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

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Background Data: Discectomy through a limited laminotomy has remained the "gold standard" for lumbar disc surgery. Surgery for lumbar disc herniation can be classified into two broad categories;open (conventional) versus minimally invasive surgery , where the last category classified into microscopic, endoscopic and percutaneous procedures. Microendoscopic discectomy (MED) is unique in that it combines open surgical principles with endoscopic technology. Purpose: To evaluate extent of tissue damage and pain relief after microendoscopic (MED) and microscopic lumbar discectomy (MD). Study Design: A prospective randomized controlled study. Patients and Methods: The study included 40 patients having lumbar disc prolapse, operated in Alexandria Main University Hospital. Twenty of them underwent MED (Group A) and the other twenty underwent MD (Group B). Clinical (VAS, ODI) and radiological and biochemical markers (CRP, CPK) for tissue inflammation data were collected preoperatively and postoperatively for comparison. Patients were followed up for 6 months. Results: 26 patients were males and 14 were females. The mean age for group A was 40.8±1.34 years and for group B was 40.2±1.06 years. Clinically all patients had low back pain and radicular leg pain. There was no statistically significant difference between the duration of surgery in both groups. The length of hospital stay was significantly less in MED group. The length of the skin wound was significantly less in MED group. Reduction of back pain VAS immediate and 1 month postoperative was reported in both groups and was statistically significantly better in MED group, however, after 6 months there was no difference between both groups. There was significant improvement with no difference between both groups regarding radicular VAS and ODI all through the follow up. Postoperative CRP and CPK was statistically significantly higher in MD group (P<0.001). Conclusion: Both techniques gave comparable clinical outcomes although early back pain score and tissue markers were in favor of MED technique. (2018ESJ153)

Section: Discussionmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Comparing the Extent of Tissue Damage between Lumbar Microendoscopic Discectomy (MED) and Microscopic Discectomy (MD) Using Biochemical Markers

Abbas

Elwany

Mohamed

2018

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“…Lumbar degenerative disc disease is a common cause of low back pain and sciatica in adults. 2,15,16,36 The process of degeneration starts with dehydration of the nucleus pulposus together with decreased tensile strength of the annulus fibrosus, leading eventually to decreased disc height, facets hypertrophy and subluxation, and segmental instability of the affected segment. 37 In our institute, posterior lumbar interbody fusion (PLIF) procedure remains the most commonly used surgical option for treatment of degenerative disc disorders and spondylolisthesis.…”

Section: Discussionmentioning

confidence: 99%

The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?

Ali

Elnaggar

Elwany

et al. 2019

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Background Data: Lumbar interbody fusion surgeries are the gold standard surgical option in degenerative disc disorders and spondylolisthesis. Achieving solid arthrodesis at the operated segment remains the main goal of surgery. Yet, the correlation of sound radiological fusion with better clinical outcomes is not well established. In recent years, spinal surgeons had much greater awareness of the influence of vitamin D deficiency and cigarette smoking on spinal fusion. Purpose: To assess the influence of vitamin D deficiency and cigarette smoking on the rate of spinal arthrodesis after posterior lumbar interbody fusion (PLIF) in degenerative disc disorders and whether successful fusion correlates with clinical outcomes. Study Design: A prospective cohort study. Patients and Methods: The study was conducted on 67 patients (with a total of 92 levels) who underwent operation for PLIF with pedicle screw fixation. Twenty-six patients had degenerative spondylolisthesis, 20 had herniated discs, and 21 patients showed degenerative disc changes with segmental canal stenosis. In 29 patients, a local bone graft was used as soft PLIF. In the remaining 38 patients, a PEEK interbody cage was utilized. Patients were categorized according to both their serum vitamin D status (39 low; 28 normal) and cigarette smoking habits (18 smokers; 49 non-smokers). The final assessment was done 6 months postoperatively. Clinical outcomes were measured by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for low back pain. Radiological fusion status was assessed on plain radiographs and graded according to Bridwell's interbody fusion grading system. The relationship between vitamin D status and cigarette smoking and radiological outcomes was also evaluated. Results: Twenty-two males and 45 females were included in this study. The mean age was 55.8±±3.78 years. L4-L5 was the most commonly operated level, followed by L5-S1 and L3-4 (51.1%, 36.95%, Egy Spine J -Volume 32 -October 2019The EGYPTIAN SPINE Journal and 11.95%, resp.). There were significant improvements in the mean ODI and VAS measures at final assessment regardless of the differences in vitamin D status or smoking habits. The fusion rate in the low vitamin D group was 79.5% versus 96.4% in the normal level group (P=0.045). 66.7% of those with poor radiological fusion were smokers versus 20.7% of those with sound fusion (P=0.004). There was no significant difference in fusion rates between the PEEK cage group and the bone graft group (P=0.128). There was no significant correlation between sound radiological fusion and better clinical outcomes (P=0.077 and P=0.157 for ODI and VAS, resp.). Conclusion: Smoking habits and low serum vitamin D seem to have a significant negative effect on the success of radiological spinal fusion. There was no significant relationship between radiological fusion and clinical outcomes. (2019ESJ190)

“…Though the results of conventional open discectomy are equally good, microdiscectomy introduced by Yasargil and Caspar (1977) is now considered the gold standard. 6 Also, microendoscopic discectomy introduced by Foley et al, 7 in 1997 combines standard lumbar microsurgical techniques with an endoscope. In general, minimally invasive discectomy techniques (MID) in treating de novo LDH showed equal or favorable outcomes compared to open approaches, 11 with added benefit of smaller incision and less tissue trauma.…”

Section: 8mentioning

confidence: 99%

Reperforming Minimally Invasive Microdiscectomy Approaches for Recurrent Lumbar Intervertebral Disc Prolapse

Hamouda¹

2017

Background Data: Reperforming minimally invasive discectomy (MID) approaches are typically challenging and demanding for patients with recurrent lumbar disc herniation (rLDH). Purpose: The aim of this study to assess the safety and efficacy of reperforming Minimally invasive discectomy in recurrent lumbar disc herniation surgery. Study Design: Retrospective clinical case study. Patients and Methods:The author reviewed the medical records all patients reoperated after MID during the period from June 2010 to April 2016 via minimally invasive approaches for recurrent lumbar disc herniation. Age, gender, presenting symptoms, disc herniation level and side, type of MID approach used in first surgery, period between 1 st and 2 nd surgeries, redo surgery duration, intra or post-operative complications, visual analogue scale VAS for pain at 1, 30, and 90 days postoperatively were recorded. Results: We could track 18 patients (12 males, 6 females), with mean age 43.2±6.3 years. The most operated level was L4/5 in 12 patients. Disc herniation on the left side was presented in 11 patients. Mean duration between the two surgeries was 44±19 weeks. Main clinical presentations were recurrent leg pain in 16 patients and new onset of partial foot drop in 2 patients. Duration of redo surgery was 97±37 minutes. Intraoperative minor dural tears were reported in 2 with no serious sequels. VAS for leg pain improved from 7.3±1.2 preoperatively to 2.1±1.1, 1.4±0.5 and 1.2±0.4 at 1, 30 and 90 postoperative days respectively. Conclusion: MID approach for rLDH following initial MID surgery sounds feasible option with better perioperative and short-term outcome. Clinical outcome in the present study showed favourable outcome regarding operative time and incidence of dural tears with CSF leak comparing to open approaches. (2017ESJ151)