BACKGROUND: Microendoscopic discectomy (MED) is less invasive than conventional open discectomy, but the long-term benefits of this technique are still debated. Controversy also remains regarding the surgical indications, patient selection, effectiveness, learning curve and complications. METHODS: From Dec 2001 to Dec 2003, 26 patients with lumbar herniated disc disease received MED. The surgical indications included the following: (1) unilateral, single level lumbar disc herniation; (2) signs and symptoms compatible with the involved nerve root; (3) failure of conservative treatment. These cases were the initial MEDs performed by one of our senior authors (TS FU). Clinical symptoms and outcomes were assessed using the Japanese Orthopaedic Association Back Scores. RESULTS: Treatment in two cases was changed to open discectomy because of irreparable dural tears during surgery. For the remaining 24 cases, the average intraoperative blood loss was 55.8 mL. The average operation length was 136.8 minutes and the average post-surgical hospital stay was 2.4 days. At 12 weeks after the operation, 22 achieved excellent or good results. The satisfactory rate was 91.7%. On final follow-up, 21 patients had excellent or good results. The satisfactory rate was 87.5%. Complications included two irreparable dural tears, two superficial wound infections and one pseudomenigocele. CONCLUSIONS: Our data indicate that MED is an effective procedure for lumbar disc herniation. The result is satisfactory under adequate surgical indications and patient selection. Despite the low complication rate, dural tears still remain a concern during the learning stage.
BACKGROUND: Microendoscopic discectomy (MED) is less invasive than conventional open discectomy, but the long-term benefits of this technique are still debated. Controversy also remains regarding the surgical indications, patient selection, effectiveness, learning curve and complications. METHODS: From Dec 2001 to Dec 2003, 26 patients with lumbar herniated disc disease received MED. The surgical indications included the following: (1) unilateral, single level lumbar disc herniation; (2) signs and symptoms compatible with the involved nerve root; (3) failure of conservative treatment. These cases were the initial MEDs performed by one of our senior authors (TS FU). Clinical symptoms and outcomes were assessed using the Japanese Orthopaedic Association Back Scores. RESULTS: Treatment in two cases was changed to open discectomy because of irreparable dural tears during surgery. For the remaining 24 cases, the average intraoperative blood loss was 55.8 mL. The average operation length was 136.8 minutes and the average post-surgical hospital stay was 2.4 days. At 12 weeks after the operation, 22 achieved excellent or good results. The satisfactory rate was 91.7%. On final follow-up, 21 patients had excellent or good results. The satisfactory rate was 87.5%. Complications included two irreparable dural tears, two superficial wound infections and one pseudomenigocele. CONCLUSIONS: Our data indicate that MED is an effective procedure for lumbar disc herniation. The result is satisfactory under adequate surgical indications and patient selection. Despite the low complication rate, dural tears still remain a concern during the learning stage.
Authors: Scott L Parker; Stephen K Mendenhall; Saniya S Godil; Priya Sivasubramanian; Kevin Cahill; John Ziewacz; Matthew J McGirt Journal: Clin Orthop Relat Res Date: 2015-06 Impact factor: 4.176