Expert consensus on the implementation of enhanced recovery after surgery in percutaneous endoscopic interlaminar lumbar decompression/discectomy (2020)_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 The Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion

Corresponding author：

The Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion, Email: tomzeng5@163.com

Keywords：

Enhanced recovery after surgery; endoscopic surgery; interlaminar approach; lumbar canal decompression; lumbar discectomy; expert consensus

DOI：

10.7507/1002-1892.202011021

Video：

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In recent years, enhanced recovery after surgery (ERAS) has been widely used in spine surgery and achieved satisfactory results. In order to standardize the ERAS implementation process and application in percutaneous endoscopic interlaminar lumbar decompression/discectomy (PEID), we reviewed the literatures and cited evidence-based medicine data, and had a national comprehensive discussion among experts of the Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion. Altogether, the up-to-date expert consensus have been achieved. The consensus may provide the reference for clinical treatment in aspect of the standardization of surgical operations, the reduction of surgical trauma and complications, the optimization of perioperative pain and sleep management, the prevention of venous thrombosis, and the guidance of patients’ functional training and perioperative education.

Citation： The Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion. Expert consensus on the implementation of enhanced recovery after surgery in percutaneous endoscopic interlaminar lumbar decompression/discectomy (2020). Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1497-1506. doi: 10.7507/1002-1892.202011021 Copy

1.	孙天胜, 沈建雄, 刘忠军, 等. 中国脊柱手术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2017, 10(4): 271-279.
2.	毛海青, 周非非, 蔡思逸, 等. 经皮腰椎内镜手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(9): 641-651.
3.	曾建成. 经皮内镜椎板间入路腰椎间盘切除术. 中国骨与关节杂志, 2014, 3(10): 795-800.
4.	Ruetten S, Komp M, Merk H, et al. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine, 2009, 10(5): 476-485.
5.	Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician, 2015, 18(1): 61-70.
6.	Komp M, Hahn P, Merk H, et al. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech, 2011, 24(5): 281-287.
7.	金翔, 吕飞舟, 马晓生, 等. 肌电图对多节段腰椎退行性疾病责任节段定位的诊断价值. 中国脊柱脊髓杂志, 2017, 27(5): 429-434.
8.	刘波, 田伟, 李勤, 等. 选择性神经根封闭在多节段腰椎疾患的定位作用. 中华外科杂志, 2002, 40(3): 200.
9.	Sasso RC, Macadaeg K, Nordmann D, et al. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging. J Spinal Disord Tech, 2005, 18(6): 471-478.
10.	Park JY, Kim DH, Seo DK, et al. Predictors of response to a medial branch block: MRI analysis of the lumbar spine. J Clin Med, 2019, 8(4): 538.
11.	Oikawa Y, Eguchi Y, Inoue G, et al. Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders. MagnReson Imaging, 2015, 33(8): 956-961.
12.	McDonald S, Hetrick S, Green S. Pre-operative education for hip or knee replacement. Cochrane Database Syst Rev, 2004, (1): CD003526.
13.	Hackett NJ, De Oliveira GS, Jain UK, et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg, 2015, 18: 184-190.
14.	Kusin DJ, Ahn UM, Ahn NU. The influence of diabetes on surgical outcomes in cervical myelopathy. Spine (Phila Pa 1976), 2016, 41(18): 1436-1440.
15.	Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg (Am), 2008, 90(1): 62-69.
16.	Sheehy AM, Gabbay RA. An overview of preoperative glucose evaluation, management, and perioperative impact. J Diabetes Sci Technol, 2009, 3(6): 1261-1269.
17.	中华医学会麻醉学分会. 2014 版中国麻醉学指南与专家共识. 北京: 人民卫生出版社, 2014.
18.	Gerstein NS, Schulman PM, Gerstein WH, et al. Should more patients continue aspirin therapy perioperatively?: clinical impact of aspirin withdrawal syndrome. Ann Surg, 2012, 255(5): 811-819.
19.	Park JH, Ahn Y, Choi BS, et al. Antithrombotic effects of aspirin on 1- or 2-level lumbar spinal fusion surgery: a comparison between 2 groups discontinuing aspirin use before and after 7 days prior to surgery. Spine (Phila Pa 1976), 2013, 38(18): 1561-1565.
20.	Bennett JA, Riegel B, Bittner V, et al. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung, 2002, 31(4): 262-270.
21.	Ikeda T, Miyamoto H, Hashimoto K, et al. Predictable factors of deep venous thrombosis in patients undergoing spine surgery. J Orthop Sci, 2017, 22(2): 197-200.
22.	Fineberg SJ, Oglesby M, Patel AA, et al. The incidence and mortality of thromboembolic events in lumbar spine surgery. Spine (Phila Pa 1976), 2013, 38(13): 1154-1159.
23.	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. ClinNutr, 2003, 22(3): 321-336.
24.	Bardou M, Quenot JP, Barkun A. Stress-related mucosal disease in the critically ill patient. Nat Rev Gastroenterol Hepatol, 2015, 12(2): 98-107.
25.	Buvanendran A, Thillainathan V. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S274-280.
26.	Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
27.	Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology, 2009, 110(5): 1139-1157.
28.	Wu AK, Auerbach AD, Aaronson DS. National incidence and outcomes of postoperative urinary retention in the Surgical Care Improvement Project. Am J Surg, 2012, 204(2): 167-171.
29.	Chaichana KL, Mukherjee D, Adogwa O, et al. Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine, 2011, 14(2): 261-267.
30.	Engel-Yeger B, Keren A, Berkovich Y, et al. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. DisabilRehabil, 2018, 40(3): 302-308.
31.	Aglio LS, Abd-El-Barr MM, Orhurhu V, et al. Preemptive analgesia for postoperative pain relief in thoracolumbosacral spine operations: a double-blind, placebo-controlled randomized trial. J Neurosurg Spine, 2018, 29(6): 647-653.
32.	Kim SI, Ha KY, Oh IS. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. Eur Spine J, 2016, 25(5): 1614-1619.
33.	Lee BH, Park JO, Suk KS, et al. Pre-emptive and multi-modal perioperative pain management may improve quality of life in patients undergoing spinal surgery. Pain Physician, 2013, 16(3): E217-226.
34.	Buvanendran A, Thillainathan V. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. Spine, 2010, 35(Supplement): 274-280.
35.	Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg (Am), 2006, 88(5): 959-963.
36.	Sakai Y, Matsuyama Y, Nakamura H, et al. The effect of muscle relaxant on the paraspinal muscle blood flow: a randomized controlled trial in patients with chronic low back pain. Spine (Phila Pa 1976), 2008, 33(6): 581-587.
37.	Khurana G, Jindal P, Sharma JP, et al. Postoperative pain and long-term functional outcome after administration of gabapentin and pregabalin in patients undergoing spinal surgery. Spine (Phila Pa 1976), 2014, 39(6): E363-368.
38.	周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
39.	Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Current Opinion in Anaesthesiology, 2015, 28(3): 364-369.
40.	Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev, 2014, (8): CD009161.
41.	Aronsson A, Al-Ani NA, Brismar K, et al. A carbohydrate-rich drink shortly before surgery affected IGF-Ⅰ bioavailability after a total hip replacement. A double-blind placebo controlled study on 29 patients. Aging Clin Exp Res, 2009, 21(2): 97-101.
42.	中华医学会外科学分会、中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南 (2018 版). 中国实用外科杂志, 2018, 38(1): 1-20.
43.	Rhodes A, Cecconi M, Hamilton M, et al. Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study. Intensive Care Med, 2010, 36(8): 1327-1332.
44.	Bacchin MR, Ceria CM, Giannone S, et al. Goal directed fluid therapy based on stroke volume variation in patients undergoing major spine surgery in the prone position: A cohort atudy. Spine, 2016, 41(18): E1131.
45.	Degoute CS, Ray MJ, Manchon M, et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth, 2001, 48(1): 20-27.
46.	Ruetten S, Komp M, Godolias G. A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg, 2006, 49(2): 80-87.
47.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
48.	陈康, 曾建成, 修鹏, 等. 经皮椎板间入路内镜下椎管减压治疗老年腰椎侧隐窝狭窄症. 中华骨科杂志, 2018, 38(008): 458-467.
49.	王亮, 曾建成, 宋跃明, 等. 经皮椎板间入路内窥镜下减压治疗退变性腰椎管狭窄症的疗效分析. 中国脊柱脊髓杂志, 2017, 27(3): 200-206.
50.	Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L₅-S₁ using a rigid working channel endoscope. Neurosurgery, 2006, 58(1 Suppl): ONS59-68.
51.	Wang B, Lü G, Liu W, et al. Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: the causes and prophylaxis of conversion to open. Arch Orthop Trauma Surg, 2012, 132(11): 1531-1538.

1. 孙天胜, 沈建雄, 刘忠军, 等. 中国脊柱手术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2017, 10(4): 271-279.
2. 毛海青, 周非非, 蔡思逸, 等. 经皮腰椎内镜手术加速康复外科实施流程专家共识. 中华骨与关节外科杂志, 2019, 12(9): 641-651.
3. 曾建成. 经皮内镜椎板间入路腰椎间盘切除术. 中国骨与关节杂志, 2014, 3(10): 795-800.
4. Ruetten S, Komp M, Merk H, et al. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine, 2009, 10(5): 476-485.
5. Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician, 2015, 18(1): 61-70.
6. Komp M, Hahn P, Merk H, et al. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech, 2011, 24(5): 281-287.
7. 金翔, 吕飞舟, 马晓生, 等. 肌电图对多节段腰椎退行性疾病责任节段定位的诊断价值. 中国脊柱脊髓杂志, 2017, 27(5): 429-434.
8. 刘波, 田伟, 李勤, 等. 选择性神经根封闭在多节段腰椎疾患的定位作用. 中华外科杂志, 2002, 40(3): 200.
9. Sasso RC, Macadaeg K, Nordmann D, et al. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopathy: comparison to magnetic resonance imaging. J Spinal Disord Tech, 2005, 18(6): 471-478.
10. Park JY, Kim DH, Seo DK, et al. Predictors of response to a medial branch block: MRI analysis of the lumbar spine. J Clin Med, 2019, 8(4): 538.
11. Oikawa Y, Eguchi Y, Inoue G, et al. Diffusion tensor imaging of lumbar spinal nerve in subjects with degenerative lumbar disorders. MagnReson Imaging, 2015, 33(8): 956-961.
12. McDonald S, Hetrick S, Green S. Pre-operative education for hip or knee replacement. Cochrane Database Syst Rev, 2004, (1): CD003526.
13. Hackett NJ, De Oliveira GS, Jain UK, et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg, 2015, 18: 184-190.
14. Kusin DJ, Ahn UM, Ahn NU. The influence of diabetes on surgical outcomes in cervical myelopathy. Spine (Phila Pa 1976), 2016, 41(18): 1436-1440.
15. Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg (Am), 2008, 90(1): 62-69.
16. Sheehy AM, Gabbay RA. An overview of preoperative glucose evaluation, management, and perioperative impact. J Diabetes Sci Technol, 2009, 3(6): 1261-1269.
17. 中华医学会麻醉学分会. 2014 版中国麻醉学指南与专家共识. 北京: 人民卫生出版社, 2014.
18. Gerstein NS, Schulman PM, Gerstein WH, et al. Should more patients continue aspirin therapy perioperatively?: clinical impact of aspirin withdrawal syndrome. Ann Surg, 2012, 255(5): 811-819.
19. Park JH, Ahn Y, Choi BS, et al. Antithrombotic effects of aspirin on 1- or 2-level lumbar spinal fusion surgery: a comparison between 2 groups discontinuing aspirin use before and after 7 days prior to surgery. Spine (Phila Pa 1976), 2013, 38(18): 1561-1565.
20. Bennett JA, Riegel B, Bittner V, et al. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung, 2002, 31(4): 262-270.
21. Ikeda T, Miyamoto H, Hashimoto K, et al. Predictable factors of deep venous thrombosis in patients undergoing spine surgery. J Orthop Sci, 2017, 22(2): 197-200.
22. Fineberg SJ, Oglesby M, Patel AA, et al. The incidence and mortality of thromboembolic events in lumbar spine surgery. Spine (Phila Pa 1976), 2013, 38(13): 1154-1159.
23. Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. ClinNutr, 2003, 22(3): 321-336.
24. Bardou M, Quenot JP, Barkun A. Stress-related mucosal disease in the critically ill patient. Nat Rev Gastroenterol Hepatol, 2015, 12(2): 98-107.
25. Buvanendran A, Thillainathan V. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S274-280.
26. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
27. Baldini G, Bagry H, Aprikian A, et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology, 2009, 110(5): 1139-1157.
28. Wu AK, Auerbach AD, Aaronson DS. National incidence and outcomes of postoperative urinary retention in the Surgical Care Improvement Project. Am J Surg, 2012, 204(2): 167-171.
29. Chaichana KL, Mukherjee D, Adogwa O, et al. Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine, 2011, 14(2): 261-267.
30. Engel-Yeger B, Keren A, Berkovich Y, et al. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. DisabilRehabil, 2018, 40(3): 302-308.
31. Aglio LS, Abd-El-Barr MM, Orhurhu V, et al. Preemptive analgesia for postoperative pain relief in thoracolumbosacral spine operations: a double-blind, placebo-controlled randomized trial. J Neurosurg Spine, 2018, 29(6): 647-653.
32. Kim SI, Ha KY, Oh IS. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. Eur Spine J, 2016, 25(5): 1614-1619.
33. Lee BH, Park JO, Suk KS, et al. Pre-emptive and multi-modal perioperative pain management may improve quality of life in patients undergoing spinal surgery. Pain Physician, 2013, 16(3): E217-226.
34. Buvanendran A, Thillainathan V. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. Spine, 2010, 35(Supplement): 274-280.
35. Busch CA, Shore BJ, Bhandari R, et al. Efficacy of periarticular multimodal drug injection in total knee arthroplasty. A randomized trial. J Bone Joint Surg (Am), 2006, 88(5): 959-963.
36. Sakai Y, Matsuyama Y, Nakamura H, et al. The effect of muscle relaxant on the paraspinal muscle blood flow: a randomized controlled trial in patients with chronic low back pain. Spine (Phila Pa 1976), 2008, 33(6): 581-587.
37. Khurana G, Jindal P, Sharma JP, et al. Postoperative pain and long-term functional outcome after administration of gabapentin and pregabalin in patients undergoing spinal surgery. Spine (Phila Pa 1976), 2014, 39(6): E363-368.
38. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
39. Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Current Opinion in Anaesthesiology, 2015, 28(3): 364-369.
40. Smith MD, McCall J, Plank L, et al. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev, 2014, (8): CD009161.
41. Aronsson A, Al-Ani NA, Brismar K, et al. A carbohydrate-rich drink shortly before surgery affected IGF-Ⅰ bioavailability after a total hip replacement. A double-blind placebo controlled study on 29 patients. Aging Clin Exp Res, 2009, 21(2): 97-101.
42. 中华医学会外科学分会、中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南 (2018 版). 中国实用外科杂志, 2018, 38(1): 1-20.
43. Rhodes A, Cecconi M, Hamilton M, et al. Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study. Intensive Care Med, 2010, 36(8): 1327-1332.
44. Bacchin MR, Ceria CM, Giannone S, et al. Goal directed fluid therapy based on stroke volume variation in patients undergoing major spine surgery in the prone position: A cohort atudy. Spine, 2016, 41(18): E1131.
45. Degoute CS, Ray MJ, Manchon M, et al. Remifentanil and controlled hypotension; comparison with nitroprusside or esmolol during tympanoplasty. Can J Anaesth, 2001, 48(1): 20-27.
46. Ruetten S, Komp M, Godolias G. A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg, 2006, 49(2): 80-87.
47. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
48. 陈康, 曾建成, 修鹏, 等. 经皮椎板间入路内镜下椎管减压治疗老年腰椎侧隐窝狭窄症. 中华骨科杂志, 2018, 38(008): 458-467.
49. 王亮, 曾建成, 宋跃明, 等. 经皮椎板间入路内窥镜下减压治疗退变性腰椎管狭窄症的疗效分析. 中国脊柱脊髓杂志, 2017, 27(3): 200-206.
50. Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L₅-S₁ using a rigid working channel endoscope. Neurosurgery, 2006, 58(1 Suppl): ONS59-68.
51. Wang B, Lü G, Liu W, et al. Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: the causes and prophylaxis of conversion to open. Arch Orthop Trauma Surg, 2012, 132(11): 1531-1538.

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Expert consensus on the implementation of enhanced recovery after surgery in percutaneous endoscopic interlaminar lumbar decompression/discectomy (2020)

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