Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up
Abstract Background Full-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a high-grade migrated herniated disc. However, because of the complexity of the surgery, success is dependent on the surgeon’s skill. Therefore, patients are frequently treated using ope...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-020-03891-1 |
| _version_ | 1818453041284644864 |
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| author | Christopher Wu Ching-Yu Lee Sheng Chi Chen Shao-Keh Hsu Meng-Huang Wu |
| author_facet | Christopher Wu Ching-Yu Lee Sheng Chi Chen Shao-Keh Hsu Meng-Huang Wu |
| author_sort | Christopher Wu |
| collection | DOAJ |
| description | Abstract Background Full-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a high-grade migrated herniated disc. However, because of the complexity of the surgery, success is dependent on the surgeon’s skill. Therefore, patients are frequently treated using open discectomy. Anatomical constraints and technical difficulties can lead to the incomplete removal of high-grade migrated discs. Methods We retrospectively reviewed patients who had undergone FELD performed by a single surgeon between January 2010 and January 2014 from a prospective spine registry in an institute. Perioperative records and data of the Oswestry Disability Index, visual analog scale scores (preoperatively and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years after the operation), and MacNab criteria were collected. Results Of 58 patients with a follow-up duration of > 5 years, (41 and 17 patients had undergone transforaminal endoscopic lumbar discectomy [TELD] and interlaminar endoscopic lumbar discectomy [IELD], respectively), the satisfaction rate was 87.8% (five unsatisfactory cases) for TELD and 100% for IELD. The overall percentage of patients with good to excellent results according to modified MacNab criteria was 91.3% (53/58 patients). Two patients had residual discs. Two patients needed an open discectomy due to recurrent disc herniation. One IELD patient received spinal fusion surgery due to segmental instability after 5 years. Conclusion FELD has a high success rate for the management of high-grade migrated herniated discs. In patients with high-grade disc migration from L1 to L5, TELD is effective and safe. However, for L4–L5 and L5–S1 high-grade upward and downward disc migration, IELD is the favorable option and provides high patient satisfaction. |
| first_indexed | 2024-12-14T21:32:41Z |
| format | Article |
| id | doaj.art-b05675c83b2944028fbf5dae4e1a8a28 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-14T21:32:41Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-b05675c83b2944028fbf5dae4e1a8a282022-12-21T22:46:40ZengBMCBMC Musculoskeletal Disorders1471-24742021-01-0122111910.1186/s12891-020-03891-1Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-upChristopher Wu0Ching-Yu Lee1Sheng Chi Chen2Shao-Keh Hsu3Meng-Huang Wu4College of Medicine, Taipei Medical UniversityDepartment of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical UniversityDepartment of Orthopedics, Tungs’ Taichung MetroHarbor HospitalDepartment of Orthopedics, Tungs’ Taichung MetroHarbor HospitalDepartment of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical UniversityAbstract Background Full-endoscopic lumbar discectomy (FELD) is an alternative to posterior open surgery to treat a high-grade migrated herniated disc. However, because of the complexity of the surgery, success is dependent on the surgeon’s skill. Therefore, patients are frequently treated using open discectomy. Anatomical constraints and technical difficulties can lead to the incomplete removal of high-grade migrated discs. Methods We retrospectively reviewed patients who had undergone FELD performed by a single surgeon between January 2010 and January 2014 from a prospective spine registry in an institute. Perioperative records and data of the Oswestry Disability Index, visual analog scale scores (preoperatively and 2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years after the operation), and MacNab criteria were collected. Results Of 58 patients with a follow-up duration of > 5 years, (41 and 17 patients had undergone transforaminal endoscopic lumbar discectomy [TELD] and interlaminar endoscopic lumbar discectomy [IELD], respectively), the satisfaction rate was 87.8% (five unsatisfactory cases) for TELD and 100% for IELD. The overall percentage of patients with good to excellent results according to modified MacNab criteria was 91.3% (53/58 patients). Two patients had residual discs. Two patients needed an open discectomy due to recurrent disc herniation. One IELD patient received spinal fusion surgery due to segmental instability after 5 years. Conclusion FELD has a high success rate for the management of high-grade migrated herniated discs. In patients with high-grade disc migration from L1 to L5, TELD is effective and safe. However, for L4–L5 and L5–S1 high-grade upward and downward disc migration, IELD is the favorable option and provides high patient satisfaction.https://doi.org/10.1186/s12891-020-03891-1DiscectomyFull-endoscopic lumbar discectomyMigrated disc herniation |
| spellingShingle | Christopher Wu Ching-Yu Lee Sheng Chi Chen Shao-Keh Hsu Meng-Huang Wu Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up BMC Musculoskeletal Disorders Discectomy Full-endoscopic lumbar discectomy Migrated disc herniation |
| title | Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up |
| title_full | Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up |
| title_fullStr | Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up |
| title_full_unstemmed | Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up |
| title_short | Functional outcomes of full-endoscopic spine surgery for high-grade migrated lumbar disc herniation: a prospective registry-based cohort study with more than 5 years of follow-up |
| title_sort | functional outcomes of full endoscopic spine surgery for high grade migrated lumbar disc herniation a prospective registry based cohort study with more than 5 years of follow up |
| topic | Discectomy Full-endoscopic lumbar discectomy Migrated disc herniation |
| url | https://doi.org/10.1186/s12891-020-03891-1 |
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