar discectomy in obese patients, but there are no studies on biportal endoscopic lumbar discectomy. The aim of this study was to compare the clinical and radiographic outcomes of microscopic and endoscopic discectomy in obese patients.
Methods Clinical and radiological data were compared and analyzed in 23 obese patients with a body mass index of >30 kg/m2 who underwent microscopic and biportal endoscopic lumbar discectomy. Clinical data on the visual analog scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D) scores were measured, and radiological data were measured using magnetic resonance imaging (MRI).
Results In total, 13 patients who underwent microscopic discectomy and 10 who underwent biportal endoscopic discectomy were enrolled in this study. The VAS, ODI, and EQ-5D scores in both groups improved after surgery compared with those before surgery, although there was no difference between the two groups. Although there was a difference in the incidence of recurrent disc herniation confirmed by MRI after surgery, there was no difference in the number of patients requiring surgery between the two groups.
Conclusions There were no significant clinical or radiological differences in outcomes between microscopic and biportal endoscopic surgery methods.
Objective This study aimed to compare the efficacy of unilateral biportal endoscopic decompression (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in reducing muscle injury by measuring serum levels of creatine phosphokinase (CK) and lactate dehydrogenase (LDH).
Materials and Methods Thirty patients with degenerative lumbar stenosis or a herniated lumbar disc underwent decompression surgery. Among them, 12 patients underwent UBE (experimental group, n=12) and 18 underwent PELD (control group, n=18). CK and LDH were determined at admission and 1, 3, and 5 days after surgery. Pain was measured with a visual analogue scale (VAS).
Results The mean age was significantly higher in the UBE group than the PELD group (63.33±13.50 vs. 49.94±14.79, p<0.035). Mean CK levels were not significantly different at admission. However, at both 3 and 5 days after surgery, CK levels were higher in the UBE group (308.44±153.93 vs. 70.43±40.15, p=0.002; 157.11±91.41 vs. 47.62±23.13, p=0.007). The mean LDH level was higher in the PELD group at 1 day after surgery (152.55±34.69 vs. 199.87±53.78, p=0.027). The operation time was significantly shorter in the PELD group (90.67±39.59 vs. 49.43±14.11, p=0.003).
Conclusions The UBE group had higher CK levels at 3 and 5 days after surgery. The PELD group had a higher LDH level at 1 day after surgery. Therefore, neither procedure is clearly superior in terms of muscle damage.
Spinal subdural hematoma (SDH) is a rare complication after spinal surgery. Only a few cases are reported on spinal SDH following open lumbar spinal decompression or fusion surgery. Moreover, there has been no case report on spinal SDH following percutaneous transforaminal endoscopic lumbar discectomy. We report a case of spinal SDH following endoscopic discectomy, review the literature of this complication and discuss the etiology to it and methods to prevent it. A 63-year-old woman presented with severe radiating pain. Pain was not improved with conservative management. Lumbar magnetic resonance imaging (MRI) was checked and revealed right L3-4 ruptured disc with severe L4 root compression. Percutaneous transforaminal endoscopic decompression was performed and the pain subsided promptly after the endoscopic procedure. On 7th post-operative day, pain on Rt. buttock, anterior thigh was deteriorated severely, more than in pre-operatively. Deteriorated pain was not controlled by oral medications and epidural block. Repeat MRI showed no definite recurrence of disc herniation at decompressed level but spinal SDH, severely compressing cauda equina was seen on T12-sacral area. Spinal SDH is a rare complication following spine surgery, including percutaneous endoscopic surgery. A spine surgeon should be aware of the possibility of spinal subdural hematoma, having severe sequel.
Purpose To evaluate and analyze the clinical results of lumbar microdiscectomy using minimally invasive tubular retractor between recurrence and non-recurrence group, and to assess the merits of minimally invasive spinal surgery.
Overview of Literature: No large registry study has so far investigated the clinical results of lumbar microdiscectomy using minimally invasive tubular retractor.
Methods From July 2003 to April 2011 we retrospectively studied a consecutive series of 156 patients who underwent lumbar microdiscectomy using minimally invasive tubular retractor. The following data were collected: clinical outcomes, operative time, intraoperative blood loss, recurrence, and complications. The clinical outcomes were measured using a visual analog scale (VAS) and assessed by the modified MacNab criteria.
Results Minimally invasive tubular microdiscectomy was performed in 156 patients. The clinical outcomes assessed by MacNab criteria were excellent in 63 patients (40%), good in 71 patients (45%). VAS scores of low-back pain decreased from a mean of 6.7 prior to surgery to 2.5 after surgery, and that of leg pain decreased from 7.2 to 2.1. The average operative time was 68 minutes (range, 25 to 180 minutes). The average blood loss was 42 mL (range, 0 to 500 mL). None of the patients needed blood replacement. One patient had wound infection problem but there was no dural tear case. Twenty-two patients had recurrence. Average time to recurrence was about 42 months. Seventeen cases recurred at the same level and five cases recurred at the adjacent level. Eleven cases in 22 patients with recurrence were contained disc type and the others were non-contained disc type. Eighteen cases in 22 patients with recurrence were paracentral disc herniation type and the others were far lateral type. Average body mass index (BMI) of recurrence cases was 24.7 (range, 17.5 to 31.3) and that of non-recurrence cases was 24.5 (range, 16.3 to 39.2).
Conclusions Lumbar microdiscectomy using tubular retractor can offer a useful modality for the treatment of lumbar herniated disc with the merits of minimally invasive spinal surgery. Further randomized, prospective investigations are needed to fully evaluate the impact of this technique.
Purpose We planned this study to comparatively analyse several clinical results depending on the range of incision in herniated nucleus pulposus surgery.
Materials and Methods We examined 49 cases herniated nucleus pulposus , performed laminectomy or discectomy from 2006.1 to 2007.2. Average age of patients was 44 years (19~73), male 25 cases and female 24 cases. 20 cases (9 male, 11 female) of conventional incision, and 17 cases (7 male, 10 female) of mini incision, 12 cases (9 male, 3 female) of microscopically assisted percutaneous nucleotomy (MAPN) were performed. All cases were protruded or extruded nucleus pulposus at L4-5 single level. Used VAS score to compare the pain after the operation with preop pain, checked ODI (Oswestry disability index) to compare the functional recovery of the ordinary activities, blood loss measured by total amount collected by drainage tube. Degrees of inflammation were compared by CRP of 1st, 7th, 14th day after the surgery.
Results Conventional incision (Group I) took average 71 minutes of operation time, degree of pain relief was 7.8→3.2, average ODI was 61%, average blood loss was 69 ml and average change in CRP was 2.5→.2.2→2.0. In mini incision (Group II), 55 minutes, 7.3→2.47, 44%, 45 ml, 2.0→1.7→0.3 and , in cases with MAPN (Group III), 71 minutes, 7.1→2.41, 48%, 19 ml, 1.6→1.1→0.4. Operation time was similar on group I and group III and took shorter on group II. Amount of pain relief showed significant change in group II and group III, indicating that these were much greater than group I. ODI was delayed in group I. Average blood loss decreased significantly in group III. CRP level increased on first day after the operation, group II and group III showed more decrease level of CRP comparing to group I as time flows.
Conclusion By comparing 3 groups, group III and group II were of better result in average ODI a, blood loss and CRP change. But, MAPN has long learning curve and longer operation time, so we recommend mini incision method in this study.
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