OUTCOME OF ENDOSCOPIC LUMBAR DISCECTOMY FOR THE TREATMENT OF SCIATICA

Main Article Content

Riaz Ur Rehman
Muhammad Nawaz Khan
Mian Iftikhar Ul Haq
Sajjad Ullah

Abstract

 


Objective: To evaluate the outcome of endoscopic lumbar discectomy in patients having sciatica due to single level prolapsed disc.


Methodology: This descriptive study was conducted in neurosurgery departments of Lady Reading Hospital and Hayatabad Medical Complex Peshawar from June 2017 to December 2019, after approval from the ethics com­mittee. All patients with straight leg raising (SLR) less than 60 degree, failed conservative treatment and with single level prolapsed disc were included while redo cases, cauda equine syndrome and traumatic disc prolapse asso­ciated with fractures were excluded. Per operative and post operative complications were documented. Patients were followed up for 3 months. Data was collected and analyzed with SPSS version 20.


Results: One hundred and fifteen endoscopic lumbar discectomies were done. There were 75 (65.2%) male and 40 (34.8%) female patients. Age range was 17 to 63 years with mean age of 31.0±2.13 years. L5-S1 was involved in 67 (58.26%) cases, L4-5 in 42 (36.52%) cases and L3-4 in 6 (5.22%) cases. Procedure time ranged from 35 to 125 min with a mean of 62 minutes. Four cases were converted to open discectomies due to technical difficulties. Sciatica pain relief was achieved in 110 (95.65%) cases. Surgical site infection was observed in 2 (1.74%) cases.


Conclusion: Endoscopic discectomy has acceptable rate of complications and good post-operative pain relief.

Article Details

How to Cite
1.
Rehman RU, Khan MN, Haq MIU, Ullah S. OUTCOME OF ENDOSCOPIC LUMBAR DISCECTOMY FOR THE TREATMENT OF SCIATICA. J Postgrad Med Inst [Internet]. 2021 Mar. 31 [cited 2024 Apr. 18];35(1):23-5. Available from: https://www.jpmi.org.pk/index.php/jpmi/article/view/2760
Section
Original Article

References

Kim M, Lee S, Kim HS, Park S, Shim SY, Lim DJ. A comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for lumbar disc herniation in the korean: a meta-analysis. BioMed Res Int. 2018; 2018: 9073460. https://doi.org/10.1155/2018/9073460.

Dohrmann GJ, Mansour N. Long-term re¬sults of various operations for lumbar disc herniation: analysis of over 39,000 pa¬tients. Med Princ Pract. 2015; 24(3): 285- 90. https://doi.org/10.1159/000375499.

Casal MR, Castro MM, Hernández BM, Bravo JA, Jorge FJ. Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clin¬ical study with a 5-year follow-up. Neu¬rosurg. 2011;68(6):1568-75. https://doi. org/10.1227/NEU.0b013e31820cd16a

Claudius T, Martin B, Johann S, Peter S. Outcome after lumbar sequestrectomy compared with microdiscectomy: a pro¬spective randomized study. J Neurosurg Spine. 2005;2(3):271-8. https://doi. org/10.3171/spi.2005.2.3.0271.

Kulkarni AG, Bassi A, Dhruv A. Micro¬endoscopic lumbar discectomy: tech¬nique and results of 188 cases. Indian J Orthop. 2014;48(1):81-7. https://doi. org/10.4103/0019-5413.125511.

Wu X, Zhuang S, Mao Z, Chen H. Mi¬croendoscopic discectomy for lum¬bar disc herniation: surgical technique and outcome in 873 consecutive cas¬es. Spine. 2006;31(23):2689-94. h t t p s : / / d o i . o r g / 1 0 . 1 0 9 7 / 0 1 . brs.0000244615.43199.07.

Jhala A, Mistry M. Endoscopic lumbar discectomy: Experience of first 100 cas¬es. Indian J Orthop. 2010;44(2):184- 90. https://doi.org/10.4103/0019- 5413.62051.

Destandau J. [Technical features of endo¬scopic surgery for lumbar disc herniation: 191 patients.] Neurochir. 2004; 50(1):6- 10. https://doi.org/10.1016/s0028- 3770(04)98300-2.

Righesso O, Falavigna A, Avanzi O. Com¬parison of open discectomy with micro¬endoscopic discectomy in lumbar disc herniations: results of a randomized con¬trolled trial. Neurosurg. 2007;61(3):545- 9. https://doi.org/10.1227/01. NEU.0000290901.00320.F5.

Katayama Y, Matsuyama Y, Yoshihara H, Sakai Y, Nakamura H, Nakashima S, et al. Comparison of surgical outcomes be¬tween macro discectomy and micro dis¬cectomy for lumbar disc herniation: a pro¬spective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech. 2006;19(5):344- 7. https://doi.org/10.1097/01. bsd.0000211201.93125.1c.

Xia Y, Zhang Q, Gao X, Wang K, Zhang X, Du Y, et al. Posterior percutaneous endoscopic lumbar discectomy com¬bined with the vertical anchoring tech¬nique for lumbar disc herniation with distant upward migration. J Orthop Surg Res. 2019;14:467-75. https://doi. org/10.1186/s13018-019-1519-9.

Kim MJ, Lee SH, Jung ES, Son BG, Choi ES, Shin JH, et al. Targeted percutane¬ous transforaminal endoscopic diskec¬tomy in 295 patients: comparison with results of microscopic diskectomy. Surg Neurol. 2007;68(6):623-31. https://doi. org/10.1016/j.surneu.2006.12.051.

Ruetten S, Komp M, Godolias G. A new full-endoscopic technique for the interla¬minar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Inva¬sive Neurosurg. 2006;49(2):80-7. https:// doi.org/10.1055/s-2006-932172.

Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlam¬inar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521-30. https://doi.org/10.3171/spi.2007.6.6.2.

Oertel JMK, Mondorf Y, Gaab MR. A new endoscopic spine system: the first results with “Easy GO”. Acta Neuro¬chir. 2009;151:1027-33. https://doi. org/10.1007/s00701-009-0454-7.

Raja RA, Khemani VD, Lakhair MA, Khan SA. Discectomy in single level lumbar disc disease. J Ayub Med Coll Abbottabad. 2012;24(2):81-3.

Pan M, Li Q, Li S, Mao H, Meng B, Zhou F, et al. Percutaneous endoscopic lumbar discectomy: indications and complica¬tions. Pain Physician. 2020;23(1):49-56.

Gu YT, Cui Z, Shao HW, Ye Y, Gu AQ. Per¬cutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 con¬secutive cases. J Orthop Surg Res. 2017; 12: 25. https://doi.org/10.1186/s13018- 017-0524-0.

Atlas SJ, Keller RB, Wu YA, Deyo RA, Sing¬er DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine. 2005;30(8):927- 35. https://doi.org/10.1097/01. brs.0000158954.68522.2a.

Gibson JN, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine. 1999;24(17):1820- 32. https://doi.org/10.1097/00007632- 199909010-00012.

Schoeggl A, Maier H, Saringer W, Red¬dy M, Matula C. Outcome after chronic sciatica as the only reason for lumbar microdiscectomy. Journal of spinal dis¬orders & techniques. 2002;15(5):415-9. https://doi.org/10.1097/00024720- 200210000-00012.

Law JD, Lehman RA, Kirsch WM. Reop¬eration after lumbar intervertebral disc surgery. J Neurosurg. 1978;48(2):259- 63. https://doi.org/10.3171/ jns.1978.48.2.0259.

Yeung AT, Tsou PM. Posterolateral en¬doscopic excision for lumbar disc herni¬ation: Surgical technique, outcome and complications in 307 consecutive cases. Spine. 2002;27(7):722-31. https://doi. org/10.1097/00007632-200204010- 00009.

Hakkinen A, Ylinen J, Kautiainen H, Tar¬vainen U, Kiviranta I. Effects of home strength training and stretching ver-sus stretching alone after lumbar disk surgery: a randomized study with a 1-year follow-up. Arch Phys Med Re-habil. 2005;86(5):865-70. https://doi. org/10.1016/j.apmr.2004.11.012.