Endoscopic lumbar discectomy: Experience of first 100 cases

Abstract

Background:Various modalities of treatment from standard discectomy, microdiscectomy, percutaneous discectomy, and transforaminal endoscopic discectomy have been in use for lumbar intervertebral disc prolapse. The access to spine is kept to a minimum without stripping paraspinal muscles minimizing muscle damage by posterior interlaminar endoscopic approach. The aim of this study was to evaluate technical problems, complications, and overall initial results of microendoscopic discectomy.Materials and Methods:First 100 consecutive cases aged 19-65 years operated by microendoscopic dissectomy between August 2002 – December 2005 are reported. All patients with single nerve root lesions including sequestrated or migrated and selected central disc at L4-5 and L5-S1 were included. The patients with bilateral radiculopathy were excluded. All patients had preoperative MRI and first 11 patients had postoperative MRI to check the adequacy of decompression. Diagnostic selective nerve root blocks were done in selective cases to isolate the single root lesion when MRI was inconclusive (n=7). All patients were operated by a single surgeon with the Metrx system (Medtronics). 97 were operated by 18-mm ports, and only three patients were operated by 16-mm ports. Postoperatively, all patients were mobilized as soon as the pain subsided and discharged within 24–48 h postsurgery. Patients were evaluated for technical problems, complications, and overall results by modified Macnab criteria. Patients were followed up at 2, 6, and 12 weeks.Results:The mean follow up was 12 months (range 3 months – 4 years). Open conversion was required in one patient with suspected root damage. Peroperatively single facet removal was done in 5 initial cases. Minor dural punctures occurred in seven cases and root damage in one case. The average surgical time was 70 min (range 25-210 min). Average blood loss was 20-30 ml. Technical difficulties encountered in initial 25 cases were insertion of guide pin, image orientation, peroperative dissection and bleeding problems, and reaching wrong levels suggestive of a definitive learning curve. Postoperative MRI (n=11) showed complete decompression. Overall 91% of patients had good-to-excellent results, with four patients having recurrence of whom three were reoperated. Four patients had postoperative discitis. One of the patients required fusion for discitis and rest were managed conservatively. One patient had root damage to L5 root that had paresthesia in L5 region even on 4 years of follow-up.Conclusion:Microendoscopic discectomy is minimally invasive procedure for discectomy with early encouraging results. Once definite learning curve was over and expertise is acquired, the results of this procedure are acceptable safe and effective.

Complications Associated With the Initial Learning Curve of Minimally Invasive Spine Surgery: A Systematic Review

“…Manual review of the reference sections of included studies yielded eight additional publications that met inclusion criteria and were included in this review. Thus, a total of 15 articles were included in our systematic review, none of which were case reports [1,3,6,8,11,12,15,16,18,19,21,[23][24][25]27] (Table 1).…”

“…We included nine publications with Level IV evidence (case series without comparison group) [3,6,12,15,16,21,23,24,27], four with Level III evidence (retrospective comparative study) [1,8,11,18], and two with Level II evidence (prospective comparative study) [19,25].…”

“…Results from 528 decompression procedures (428 prospective, 100 retrospective) were included from six publications [6,12,15,16,18,23] (Table 1). Five studies had Level IV evidence [6,12,15,16,23] and one had Level III evidence [18].…”

“…Five studies had Level IV evidence [6,12,15,16,23] and one had Level III evidence [18]. There were 195 microendoscopic discectomy cases, 282 tubular microdiscectomy cases, and 51 percutaneous endoscopic lumbar discectomy cases included in this review [6,12,15,16,18,23].…”

Three-year Follow-Up Results of Lumbar Microendoscopic Discectomy (MED): A Prospective Study in 150 Patients

“…Open discectomy was considered as the gold standard for the treatment of lumbar disc prolapse by many authors 9,35 , and the majority of series 2,6,12,[14][15][16]18,36,42,44,45,47,48,51 reported satisfactory results in 75 to 95% of patients. Though the results of conventional discectomy are equally good, microdiscectomy introduced by Yasargil and Caspar (1977) is now considered the gold standard.…”