Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT06448416 |
Other study ID # |
RGDS-2023-12-014 |
Secondary ID |
|
Status |
Completed |
Phase |
|
First received |
|
Last updated |
|
Start date |
July 1, 2022 |
Est. completion date |
March 31, 2024 |
Study information
Verified date |
June 2024 |
Source |
GCS Ramsay Santé pour l'Enseignement et la Recherche |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Observational
|
Clinical Trial Summary
Lumbar disc herniation (HDL) is one of the main causes for low back pain and sciatica.
Although non surgical care remains the gold standard as first treatment, lumbar discectomy is
used to effectively relieve symptoms that persist for prolonged periods.
With surgical techniques evolution, minimally invasive spine surgery has emerged in recent
decades as an alternative to conventional open surgery and is widely used for HDL treatment.
Several minimally invasive surgical endoscopic techniques have been developed for disc
herniation: Single Portal Endoscopy (SE), Video Assisted Endoscopic Discectomy, and recently
Unilateral Biportal Endoscopy (UBE).
Currently, SE is considered as the minimally invasive surgery gold standard for HDL but, over
the past two years, UBE for the treatment of degenerative lumbar diseases has increased
exponentially with faster learning curve than other endoscopic techniques.
As an emerging technique, further studies are needed to better understand UBE. This is why
Dr. Cristini's team wish to analyze a cohort of patients for whom this technique has been
used since July 2022, in particular the complication rate.
Controlling a new technique requires a learning phase. This is why Dr. Cristini's team also
wishes to describe the learning curve on the cohort of patients for whom UBE was used since
July 2022.
Description:
Lumbar disc herniation (HDL) is one of the main causes for low back pain and sciatica,
affecting 1 to 5% of the population each year. Although non surgical care remains the gold
standard as first treatment, lumbar discectomy is used to effectively relieve symptoms that
persist for prolonged periods.
With surgical techniques evolution, minimally invasive spine surgery has emerged in recent
decades as an alternative to conventional open surgery and is widely used for HDL treatment.
Compared to traditional open surgery, minimally invasive surgical technique offers muscle and
bone sparing, pain reduction and faster recovery, allowing patient management in Enhanced
Recovery After Surgery (RAAC).
Several minimally invasive surgical endoscopic techniques have been developed for disc
herniation: Single Portal Endoscopy (SE), Video Assisted Endoscopic Discectomy, and recently
Unilateral Biportal Endoscopy (UBE). SE relies on a single entry route whereas UBE is based
on two entry routes : one way for optical instruments and saline irrigation system and one
way for surgical instruments. Currently, SE is considered as the minimally invasive surgery
gold standard for HDL treatment thanks to its advantages for controlling muscles trauma,
reducing hospital stay and maintaining spinal segment stability.
Over the past two years, UBE for the treatment of degenerative lumbar diseases has increased
exponentially with faster learning curve than other endoscopic techniques.
UBE allows a wider field of vision, wide and ergonomic operating gestures, is minimally
invasive and contributes to complete nervous decompression and faster recovery. With UBE, the
surgeon can use one hand to guide endoscope and he other one to guide surgical instruments .
In addition, UBE generates less trauma, less bleeding, rapid recovery and good effectiveness
in HDL treatment . UBE can significantly reduce postoperative nerve fibrosis, and
postoperative spinal instability incidence.
During UBE, some postoperative complications have been described as poor treatment
effectiveness (nucleus pulposus nucleus residue), epidural hematoma, dural tear, nerve root
injury and incomplete surgery.
As an emerging technique, further studies are needed to better understand UBE. This is why
Dr. Cristini's team wish to analyze a cohort of patients for whom this technique has been
used since July 2022, in particular the complication rate.
Controlling a new technique requires a learning phase. Chen, L et al. showed that the
operation duration and the postoperative hospitalization duration, were reduced from the 24th
patient until the 97th patient out of a cohort of 97 patients with lumbar disc herniation
treated by UBE. However, there was no significant difference in the visual analogue scale
(VAS) and the Oswestry disability index (ODI) in all operated patients. This indicates that
UBE still guarantees clinical effect and safety on all operated patients. This is why Dr.
Cristini's team also wishes to describe the learning curve on the cohort of patients for whom
UBE was used since July 2022.