EXPERIENCE OF ENDOSCOPIC LUMBAR DISCECTOMY

Abstract

Background: Lumbar intervertebral disc prolapse has been treated using a variety of techniques, including normal, micro, percutaneous, and transforminal endoscopic discectomy. By using a posterior interlinear endoscopic technique, the access to the spine is maintained to a minimum without stripping the paraspinal muscles and limiting muscular injury. 

Objective this study's objective was to assess the technical issues, side effects, and overall preliminary outcomes of micro endoscopic discectomy.

Materials and Methods: This study was retrospective, carried out at the department of neurosurgery Qazi Hussain Ahmad Medical Complex, MTI Kpk Pakistan for a duration of two years from January 2021 to January 2022. Overall 100 consecutive cases of microendoscopic dissectomy performed on patients between the ages of 19 and 65 are documented. The criteria for inclusion were every individual with single nerve root injuries, as well as migratory discs at L4-L5 and L5-S1. Bilateral radiculopathy patients were excluded. To assess the effectiveness of the decompression, all individuals had preoperative MRI, and the first 11 patients experienced postoperative MRI. When an MRI was equivocal (n=7), diagnostic chosen nerve root slabs were performed in some instances to localize the particular root cut. Using the Medtronics Metrx system, a single surgeon performed all of the surgeries on the patients. Only three patients had operations using 16-mm ports, whereas 97 received operations using 18-mm ports. Following surgery, all persons were organized as soon as the pain reduced and were released 24 to 48 hours later. According to modified Macnab criteria, patients were assessed for technical issues, problems, and inclusive outcomes. Patients were monitored after two, six, and twelve weeks.

Results: The average continuation time was 12 months (with a range of 3 months - 4 years). One individual with suspected root wound needed open transformation. In five initial instances, single facet excision was performed intraoperatively. In seven instances, there were minor dural punctures, and one case had root injury. The average surgery was 70 minutes; the range was 25 to 210 minutes. 20 to 30 ml of blood were lost on average. In the first 25 instances, technical challenges included guide pin insertion, picture orientation, peroperative dissection, bleeding issues, and attaining incorrect levels, all of which are indicative of a clear learning curve. An MRI performed after surgery (n=11) revealed total decompression. Overall, 91% of patients had satisfactory to outstanding outcomes, and three of the four patients who had recurrence underwent further surgery. Postoperative discitis affected four individuals. One of the patients had discitis and needed to be fused, while the others were treated conservatively. Even after four years of continuation, one patient with root injury to the L5 root still had numbness in the L5 area.

Conclusion: Micro endoscopic discectomy is a less invasive discectomy technique with promising preliminary outcomes. The outcomes of this treatment are acceptable, safe, and successful after a certain learning curve has been overcome and skill has been attained.