Endoscopic surgery for lumbar disc herniation –  the first experience


Authors: K. Máca 1;  K. Ďuriš 1,2;  M. Smrčka 1
Authors‘ workplace: Neurochirurgická klinika, LF MU a FN Brno 1;  Ústav patologické fyziologie, LF MU, Brno 2
Published in: Cesk Slov Neurol N 2019; 82(5): 541-547
Category: Original Paper
doi: 10.14735/amcsnn2019541

Overview

Aim: Lumbar disc herniation is the most frequent indication for spinal surgery. Open discectomy is considered as a standard surgical procedure; however, the endoscopic technique has evolved recently as an alternative method of treatment. Compared to open discectomy, the endoscopic technique has a similar ef­fect in terms of outcome and additional­ly, it is beneficial for both surgeon and patient, because the endoscopic technique is a minimal­ly invasive procedure. Department of Neurosurgery in The University Hospital Brno is the first department in the Czech Republic in which endoscopic discectomy has been implemented. The aim of this article is to present the first results and experiences with this technique, which has been used in our department since 2017.

Methods: So far, 15 patients (20– 70 years old) underwent endoscopic surgery for L4– 5 or L5– S1 herniation. Evaluation parameters were pain intensity (dorsalgia and radiculopathy) as­ses­sed by Visual Analogue Score (VAS) and limitations of com­mon activities as­ses­sed by Oswestry Disability Index (ODI). The parameters were evaluated before surgery and after the surgery at the 6-week and 6-month time-points.

Results: In all study groups the VAS score (for both dorsalgia and radiculopathy) was significantly higher before surgery compared to the 6-week and 6-month time-points. Similar results were found in male and female subgroups, and significant improvement was observed at both the 6-week and 6-month time-points. The ODI before surgery was significantly higher in all patients before surgery compared to the 6-week and 6-month time-points. In the male subgroup, there was no significant dif­ference between ODI before surgery and the 6-week time-point, while ODI at the 6-month time-point was significantly lower. In the female subgroup, ODI at both the 6-week and 6-month timepoints was significantly lower than before surgery. Recur­rent herniation had occur­red in one case and was resolved by reoperation.

Conclusion: In conclusion, endoscopic lumbar discectomy is a safe and ef­fective option for lumbar disc herniation surgery.

Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

The authors declare they have no potential 
conflicts of interest concerning drugs, products, or services used in the study.

Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.

 

 

K. Máca1, K. Ďuriš1,2, M. Smrčka1

1 
Neurochirurgická klinika 
LF MU a FN Brno

2 
Ústav patologické fyziologie, 
LF MU, Brno

 

prof. MUDr. Martin Smrčka, Ph.D., MBA

Neurochirurgická klinika

LF MU a FN Brno

Jihlavská 20

625 00 Brno

e-mail: smrcka.martin@fnbrno.cz

 

Přijato k recenzi: 21. 3. 2019

Přijato do tisku: 15. 8. 2019

Keywords:

lumbar disc herniation – endoscopy – Visual Analogue Score – Oswestry Disabilty Index


Sources

1. Spijker-Huiges A, Groenhof F, Winters JC et al. Radiat­­ing low back pain in general practice: Incidence, preva­lence, dia­gnosis, and long-term clinical course of il­l­nes­s. Scand J Prim Health Care 2015; 33(1): 27– 32. doi: 10.3109/ 02813432.2015.1006462.

2. Seiger A, Gadjradj PS, Harhangi BS et al. PTED study: design of a non-inferiority, randomised control­led trial to compare the ef­fectiveness and cost-ef­fectiveness of percutaneous transforaminal endoscopic discectomy (PTED) versus open microdiscectomy for patients with a symp­tomatic lumbar disc herniation. BMJ Open 2017; 7(12): e018230. doi: 10.1136/ bmjopen-2017-018230.

3. Nováková E, Říha M. Low back pain –  evidence-based medicine and cur­rent clinical practice. Is there any reason to change anything? Cesk Slov Neurol N 2017; 80/ 113(3): 280– 284. doi: 10.14735/ amcsn­n2017280.

4. Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976) 2007; 32(16): 1735– 1747. doi: 10.1097/ BRS.0b013e3180bc2431.

5. Gibson JN, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: the future “gold standard” for discectomy? –  a review. Surgeon 2012; 10(5): 290– 296. doi: 10.1016/ j.surge.2012.05.001.

6. Vaněk P, Bradáč O, Saur K et al. Faktory ovlivňující výsledek chirurgické léčby výhřezu meziobratlové ploténky bederní. Cesko Slov Neurol N 2010; 73/ 106(2): 157– 163.

7. Yadav YR, Parihar V, Kher Y et al. Endoscopic inter lami­nar management of lumbar dis­ease. Asian J Neurosurg 2016; 11(1): 1– 7. doi: 10.4103/ 1793-5482.145377.

8. Righes­so O, Falavigna A, Avanzi O. Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized control­led trial. Neurosurgery 2007; 61(3): 545– 549. doi: 10.1227/ 01.NEU.0000290901.00320.F5.

9. Choi G, Lee S-H, Raiturker PP, Lee S, Chae Y-S. Percutaneous endoscopic interlaminar discectomy for intracana­licular disc herniations at L5-S1 us­­ing a rigid work­­ing chan­nel endoscope. Neurosurgery 2006; 58 (Suppl 1): ONS59– ONS68. doi: 10.1227/ 01.neu.0000192713.95921.4a.

10. Hsu HT, Chang SJ, Yang SS et al. Learn­­ing curve of ful­l--endoscopic lumbar discectomy. Eur Spine J 2013; 22(4): 727– 733. doi: 10.1007/ s00586-012-2540-4.

11. Ruetten S, komp M, Merk H et al. Use of newly developed instruments and endoscopes: ful­l-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 2007; 6(6): 521– 530.

12. Palmer S. Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients. Neurosurg Focus 2002; 13(2): E5.

13. Ruetten S, Komp M, Merk H et al. Use of newly developed instruments and endoscopes: ful­l-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 2007; 6(6): 521– 530. doi: 10.3171/ spi.2007.6.6.2.

14. Righes­so O, Falavigna A, Avanzi O. Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized control­led trial. Neurosurgery 2007; 61(3): 545– 549. doi: 10.1227/ 01.NEU.0000290901.00320.F5.

15. Moliterno JA, Knopman J, Parikh K et al. Results and risk factors for recur­rence fol­low­­ing single-level tubular lumbar microdiscectomy. J Neurosurg Spine 2010; 12(6): 680– 686. doi: 10.3171/ 2009.12.SPINE08843.

16. Wang Y, Liang Z, Wu J et al. Comparative clinical ef­fectiveness of tubular microdiscectomy and conventional microdiscectomy for lumbar disc herniation: a systematic review and network meta-analysis. Spine (phil Pa 1976) 2019; 44(14): 1025– 1033. doi: 10.1097/ BRS.0000000000003001.

17. Ruetten S, Komp M, Godolias G. A New ful­l-endoscopic technique for the interlaminar operation of lumbar disc herniations us­­ing 6- mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg 2006; 49(2): 80– 87. doi: 10.1055/ s-2006-932172.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2019 Issue 5

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account