Microendoscopic lumbar discectomy: Technique and results of 188 cases

Abstract

Background:Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED) utilizing tubular retractors in terms of safety and efficacy of the technique.Materials and Methods:188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging) and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN) using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5) for back and leg pain and ODI (Oswestry Disability Index). Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years.Results:The mean age of patients was 46 years (range 16-78 years) and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months). The mean VAS scale for leg pain improved from 4.14 to 0.76 (P < 0.05) and the mean VAS scale for back pain improved from 4.1 to 0.9 (P < 0.05). The mean ODI changed from 59.5 to 22.6 (P < 0.05). The mean operative time per level was about 50 minutes (range 20-90 minutes). Dural punctures occurred in 11 (5%) cases. Average blood loss was 30 ml (range 10-500 ml). A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement.Conclusion:MED for herniated discs effectively achieves the goals of surgery with minimal access. The advantages of the procedure are cosmesis, early postoperative recovery and minimal postoperative morbidity.

Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease

“…This surgical procedure has the following advantages: The field of operation is adjustable and anatomical structures such as nerves and the dural sac can be seen clearly through the endoscope. During the procedure, surgical instruments are less limited by the canals than with the METRx (Medtronic, Sofamor Danek, Memphis, TN, USA) system. The sleeves can be tilted at any angle according to the need to decompress the proximal, distal, lateral and contralateral spinal canals as well as the nerve root canals. The intervertebral disc and cartilaginous endplate structure can be scraped from all directions and the intervertebral space can be cleaned thoroughly by altering the angles of the sleeves. In contrast with open surgery, all required procedures, including segmental interlaminar fenestration decompression, discectomy, scraping of cartilaginous endplate and intervertebral bone grafting are performed with the aid of the endoscope; thus, the procedure can be performed with greater finesse and more safely.…”

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

“…Garg et al, 13 reported one patient had a recurrence of disc herniation after 7 months. Kullarni et al, 23 reported a rate of recurrence 1.5%. Yadav et al, 50 reported recurrence occurred in 2 patients (0.5%).…”

“…Most of the clinical series using this technique show low morbidity; which is usually related to dural tears. 17,23,24,31,38,39,46 In our series we had four patients of dural tears (2.6%); two of them (1.3%) developed CSF leaks; and one (0.6%) developed pseudomeningocele. We had one patient (0.6%) of partial nerve root injury (L5 root) that responded to pregabalin.…”

“…Hussein et al, 17 had 3 dual tears (1.6%). Kullarni et al, 23 had a relatively larger incidence of dural tears; 11 patients (5%). Similarly, Soliman et al, 39 had 2 dural tears (4.8%).…”

“…Our results were comparable to others. 17,19,23,38,39,46 In Choi et al, 7 series the mean preoperative VAS was 7.89 (Ranged from 6-10). At the last follow-up examination, after an average period of 18 months postoperatively, the mean VAS was 1.58 (Range 0-7), this improvement was statistically significant (P<0.001).…”