Advantages and Weaknesses of Percutaneous Endoscopic Lumbar Discectomy: Algorithm Selection

Abstract

Objective: Degenerative diseases of the spine are the most common disorder seen in the practice of the neurosurgeon. According to many surgeons, microdiscectomy is the “gold standard” of surgical treatment. Analyzing the current literature, it is seen that the use of endoscopic techniques in spinal surgery is increasing. However, due to the lack of detailed information on the advantages and disadvantages of these methods, there is a need for continuing research in this area. Work to clarify the features of these methods, their specificity and algorithmization will increase the effectiveness of surgical treatment. Methods: This study included patients with herniated lumbar intervertebral discs, the presence of pain in the leg, and failed of conservative therapy. In the period 2014 to 2017, 172 endoscopic lumbar discectomies were performed, using microendoscopic discectomy and percutaneous endoscopic lumbar discectomy. The effectiveness of each technique was evaluated through comparative analysis. Results: In both groups, the methods used obtained high efficacy rates. Comparative analysis showed the advantages of the percutaneous technique in terms of shortening the return to normal activity time, hospitalization time, and disability, and reducing back pain in the early postoperative period. On the other hand, the microendoscopic discectomy enabled greater radicality to be achieved in cases with herniated disc ossification and complex anatomy of the vertebral segment. Conclusions: Analysis of the data obtained led to the formulation of an algorithm for selecting the optimum endoscopic method for achieving positive results of surgical treatment. Level of Evidence II; Therapeutic studies, investigating the results of treatment.

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