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Subject Area

Degenerative, Minimally invasive procedures

Article Type

Original Study

Abstract

Background Data: The goal of all described surgical techniques to treat lumbar disc prolapse is removing the offending disc material, decompressing the nerve root, and relieving neurologic symptoms while avoiding complications. The goal of minimum invasiveness is to minimize the added morbidity of a larger exposure; including the creation of perineural scarring. Microendoscopic discectomy (MED) is a minimally invasive technique to treat lumbar disc prolapse. It is unique in that it combines open surgical principles with endoscopic technology. Follow-up will show whether MED will improve upon the long-term results of the “gold standard” procedures.Purpose: To evaluate the efficacy of lumbar MED, regarding results, safety, complications, stability of effectiveness, incidence of recurrence, instability and redo surgeries after 3 years of follow up.Study Design: A prospective clinical case studyPatients and Methods: We report 150 patients with lumbar disc prolapse, admitted at the Neurosurgery Department; Alexandria Main University Hospital and operated with MED technique. Patients were followed for 3 years. Clinical and radiological data were collected preoperatively and postoperativly. The degree of pain and disability were assessed using VAS and ODI. The length of the incision, the duration of surgery, and the average operative blood loss were calculated. Patients were followed at 2 weeks, 3 months, 1 year and 3 years.Results: This study included 150 patients; with 162 levels operated. 138 patients (92 %) had single level and 12 patients (8%) had double level surgery. L4-5 was the most common level. The mean duration of surgery was 55.0 minutes. The mean blood loss was 40.0 cc. The mean duration of hospital stay was 1.3 day. 81.3% of patients returned to their work in less than four weeks. The average length of skin incision was 2.38 cm. Intraoperative complications included four dural tears (2.6%), one (0.6%) pseudomeningocele, one (0.6%) partial nerve root injury (L5 root), and 3 (2%) superficial wound infection. No patient had postoperative instability or recurrences in the follow up period. There was a statistically significant difference between preoperative and postoperative VAS and ODI in the follow up evaluations (at 2 weeks, 3 months, 1 year & 3 years) (P=<0.001).Conclusion: MED technique allowed nerve root decompression; with minimal complications and preserving normal anatomy, with faster recoveries. For surgeons accustomed to performing endoscopic surgery, the use of MED is a safe and reliable alternative to microscopic discectomy. (2017ESJ124)

Keywords

Lumbar discectomy, microendoscopic discectomy, recurrent disc, Minimally invasive surgery, Endospine

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