내시경을 이용한 경피적 요추 절제술에서의 학습곡선 Learning curve for percutaneous endoscopic lumbar discectomy

Brief review

이 논문은 PELD에서의 learning curve에 대한 논문 입니다.

요새 계속 PELD learning curve에 대한 논문을 보고 있는데, 각 논문별로 언급된 항목에 조금씩 차이가 있네요. 여기서는 수술시간, 1년 후의 임상적 결과, 수술 성공률, 수술 실패율, 합병증 발생률, 재발률 등의 항목을 조사하였습니다. 

이 논문이 2008년에 출판되었는데, 최근에 출판된 PELD learning curve관련 논문들과 큰 차이는 없어보입니다.

Clinical success를 아래의 기준으로 판단했습니다.

1. 통증지수(VAS)의 향상률이 2점 이상

2. 장애지수(ODI)의 향상률이 25% 이상

3. 환자의 주관적인 회복률이 50% 이상

4. 주요한 합병증이 없음

그런데 주관적인 회복률을 어떻게 평가했는지 안나와있네요.. clinical outcome 평가 시 처럼 환자에게 전화하여 환자가 느끼는 회복률을 적용한 것 일까요

그리고 특이한점은 일반적으로 의학통계에 널리 사용되는 SPSS가 아니라 SAS라는 프로그램을 사용하여 분석을 했습니다.

아래의 링크 따라가셔서 전체 내용 확인하세요^^

*Title: Learning curve for percutaneous endoscopic lumbar discectomy

내시경을 이용한 경피적 요추 절제술에서의 학습곡선

*Authors: Lee DY, Lee SH

*Bibliography: Neurol Med Chir (Tokyo). 2008Sep;48(9):383-8; discussion 388-9.

Background of data

Percutaneous endoscopic lumbar discectomy (PELD) is one of the surgical options for soft lumbar disk herniation, but the learning curve is perceived to be steep.

Methods

▶Subjects: 51 PELD cases performed for single-level intracanalicular lumbar disk herniation causing radiculopathy.

▶Divided into 3 groups: each 17 patients

▶Evaluating parameters: operating time, failure rate, complication rate, and 1-year reherniation rate.

▶1 year clinical success rate was assessed by telephone interviews

Results

▶4 patients required subsequent open discectomy due to PELD failure.

▶2 minor complications.

▶1 year clinical success: achieved in 42 of the 47 patients

▶Reherniation developed in 5 patients

-A significant reduction in operating time was observed after 17 patients had been treated (p = 0.0004).

▶Failure rate, complication rate: no significant differences between the 3 groups

▶1year clinical success rate, reherniation rate: no significant differences

Conclusion

The PELD learning curve seems to be stable and acceptable with proper pre-PELD training.

Percutaneous endoscopic decompression for lumbar spinal stenosis: 우리들병원 안용 병원장 SCI(E) 논문 게재

안용 병원장님의 논문이 Experts reviews of medical devices 7월호에 게재되었습니다.
요추 협착증 치료를 위한 경피적 내시경 감압술에 대한 review article 입니다.
그동안 리뷰했던 original article과는 다르게 내시경 감압술에 대한 전반적인 설명이 나와있습니다. 특히 각 approach 별로 그림과 사진이 잘 나와있어 많은 도움이 될 것 같습니다.
아래 서지사항 클릭하면 전문을 보실 수 있습니다^^

*Title: Percutaneous endoscopic decompression for lumbar spinal stenosis.

*Author: Ahn Y

*Bibliography: Expert Rev Med Devices. 2014 Jul 18:1-12.[Epub ahead of print]

Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation.

Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis.

Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: 1)central stenosis, 2)lateral recess stenosis and 3)foraminal stenosis.

Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy.

However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery.

Twist technique for removal of spinal extradural arachnoid cyst: technical note (우리들병원 은상수 진료부장 European spine journal 논문 게재)

우리들병원 은상수 진료부장님이 European Spine Journal에 논문을 게재하셨습니다.

European Spine Journal은 최근 발표된 2013 impact factor에서 2.473까지 오른 영향력있는 척추전문저널 입니다.

이 논문에서는 손상에 의해 발생되는 경막 외 낭종을 제거하기 위한 새로운 방법으로서 낭종을 바로 잘라내지 않고 꼬아서 확실히 닫아 봉합한 후 제거하는 방법을 제시하고 한 증례를 보고하였습니다. 기존의 방법에 비해 안전하고 효과적인 방법이라는 결론 입니다.

아래 링크로 따라가시면 저자가 연구에 대해 쉽게 설명한 동영상이 있습니다^^

http://www.youtube.com/watch?v=wjV-szb2zjM&feature=youtu.be

*Title: Twist technique for removal of spinal extradural arachnoid cyst: technical note.

경막외 지주막 낭종 제거의 새로운 치료법

*Authors: Lee SH, Shim HK, Eun SS

*Bibliography: Eur Spine J. 2014Aug;23(8):1755-60.

STUDY DESIGN

We document a spinal extradual arachnoid cyst treated by twist technique. The cyst is tightly adherent to the neural tissue or the dura, and the communication stalk is little or short.

OBJECTIVE

To demonstrate the effectiveness of twist technique of closure of the communication stalk for the removal of spinal extradural arachnoid cyst.

METHODS

▶Subject: 44-year-old woman presented with a 10-year history of pain and dysesthesia

(initially in the posterior neck region and extending gradually to the distal portion of the right upper extremity)

-Pain and dysesthesia were exaggerated when she was lying down and relieved when standing or walking. She was diagnosed with an extradural arachnid cyst ranging from spinal regions T1 to T3 using MRI.

-Computerized tomography myelography revealed a mass located posterior to the spinal cord.

-Pooling of contrast medium was observed in the lesion indicating communication with the subarachnoid space.

-Laminectomy of the T1-T3 region was performed, preserving the spinous processes and the facet joints.

-A short communication stalk was found at the proximal root sleeve of right T3. This stalk was closed using twist technique.

RESULTS

-The patient experienced marked reduction of pain and dysesthesia after surgery, and the headache and blurred vision completely disappeared.

-5 days after the operation, she was discharged home in good condition. Postoperative 1 year later, the patient had completely recovered and resumed her normal life.

CONCLUSIONS

Twist technique can be seen safe and effective as another surgical option for spinal extradural arachnoid cysts containing a short stalk and dense fibrous adhesion with the dura mater.

우리들병원 최경철 부장 SCI(E)급 논문 출판_Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation: a technical case report

우리들병원 최경철 부장님이 SCI(E)급 학술지인 SPINE저널에 논문을 출판 하였습니다.
젊은환자들에게 종종 발생하는 거대디스크 탈출증의 새로운 내시경 치료방법에 대한 증례보고 입니다. 
기존에는 내시경을 섬유륜쪽으로 25도 정도 접근시켜 치료했던 것에 반해 이 거대디스크 내시경 치료법은 15도 가량만 접근하여 디스크에 가해지는 손상도 최소화 하였습니다.
논문에 수술방법이 자세히 기술되어 있으니 읽어보시면 도움이 많이 될 듯 합니다.
서지정보 클릭하시면 SPINE홈페이지로 이동합니다^^

*Title: Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation: a technical case report

*Authors: Lee SH, Choi KC, Baek OK, Kim HJ, Yoo SH

*Bibliography: Spine(Phila Pa 1976). 2014 Apr 1;39(7):E473-9

STUDY DESIGN

Technical case report

OBJECTIVE

To describe the novel technique of percutaneous endoscopic herniotomy using a unilateral intra-annular subligamentous approach for the treatment of large centrally herniated discs.

SUMMARY OF BACKGROUND DATA

Open discectomy for large central disc herniations may have poor long-term prognosis due to heavy loss of intervertebral disc tissue, segmental instability, and recurrence of pain.

METHODS

▶Subjects: 6 patients treated using percutaneous endoscopic herniotomy with a unilateral intra-annular subligamentous approach (2011.01~06)

-presented with back and leg pain, and/or weakness due to a large central disc herniation were.

RESULTS

The patients experienced relief of symptoms and intervertebral disc spaces were well maintained.

The annular defects were noted to be in the process of healing and recovery.

CONCLUSION

Percutaneous endoscopic unilateral intra-annular subligamentous herniotomy was an effective and affordable minimally invasive procedure for patients with large central disc herniations, allowing preservation of nonpathological intradiscal tissue through a concentric outer-layer annular approach.