Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 61-70
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.61
Massively prolapsed intervertebral disc herniation with interlaminar endoscopic spine system Delta endoscope: A case series
Sheng-Wei Meng, Chen Peng, Chuan-Li Zhou, Hao Tao, Chao Wang, Kai Zhu, Meng-Xiong Song, Xue-Xiao Ma
Sheng-Wei Meng, Chen Peng, Chuan-Li Zhou, Hao Tao, Chao Wang, Kai Zhu, Meng-Xiong Song, Xue-Xiao Ma, Spinal Department, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Meng SW wrote the article; Peng C provided the typical cases; Zhou CL was responsible for the operation; Wang C collected the clinical cases; Zhu K tracked the cases; Song MX conducted the statistical analyses; Ma XX supervised the study.
Supported by National Natural Science Foundation of China, No. 81871804 and No. 81672200.
Institutional review board statement: The study was approved by the Ethics Committee of The Affiliated Hospital of Qingdao University.
Informed consent statement: Informed consent was waived by the committee because of the retrospective nature of the study.
Conflict-of-interest statement: The authors of this work have nothing to disclose.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xue-Xiao Ma, MD, Doctor, Spinal Department, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao 266000, Shandong Province, China. maxuexiao@qduhospital.cn
Received: April 24, 2020
Peer-review started: April 24, 2020
First decision: September 14, 2020
Revised: October 14, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: January 6, 2021
Processing time: 248 Days and 7.4 Hours
ARTICLE HIGHLIGHTS
Research background

Lumbar disk herniation is caused by protrusion, extrusion, or sequestration of the intervertebral disk from its usual anatomic location, and may be asymptomatic or result in radiculopathy or non-radicular pain. Conservative treatments are sufficient to manage the condition in most patients, but surgery is indicated in cases of cauda equine syndrome, severe and progressive neurologic deficits, and no improvement after conservative treatments.

Research motivation

Massively prolapsed lumbar intervertebral disc (IVD) herniation has an acute onset and with severe radicular pain and these symptoms or fear of dural compression and cauda equina syndrome can require surgery. Conventional fenestration, transforaminal lumbar interbody fusion (TLIF), and minimally invasive TLIF have definite treatment efficacies and decompression effects and therefore are often used. However, endoscopic discectomy through the interlaminar endoscopic spine system (iLESSYS) Delta 6-mm working channel endoscope, which has been widely applied in the treatment of lumbar spinal stenosis, is possible. But very few studies have used this method for the treatment of prolapsed intervertebral disc herniation.

Research objectives

This retrospective study explored the clinical benefits of treating massively prolapsed IVD herniation with the iLESSYS Delta endoscope.

Research methods

The clinical data of 37 patients that underwent surgery with the iLESSYS Delta endoscope at The Affiliated Hospital of Qingdao University were retrospectively analyzed. Intraoperative blood loss, operation time, and complications were collected. The visual analog scale (VAS), oswestry disability index (ODI), and modified MacNab criteria were determined before and at 1 d, 3 mo and 6 mo after surgery.

Research results

The mean intraoperative blood loss for the 37 patients was 20.4 ± 1.2 mL. The mean operation time was 97.3 ± 12.4 min. The VAS scores for leg decreased from 68.0 ± 7.3 to 2.5 ± 1.7 and back pain decreased from 34.4 ± 8.5 to 5.5 ± 1.9 from the measurements before operation to 6 mo after surgery. The ODI also decreased from 60.2 ± 7.3 to 17.9 ± 3.4 at 6 mo after surgery. The improvement rate of the MacNab score was 86.4%, which was considered excellent. No spinal dural injury, nerve root injury, secondary protrusion of intervertebral disc, or myeloid hypertension was found during follow-up.

Research conclusions

We demonstrated that the iLESSYS Delta 6-mm working channel endoscope has several advantages in terms of clinical and functional benefits, complications, and low risk of residual vertebral pulp in treating patients with massively prolapsed IVD herniation.

Research perspectives

We consider that further randomized controlled trials are necessary to determine the exact benefits of the iLESSYS Delta 6-mm working channel endoscope for a wide variety of patients.