{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:33Z","timestamp":1753893273822,"version":"3.41.2"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T00:00:00Z","timestamp":1672963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Percutaneous transforaminal endoscopic surgery (PTES) is a novel, minimally invasive technique used to treat lumbar degenerative diseases (LDDs). PTES under local anesthesia was performed to treat the culprit segment of LDDs predicted by radiologic images or clinical symptoms, and the efficacy, security, and feasibility were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty-seven cases of LDDs with nerve root symptoms, which were not consistent with lumbar degenerative levels and degrees on MRI and CT, were treated with PTES under local anesthesia in a day surgery ward from January 2015 to December 2019. Forty-two patients, whose culprit segments were predicted by radiologic images, were included in group A. The other 45 patients, whose culprit segments were predicted by clinical symptoms, were included in group B. Leg pain VAS and ODI scores before and after PTES were recorded. The outcome was defined according to the MacNab grade at the 2-year follow-up. Postoperative complications were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In group A, 2 patients underwent PTES for one segment, 37 patients underwent PTES for two segments, and 3 patients underwent PTES for three segments. One of the one-segment PTES patients had no relief from symptoms and underwent another PTES for other culprit segments 3 months after surgery. In group B, 44 of 45 patients were treated using PTES for one segment and 1 patient was treated for two segments. Group B showed significantly less operative duration, less blood loss, and less fluoroscopy frequency than group A (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). The leg pain VAS score and the ODI score significantly decreased after the operation in both groups (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and the excellent and good rates were 97.6% (41\/42) in group A and 100% (45\/45) in group B at the 2-year follow-up. The leg pain VAS score of group B was significantly lower than that of group A immediately and 1 week, 1 month, 2 months, and 3 months after surgery (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). There was no statistical difference in ODI scores and the excellent and good rates between the two groups. No complications, such as wound infection or permanent nerve injury, were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It is much more accurate to predict the culprit segment according to clinical symptoms than radiologic images in PTES under local anesthesia for surgical treatment of LDDs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.1060318","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T05:58:29Z","timestamp":1672984709000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["How to predict the culprit segment in percutaneous transforaminal endoscopic surgery under local anesthesia for surgical treatment of lumbar degenerative diseases? Radiologic images or clinical symptoms"],"prefix":"10.3389","volume":"9","author":[{"given":"Tianyao","family":"Zhou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianle","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutong","family":"Gu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wu","family":"Che","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yichao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1186\/s13018-021-02841-4","article-title":"Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study","volume":"16","author":"Xue","year":"2021","journal-title":"J Orthop Surg Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e1084","DOI":"10.5435\/JAAOS-D-21-01155","article-title":"Intradiscal therapies for lumbar degenerative disk disease","volume":"30","author":"Canseco","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.jocn.2011.10.004","article-title":"Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies","volume":"19","author":"Mobbs","year":"2012","journal-title":"J Clin Neurosci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1007\/s00586-013-2732-6","article-title":"Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis","volume":"22","author":"Archavlis","year":"2013","journal-title":"Eur Spine J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E91","DOI":"10.1097\/BRS.0000000000001161","article-title":"Minimally invasive versus open laminectomy for lumbar stenosis a systematic review and meta-analysis","volume":"41","author":"Phan","year":"2016","journal-title":"Spine (Phila Pa 1976)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"E1262","DOI":"10.1016\/j.wneu.2020.11.145","article-title":"Minimally invasive versus open surgery for degenerative spine disorders for elderly patients: experiences from a single institution","volume":"146","author":"Yolcu","year":"2021","journal-title":"Neurosurg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"5138","DOI":"10.3390\/jcm10215138","article-title":"Risk factors for spine reoperation and joint replacement surgeries after short-segment lumbar spinal surgeries for lumbar degenerative disc disease: a population-based cohort study","volume":"10","author":"Wu","year":"2021","journal-title":"J Clin Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2942","DOI":"10.12998\/wjcc.v8.i14.2942","article-title":"Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation","volume":"8","author":"Pang","year":"2020","journal-title":"World J Clin Cases"},{"key":"B9","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1097\/00007632-199603010-00017","article-title":"The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments","volume":"21","author":"Fritsch","year":"1996","journal-title":"Spine (Phila Pa 1976)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"2689","DOI":"10.1097\/01.brs.0000244615.43199.07","article-title":"Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases","volume":"31","author":"Wu","year":"2006","journal-title":"Spine (Phila Pa 1976)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1115\/1.2891215","article-title":"Possible role of stresses in inducing spinal stenosis\u2013a long term complication following disk excision","volume":"112","author":"Goel","year":"1990","journal-title":"J Biomech Eng"},{"key":"B12","doi-asserted-by":"publisher","first-page":"01188-3","DOI":"10.1016\/j.wneu.2022.08.078","article-title":"Treatment of lumbar degenerative disease by lateral lumbar interbody fusion in patients under and over 80 years of age","author":"Hiyama","year":"2022","journal-title":"World Neurosurg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3234","DOI":"10.1177\/03635465211032612","article-title":"Implementation of percutaneous transforaminal endoscopic discectomy in competitive elite athletes with lumbar disc herniation: original study and review of the literature","volume":"49","author":"Kapetanakis","year":"2021","journal-title":"Am J Sports Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"106460","DOI":"10.1016\/j.cmpb.2021.106460","article-title":"Multi-Modality guidance based surgical navigation for percutaneous endoscopic transforaminal discectomy","volume":"212","author":"Pan","year":"2021","journal-title":"Comput Methods Programs Biomed"},{"key":"B15","doi-asserted-by":"publisher","first-page":"3458","DOI":"10.1016\/j.ultrasmedbio.2021.08.011","article-title":"Potential application of MR-MR-US fusion imaging navigation with needle tail intelligent positioning in guiding puncture in percutaneous transforaminal endoscopic discectomy","volume":"47","author":"Cao","year":"2021","journal-title":"Ultrasound Med Biol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13018-017-0524-0","article-title":"Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases","volume":"12","author":"Gu","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12891-020-03938-3","article-title":"Evaluation of efficacy and safety of percutaneous transforaminal endoscopic surgery (PTES) for surgical treatment of calcified lumbar disc herniation: a retrospective cohort study of 101 patients","volume":"22","author":"Wang","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"B18","doi-asserted-by":"publisher","first-page":"CD007431","DOI":"10.1002\/14651858.CD007431.pub2","article-title":"Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain","volume":"2","author":"van der Windt","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1097\/00002517-199306040-00009","article-title":"Upper lumbar disc herniations","volume":"6","author":"Albert","year":"1993","journal-title":"J Spinal Disord"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1016\/j.spinee.2021.07.006","article-title":"Long-term clinical outcome of minimally invasive versus open single-level transforaminal lumbar interbody fusion for degenerative lumbar diseases: a meta-analysis","volume":"21","author":"Heemskerk","year":"2021","journal-title":"Spine J"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2196","DOI":"10.1111\/os.13088","article-title":"A postoperative phenomenon of percutaneous endoscopic lumbar discectomy: rebound pain","volume":"13","author":"Zhang","year":"2021","journal-title":"Orthop Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1097\/00024720-200204000-00001","article-title":"Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis","volume":"15","author":"Iguchi","year":"2002","journal-title":"J Spinal Disord Tech"},{"key":"B23","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1097\/01.bsd.0000146761.36658.45","article-title":"Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging","volume":"18","author":"Sasso","year":"2005","journal-title":"J Spinal Disord Tech"},{"key":"B24","doi-asserted-by":"publisher","first-page":"225","DOI":"10.36076\/ppj.2005\/8\/225","article-title":"A systematic review of diagnostic utility of selective nerve root blocks","volume":"8","author":"Everett","year":"2005","journal-title":"Pain Physician"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1722","DOI":"10.2106\/JBJS.E.00278","article-title":"Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up","volume":"88","author":"Riew","year":"2006","journal-title":"J Bone Joint Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"113","DOI":"10.36076\/ppj.2007\/10\/113","article-title":"An updated systematic review of the diagnostic utility of selective nerve root blocks","volume":"10","author":"Datta","year":"2007","journal-title":"Pain Physician"},{"key":"B27","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/BSD.0b013e3182014aa1","article-title":"Multilevel lumbar spinal stenosis decompression: midterm outcome using a modified hinge osteotomy technique","volume":"24","author":"El-Abed","year":"2011","journal-title":"J Spinal Disord Tech"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1007\/s00264-020-04558-1","article-title":"Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve","volume":"44","author":"Sun","year":"2020","journal-title":"Int Orthop"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e025790","DOI":"10.1136\/bmjopen-2018-025790","article-title":"The utility of diagnostic selective nerve root blocks in the management of patients with lumbar radiculopathy: a systematic review","volume":"9","author":"Beynon","year":"2019","journal-title":"BMJ Open"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.1060318\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T05:58:30Z","timestamp":1672984710000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.1060318\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,6]]},"references-count":29,"alternative-id":["10.3389\/fsurg.2022.1060318"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.1060318","relation":{},"ISSN":["2296-875X"],"issn-type":[{"type":"electronic","value":"2296-875X"}],"subject":[],"published":{"date-parts":[[2023,1,6]]},"article-number":"1060318"}}