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Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis
INTRODUCTION: Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyz...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Healthcare
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586101/ https://www.ncbi.nlm.nih.gov/pubmed/34490586 http://dx.doi.org/10.1007/s40122-021-00309-1 |
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author | Giordan, Enrico Billeci, Domenico Del Verme, Jacopo Varrassi, Giustino Coluzzi, Flaminia |
author_facet | Giordan, Enrico Billeci, Domenico Del Verme, Jacopo Varrassi, Giustino Coluzzi, Flaminia |
author_sort | Giordan, Enrico |
collection | PubMed |
description | INTRODUCTION: Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyzed the effectiveness of the technique for chronic pain after arthrodesis or previous spinal surgery. METHODS: Multiple databases were searched for studies published in the English language, involving patients > 18 years old who underwent endoscopic foraminotomy. Outcomes included the rate of patients who showed “excellent” and “good” postoperative improvement, decreased leg pain, and improved Oswestry Disability Index (ODI) scores. Adverse events considered in the analysis included nerve root damage and intraoperative dural tear, the proportion of patients requiring revision surgery or recurrences, and infections. RESULTS: A total of 14 studies, encompassing 600 patients, were identified. Approximately 85% of patients improved significantly after TELF, without significant differences among different groups (85% vs. 78%, respectively). Mean leg pain decreased an average of 5.2 points, and ODI scores improved by 41.2%. Patients with previous spine surgery or failed back surgery syndrome had higher postoperative leg dysesthesia rates after TELF (14% vs. 1%, respectively). CONCLUSION: TELF is a useful and safe method to achieve decompression in foraminal stenosis. This technique is indicated in the elderly or patients with comorbidities. Preoperative planning is paramount in determining the foraminal size and endoscope trajectory. A diamond burr is recommended because it has an advantage over the regular endoscopic shaver in bleeding control and complication avoidance. |
format | Online Article Text |
id | pubmed-8586101 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Healthcare |
record_format | MEDLINE/PubMed |
spelling | pubmed-85861012021-11-15 Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis Giordan, Enrico Billeci, Domenico Del Verme, Jacopo Varrassi, Giustino Coluzzi, Flaminia Pain Ther Original Research INTRODUCTION: Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyzed the effectiveness of the technique for chronic pain after arthrodesis or previous spinal surgery. METHODS: Multiple databases were searched for studies published in the English language, involving patients > 18 years old who underwent endoscopic foraminotomy. Outcomes included the rate of patients who showed “excellent” and “good” postoperative improvement, decreased leg pain, and improved Oswestry Disability Index (ODI) scores. Adverse events considered in the analysis included nerve root damage and intraoperative dural tear, the proportion of patients requiring revision surgery or recurrences, and infections. RESULTS: A total of 14 studies, encompassing 600 patients, were identified. Approximately 85% of patients improved significantly after TELF, without significant differences among different groups (85% vs. 78%, respectively). Mean leg pain decreased an average of 5.2 points, and ODI scores improved by 41.2%. Patients with previous spine surgery or failed back surgery syndrome had higher postoperative leg dysesthesia rates after TELF (14% vs. 1%, respectively). CONCLUSION: TELF is a useful and safe method to achieve decompression in foraminal stenosis. This technique is indicated in the elderly or patients with comorbidities. Preoperative planning is paramount in determining the foraminal size and endoscope trajectory. A diamond burr is recommended because it has an advantage over the regular endoscopic shaver in bleeding control and complication avoidance. Springer Healthcare 2021-09-06 2021-12 /pmc/articles/PMC8586101/ /pubmed/34490586 http://dx.doi.org/10.1007/s40122-021-00309-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Giordan, Enrico Billeci, Domenico Del Verme, Jacopo Varrassi, Giustino Coluzzi, Flaminia Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis |
title | Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis |
title_full | Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis |
title_fullStr | Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis |
title_full_unstemmed | Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis |
title_short | Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis |
title_sort | endoscopic transforaminal lumbar foraminotomy: a systematic review and meta-analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8586101/ https://www.ncbi.nlm.nih.gov/pubmed/34490586 http://dx.doi.org/10.1007/s40122-021-00309-1 |
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