title: Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series.
abstract: OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery (± SD) was 51.0 ± 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 ± 17.3 mm and 60.0 ± 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 ± 24.5 mm and 26.7 ± 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 ± 23.5 mm on the VAS and 20.2 ± 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED.
authors.affiliation: Department of Neurosurgery, Erasmus Medical Center;|Department of Neurosurgery, Leiden University Medical Center, Leiden;|Faculty of Earth and Life Sciences, Department of Health Sciences, VU University Amsterdam, The Netherlands.
authors.forename: Pravesh S
authors.initials: PS
authors.lastname: Gadjradj
authors.affiliation: Faculty of Earth and Life Sciences, Department of Health Sciences, VU University Amsterdam, The Netherlands.
authors.forename: Maurits W
authors.initials: MW
authors.lastname: van Tulder
authors.affiliation: Department of Neurosurgery, Erasmus Medical Center;
authors.forename: Clemens M F
authors.initials: CM
authors.lastname: Dirven
authors.affiliation: Department of Neurosurgery, Leiden University Medical Center, Leiden;
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
authors.affiliation: Department of Neurosurgery, Erasmus Medical Center;|Department of Neurosurgery, Park Medical Center, Rotterdam;
authors.forename: B Sanjay
authors.initials: BS
authors.lastname: Harhangi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D017587:Diskectomy, Percutaneous / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult
keywords: LDH = lumbar disc herniation; PTED = percutaneous transforaminal endoscopic discectomy; QBPDS = Quebec Back Pain Disability Scale; SAP = superior articular process; VAS = visual analog scale; lumbar disc herniation; minimally invasive spine surgery; percutaneous transforaminal endoscopic discectomy