Minimally invasive open lumbar discectomy: An alternative to microlumbar discectomy

Abstract

Background: Lumbar disc surgery has come a long way since its fi rst description by Dandy in 1929 1 . Evolving through the transdural approach and a laminectomy for the removal of a disc, it now surpasses the primal technique with essentially a minimally invasive procedure, an extradural approach without laminectomy 2 . Objective: The objective of this study is to ascertain the effectiveness of Minimally Invasive Open Lumbar Discectomy in the treatment of lumbar disc prolapse. Materials and methods:It is a descriptive study entailing the patients with paramedian or central disc prolapse at single or two consecutive lumbosacral levels undergoing surgery at the National Institute of Neurological and Allied Sciences, Bansbari, Nepal, over a period of one and a half years. Patients who underwent either laminectomy or bilateral fenestration were excluded. Results of surgery were measured prospectively in terms of primary outcome measure (outcome at six months follow up as measured with Prolo Functional and Economic Scale) and secondary outcome measures (radicular pain relief, mobilisation, complication, and residual disc). Results: In the series of 137 consecutive patients, 120 fulfi lled the criteria. 98.33 % of patients had an improvement in the radicular pain and ambulation was commenced from the fi rst post-operative day. There were three instances of inadvertent dural tear without fascicle injury, and one instance of residual disc requiring reoperation. At 6 months, 97.5 % had good to excellent (grade 4, or 5) results reaching the premorbid states in the Prolo Functional and Economic Scale. Conclusion:The results of Minimally Invasive Open Lumbar Discectomy compare favourably with those of a microlumbar discectomy, and could therefore be an alternative to the latter in resource deprived circumstances.

A Retrospective Observational Analysis on the Outcome of Microlumbar Discectomy among 70 Consecutive Cases in the Tertiary Care Spine Center in Nepal

“…Immediate pain relief was seen in 98.33% in Devkota et al series, 97.5% in PS Ramani series, 96% in Yash Gulati series and 90% in CJ Koebbe et al series. 55,56,57,58 In this study immediate radicular pain relief was seen in 96% of cases comparable to other studies.…”

Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation

“…Among three published Nepalese articles on LDH surgery, only two have mentioned outcome after surgery after follow up period of 6-24 months, but have not analyzed variables that influence outcome. [9][10][11] The objective of the current retrospective study is to evaluate different clinical variables related to LDH which can affect outcome after LDH surgery.…”

Clinical Outcomes of a Novel Capsule Lumbar Interbody Fusion (CLIF) in Delayed Surgical Treatment of Cauda Equina Syndrome Retention (CESR) due to Lumbar Disc Herniation

“…In 1929, Dandy et al described two patients with severe CESR, and the dura mater of both patients had been opened and the herniated intervertebral disc was removed through the dural sac [27]. Similarly, Schneider et al reported 2 cases of CESR with lumbar disc herniation into dural sac [28].…”