Skip to main content

Advertisement

SpringerLink
Log in

2nd and 3rd generation full endoscopic lumbar spine surgery: clinical safety and learning curve

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Aim

2nd and 3rd generation endoscopic spine surgery techniques offer visualisation of familiar inter-laminar anatomy to spinal surgeons. We have prospectively evaluated the clinical outcome, complications and learning curve associated with these techniques in patients with lumbar spine radiculopathy.

Methods

This is a prospective study of 50 consecutive patients with radicular pain from disc herniation and/or lateral recess stenosis. In 6 patients, endoscopy couldn’t be done. Operating times, PROM’s (VAS, ODI and EQ-5D scores) and complication rates of 44 patients were evaluated after mean FU of 52 months (range 39–65). MRI was used to divide these into protrusions (n = 19), extrusions (n = 17) and lateral recess stenosis (n = 8). Evidence about the learning curve was gathered by curvilinear regression analyses.

Results

Using a composite clinical success criterion, 95% patients had a successful outcome, with no major complications. ODI, VAS and EQ-5D scores had a statistically significant improvement and achieved MCID. Revision discectomy rate was only 4.5% (n = 2). MRI based grouping, case sequence and degree of difficulty influenced the duration of surgery and a learning curve was found for protrusions and lateral recess decompressions, but not for extrusions. A learning curve effect was also observed with respect to the ODI.

Conclusions

Although anatomy visualised in 2nd and 3rd generation endoscopy is familiar to spinal surgeons, our learning curve experience suggests a careful and MRI pathology based take up of this technique in clinical practice, despite its clinical safety in our series.

Level of Evidence

Level 3, prospective cohort study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fritsch EW, Heisel J, Rupp S (1996) The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine 21:626–633

    Article  CAS  PubMed  Google Scholar 

  2. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique. Spine 33(9):931–939

    Article  PubMed  Google Scholar 

  3. Ruetten S, Komp M, Merk H, Godolias G (2009) Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 10(5):476–485

    Article  PubMed  Google Scholar 

  4. Muthu S, Ramakrishnan E, Chellamuthu G (2020) Is endoscopic discectomy the next gold standard in the management of lumbar disc disease? Systematic review and superiority analysis. Global Spine J 11(7):1104–1120

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kim H, Wu P, Jang I (2021) Clinical results and review of techniques of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) for lumbar stenosis. J Minim Invasive Spine Surg Tech 6(Suppl 1):S117–S122

    Article  Google Scholar 

  6. Hofstetter C, Ahn Y, Choi G, Gibson J, Ruetten S, Zhou Y, Li Z, Siepe C, Wagner R, Lee J, Sairyo K, Choi K, Chen C, Telfeian A, Zhang X, Banhot A, Lokhande P, Prada N, Shen J, Cortinas F, Brooks N, Van Daele P, Kotheeranurak V, Hasan S, Keorochana G, Assous M, Härtl R, Kim J (2020) AOSpine consensus paper on nomenclature for working-channel endoscopic spinal procedures. Global Spine J 10(2):111S-121S

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lee DY (2008) Lee SH learning curve for percutaneous endoscopic lumbar discectomy. Neuro Med Chir (Tokyo) 48:383–438

    Article  Google Scholar 

  8. Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731

    Article  PubMed  Google Scholar 

  9. Ruetten S, Komp M, Merk H, Godalias S (2007) Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6:521–530

    Article  PubMed  Google Scholar 

  10. Shim CS, Lee SH, Shin HD, Kang HS, Choi WC, Jung B, Choi G, Ahn Y, Lee S, Lee HY (2006) 9: 37114 SB Charité versus ProDisc: a comparative study of minimum 3-year follow-up. Spine J 6(5):56S

    Article  Google Scholar 

  11. Evaniew N, Swamy G, Jacobs WB et al (2021) Lumbar fusion surgery for patients with back pain and degenerative disc disease: An observational study from the Canadian Spine Outcomes and Research Network. Glob Spine J. 12(8):1676–1686. https://doi.org/10.1177/2192568220985470

    Article  Google Scholar 

  12. Copay AG, Glassman SD, Subach BR et al (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the oswestry disability index, medical outcomes study questionnaire short form 36, and pain scales. Spine J Off J North Am Spine Soc 8(6):968–974

    Article  Google Scholar 

  13. Díaz-Arribas MJ, Fernández-Serrano M, Royuela A et al (2017) Minimal clinically important difference in quality of life for patients with low back pain. Spine 42(24):1908–1916

    Article  PubMed  Google Scholar 

  14. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5(12):1–79

    Article  CAS  PubMed  Google Scholar 

  15. Van Hooff M, Mannion A, Staub L, Ostelo R, Fairbank J (2016) Determination of the oswestry disability index score equivalent to a satisfactory symptom state in patients undergoing surgery for degenerative disorders of the lumbar spine—a spine tango registry-based study. Spine J 16(10):1221–1230

    Article  PubMed  Google Scholar 

  16. Werner D, Grotle M, Gulati S, Austevoll I, Madsbu M, Lønne G, Solberg T (2019) Can a successful outcome after surgery for lumbar disc herniation be defined by the oswestry disability index raw score? Global Spine J 10(1):47–54

    Article  PubMed  PubMed Central  Google Scholar 

  17. Asher A, Chotai S, Devin C, Speroff T, Harrell F, Nian H, Dittus R, Mummaneni P, Knightly J, Glassman S, Bydon M, Archer K, Foley K, McGirt M (2016) Inadequacy of 3-month oswestry disability index outcome for assessing individual longer-term patient experience after lumbar spine surgery. J Neurosurg Spine 25(2):170–180

    Article  PubMed  Google Scholar 

  18. Bohl DD, Russo GS, Basques BA, Golinvaux NS, Fu MC, Long WD III, Grauer JN (2014) Variations in data collection methods between national databases affect study results: a comparison of the nationwide inpatient sample and national surgical quality improvement program databases for lumbar spine fusion procedures. JBJS 96(23):e193

    Article  Google Scholar 

  19. Hsu H, Chang S, Yang S, Chai C (2012) Learning curve of full-endoscopic lumbar discectomy. Eur Spine J 22(4):727–733

    Article  PubMed  PubMed Central  Google Scholar 

  20. Morgenstern R, Morgenstern C, Yeung A (2007) The learning curve in foraminal endoscopic discectomy: experience needed to achieve a 90% success rate. SAS J 1(3):100–107

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, Kang HY (2006) Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine 31(10):E285–E290

    Article  PubMed  Google Scholar 

  22. Son S, Ahn Y, Lee S, Kim W, Yoo B, Jung J, Cho J (2021) Learning curve of percutaneous endoscopic transforaminal lumbar discectomy by a single surgeon. Medicine 100(4):e24346

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ayling OG, Ailon T, McIntosh G, Soroceanu A, Hall H, Nataraj A, Bailey CS, Christie S, Stratton A, Ahn H, Johnson M (2018) Clinical outcomes research in spine surgery: what are appropriate follow-up times? J Neurosurg Spine 30(3):397–404

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Spinal Disorders, Robert Jones and Agnes Hunt Orthoapedic Hospital, Oswestry, Shropshire, SY107AG, UK

    B. Balain, Davinder Singh Bhachu, A. Gadkari, A. Ghodke & J. H. Kuiper

Authors
  1. B. Balain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Davinder Singh Bhachu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Gadkari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Ghodke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. H. Kuiper
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Balain.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Balain, B., Bhachu, D.S., Gadkari, A. et al. 2nd and 3rd generation full endoscopic lumbar spine surgery: clinical safety and learning curve. Eur Spine J 32, 2796–2804 (2023). https://doi.org/10.1007/s00586-023-07703-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-07703-7

Keywords

Search

Navigation