OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC LUMBAR DISCECTOMY FOR PROLAPSED PARA SPINAL INTERVERTEBRAL DISC

  • Syed Shahzad Husain Department of Neurosurgery, Allama Iqbal Medical College, Lahore, Pakistan.
  • Usman Ahmed Kamboh Department of Neurosurgery, Jinnah Hospital/Allama Iqbal Medical College, Lahore, Pakistan.
  • Asif Raza Department of Neurosurgery, Jinnah Hospital/Allama Iqbal Medical College, Lahore, Pakistan.
  • Muhammad Adil Department of Neurosurgery, Jinnah Hospital/Allama Iqbal Medical College, Lahore, Pakistan.
  • Naveed Ashraf Department of Neurosurgery, Jinnah Hospital/Allama Iqbal Medical College, Lahore, Pakistan.

Abstract

Background: Backache is second most common problem presenting to the primary healthcare providers. Lumbar discectomy has been revolutionized from open conventional discectomy to endoscopic removal. Endoscopic procedures are proving their superiority regarding good outcome, less wound site pain and shorter hospital stay, in Neurosurgery as well. Micro discectomy and Endoscopic discectomy is used only in few centres in Pakistan. This study aimed to share our experience of early surgical outcome endoscopic lumbar discectomy in terms postoperative pain improvement and duration of hospital stay Methods: This prospective study was carried out at Neurosurgery Department, Jinnah Hospital, Lahore from Jan 2014 to Jan 2016. During this period, 35 patients of both sexes, aging between 20 and 60 years, with symptoms and signs of lumbago with sciatica were enrolled. Data was collected on a questionnaire after informed verbal and written consent. Results: A total of 35 patients were operated including 10 males and 25 females. Their age ranged from 20 to 60 years with mean age 33.14±8 years. Majority (32, 91%) of the patients had left side prolapsed paracentral disc, and remaining (3, 9%) had right sided prolapsed disc. Regarding the level of disc 19 (54%) patients had L4-5 while 15 (43%) had L5-S1 and remaining one (2.9%) patients had L3-4 level. The post-op wound site visual analogue score was 1.57±1.1. Twenty-five patients had VAS of 1 (71.4%). Minimum hospital stay was 1 day in 16 (45.75%) patients and maximum was 4 days in 3 (8.6%) patients. Mean hospital stay was 1.83±0.95 days. The only complication encountered was iatrogenic dural tear seen in one patient but with no CSF leak from wound site. No surgical site infections were reported at follow-ups. Conclusion: Endoscopic Lumbar discectomy is a safe procedure with short hospital stay.


Keywords: sciatica, prolapsed intervertebral disc, microscopic discectomy, endoscopic discectomy


Pak J Physiol 2017;13(2):34–7

Author Biography

Syed Shahzad Husain, Department of Neurosurgery, Allama Iqbal Medical College, Lahore, Pakistan.

Associate Professor Neurosurgery, Allama Iqbal Medical College, Lahore-54000, Pakistan.

References

1. Cypress BK. Characteristics of physician visits for back symptoms: A national perspective. Am J Public Health 1983;73:389–95.
2. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008;299:656–64.
3. Wahlstrom J, Burstrom L, Nilsson T, Jarvholm B. Risk factors for hospitalization due to lumbar disc disease. Spine 2012;37:1334–9.
4. Akbar A, Mahar A. Lumbar disc prolapse: Management and outcome analysis of 96 surgically treated patients. J Pak Med Assoc 2002;52(2):62–5.
5. Friberg S, Hirsch C. Anatomical and clinical studies on lumbar disc degeneration. Acta Orthop Scand 1949;19:222–42.
6. Schultz A, Andersson G, Ortengren R, Haderspeck K, Nachemson A. Loads on the lumbar spine. J Bone Joint Surg Am 1982;64:713–20.
7. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992;268:760–5.
8. Taher F, Essig D, Lebl DR, Hughes AP, Sama AA, Cammisa FP, et al. Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Adv Orthop 2012; 2012:970752. doi:10.1155/2012/970752.
9. Fager CA. Observations on spontaneous recovery from intervertebral disc herniation. Surg Neurol 1994;42:282–6.
10. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934; 211:210–5.
11. Love JG. Protruded intervertebral disc (fibrocartilage): section of orthopaedics and section of neurology. Proc R Soc Med 1939;32:1697–721.
12. Yasargil MG. Microsurgical Operation of Herniated Lumbar Disc. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O, (Eds). Advances in Neurosurgery, Vol 4. Berlin, New York: Springer-Verlag; 1977.p. 81–94.
13. Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 1977;4:74–7.
14. Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine (Phila Pa 1976) 1978;3(2):175–82.
15. Kambin P, Gellman H. percutaneous lateral discectomy of the lumbar spine: A preliminary report. Clin Orthop 1983;174:127–32.
16. Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg 1997;3(4):301–7.
17. Yeung AT. Minimally invasive disc surgery with the Yeung Endoscopic Spine System (YESS). Surg Technol Int 1999;8:267–77.
18. Katayama Y, Matsuyama Y, Yoshihara H, Sakai Y, Nakamura H, Nakashima S, et al. Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: A prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech 2006;19:344–7.
19. Perez-Curet MJ, Fessler RG, editors. Outpatient spine surgery. 1st ed. St. Louis (MO): Quality Medical Publishing; 2002.
20. Ranjan A, Lath R. Microendoscopic discectomy for prolapsed lumbar intervertebral disc. Neurol India 2006;54:190–4.
21. Schizas C, Tsiridis E, Saksena J. Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Neurosurgery 2005;57(4 Suppl):357–60.
22. Huang CJ, Tang HW, Liang DB, Lou YM, Guan W. Treatment of the recurrent lumbar disc herniation: a comparison between endoscopic surgery and open surgery. Zhongguo Gu Shang 2013;26:810–4.
23. Teli M, Lovi A, Brayda-Bruno M, Zarga A, Corriero A, Giudici F, et al. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 2010;19:443–50.
24. Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J 2013;22(4):727–33.
25. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar micro discectomy for recurrent disc herniation. J Korean Neurosurg Soc 2009;46:515–21.
26. Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome: Reasons, intraoperative findings, and long-term results: A report of 182 operative treatments. Spine (Phila Pa 1976) 1996;21:626–33.
27. Donceel P, Du Bois M. Fitness for work after surgery for lumbar disc herniation: A retrospective study. Eur Spine J 1998;7:29–35.
28. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: Surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976) 2004;29:E326–32.
29. Andrews DW, Lavyne MH. Retrospective analysis of microsurgical and standard lumbar discectomy. Spine (Phila Pa 1976) 1990;15:329–35.
30. Lee SH, Kang BU, Ahn Y, Choi G, Choi YG, Ahn KU, et al. Operative failure of percutaneous endoscopic lumbar discectomy: A radiologic analysis of 55 cases. Spine (Phila Pa 1976) 2006;31:E285–90.
31. Wu X, Zhuang S, Mao Z, Chen H. Microendoscopic discectomy for lumbar disc herniation: Surgical technique and outcome in 873 consecutive cases. Spine (Phila Pa 1976) 2006;31:2689–94.
32. Lee S, Kim SK, Lee SH, Kim WJ, Choi WC, Choi G, et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: Classification of disc migration and surgical approaches. Eur Spine J 2007;16:431–7.
33. Ozer AF, Oktenoglu T, Sasani M, Bozkus H, Canbulat N, Karaarslan E, et al. Preserving the ligamentum flavum in lumbar discectomy: A new technique that prevents scar tissue formation in the first 6 months postsurgery. Neurosurgery. 2006;59:ONS126–33.
34. Park YK, Kim JH, Chung HS. Outcome analysis of patients after ligament-sparing microdiscectomy for lumbar disc herniation. Neurosurg Focus. 2002;13(2):E4.
35. Ross JS, Robertson JT, Frederickson RC, Petrie JL, Obuchowski N, Modic MT, et al. Association between peridural scar and recurrent radicular pain after lumbar discectomy: Magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 1996;38:855–61.
36. Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine (Phila Pa 1976) 2005;30:2570–8.
37. Ruetten S, Meyer O, Godolias G. Epiduroscopic diagnosis and treatment of epidural adhesions in chronic back pain syndrome of patients with previous surgical treatment: first results of 31 interventions. Z Orthop Ihre Grenzgeb 2002;140:171–5.
38. Segnarbieux F, Van de Kelft E, Candon E, Bitoun J, Frèrebeau P. Disco-computed tomography in extraforaminal and foraminal lumbar disc herniation: Influence on surgical approaches. Neurosurgery 1994;34:643–7.
39. Tomecek FJ, Anthony CS, Boxell C, Warren J. Discography interpretation and techniques in the lumbar spine. Neurosurg Focus 2002;13:E13.
40. Gill K. Retroperitoneal bleeding after automated percutaneous discectomy. A case report. Spine (Phila Pa 1976) 1990;15:1376–7.
41. Choi G, Lee SH, Bhanot A, Raiturker PP, Chae YS. Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: Extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine (Phila Pa 1976) 2007;32:E93–9.
42. Ditsworth DA. Endoscopic transforaminal lumbar discectomy and reconfiguration: A postero-lateral approach into the spinal canal. Surg Neurol 1998;49:588–97.
43. Tsou PM, Yeung AT. Transforaminal endoscopic decompression for radiculopathy secondary to intra-canal noncontained lumbar disc herniations: outcome and technique. Spine J 2002;2:41–8.
44. Tsou PM, Alan Yeung C, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: A minimal access visualized intradiscal surgical procedure. Spine J. 2004;4:564–73.
45. Williams RW. Microlumbar discectomy. A 12-year statistical review. Spine (Phila Pa 1976) 1986;11:851–2.
Published
2017-06-30
How to Cite
HUSAIN, Syed Shahzad et al. OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC LUMBAR DISCECTOMY FOR PROLAPSED PARA SPINAL INTERVERTEBRAL DISC. Pakistan Journal of Physiology, [S.l.], v. 13, n. 2, p. 34-37, june 2017. ISSN 2073-1183. Available at: <http://pjp.pps.org.pk/index.php/PJP/article/view/49>. Date accessed: 20 apr. 2018.

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