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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
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Related Experiment Video

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Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
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Cost-effectiveness of full endoscopic versus open discectomy for sciatica.

Pravesh Shankar Gadjradj1,2, Hana M Broulikova3, Johanna M van Dongen3

  • 1Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian/Weil Cornell Medicine New York, New York, USA.

British Journal of Sports Medicine
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Percutaneous transforaminal endoscopic discectomy (PTED) is more cost-effective than open microdiscectomy for sciatica patients. This minimally invasive procedure offers better outcomes and lower societal costs, making it a preferred choice.

Keywords:
arthroscopyrandomized controlled trialspine

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Area of Science:

  • Spine surgery outcomes
  • Health economics in orthopedics
  • Minimally invasive spinal procedures

Background:

  • Sciatica significantly impacts patient quality of life and healthcare costs.
  • Open microdiscectomy is a traditional surgical approach for lumbar disc herniation.
  • Percutaneous transforaminal endoscopic discectomy (PTED) offers a minimally invasive alternative.

Purpose of the Study:

  • To compare the costs and cost-effectiveness of PTED versus open microdiscectomy for sciatica.
  • To evaluate patient-reported outcomes including leg pain and quality-adjusted life years (QALYs).
  • To assess the economic impact from a societal perspective.

Main Methods:

  • A 12-month multicentre randomized controlled trial with a non-inferiority design.
  • Patients aged 18-70 with lumbar disc herniation and radiating leg pain were randomized.
  • Societal costs, leg pain, and QALYs (EQ-5D-5L) were measured; data were multiply imputed and analyzed with bootstrapping.

Main Results:

  • PTED demonstrated statistically significant improvements in leg pain and QALYs compared to open microdiscectomy at 12 months.
  • While PTED had higher surgery costs, total societal costs were lower.
  • Cost-effectiveness acceptability curves showed a >99% probability of PTED being dominant (less costly, more effective).

Conclusions:

  • PTED is a more cost-effective treatment option for sciatica compared to open microdiscectomy.
  • The findings support PTED as a superior approach from both clinical and economic perspectives.
  • This study provides strong evidence for the adoption of PTED in clinical practice.