Microendoscopic Discectomy (MED) for Lumbar Disc Herniation / 한양의대학술지

Lumbar disc herniation is one of the most common disorders and its current surgical standard is a microsurgical discectomy. The microendoscopic discectomy (MED) was initially developed in 1997 by Foley and Smith and it is a minimally invasive surgical technique. This article discusses the technique, outcome and complications of this procedure. MED is performed by a muscle splitting approach using a series of tubular dilators with consecutively increasing diameters. The original endoscopic procedure is modified with microscope which has led to the development of the Microscopic Endoscopic Tubular Retractor System (METRX, Medtronic Sofamor Danek, Memphis, TN). A tubular retractor is inserted over the final dilator, and then the microscope is placed inside the tubular retractor instead of the endoscope. And then microdiscectomy is performed in the usual fashion via tubular retractor. Clinical outcomes by modified MacNab criteria were revealed excellent to good results in up to 95% of the patients. Average return to work period was within 1 month. Complications included nerve root injury, dural tear, and recurrent disc herniations. MED is at least as effective as microdiscectomy for the treatment of lumbar disc herniations with regard to long-term outcomes. MED can be performed safely and effectively with a smaller incision, resulting in a shortened hospital stay and faster return to work.

Surgical Treatments for Lumbar Disc Disease in Adolescent Patients; Chemonucleolysis / Microsurgical Discectomy/ PLIF with Cages

The herniated lumbar disc (HLD) in adolescent patients is characterized by typical discogenic pain that originates from a soft herniated disc. It is frequently related to back trauma, and sometimes it is also combined with a degenerative process and a bony spur such as posterior Schmorl's node. Chemonucleolysis is an excellent minimally invasive treatment having these criteria: leg pain rather than back pain, severe limitation on the straight leg raising test (SLRT), and soft disc protrusion on computed tomography (CT). Microsurgical discectomy is useful in the cases of extruded or sequestered HLD and lateral recess stenosis due to bony spur because the nerve root is not decompressed with chymopapain. Spinal fusion, like as PLIF, should be considered in the cases of severe disc degeneration, instability, and stenosis due to posterior central bony spur. In our study, 185 adolescent patients, whose follow-up period was more than 1 year (the range was 1 - 4 years), underwent spinal surgery due to HLD from March, 1998 to December, 2002 at our institute. Among these cases, we performed chemonucleolysis in 65 cases, microsurgical discectomy in 94 cases, and posterior lumbar interbody fusion (PLIF) with cages in 33 cases including 7 reoperation cases. The clinical success rate was 91% for chemonucleolysis, 95% for microsurgical disectomy, and 89% for PLIF with cages, and there were no non- union cases for the PLIF patients with cages. In adolescent HLD, chemonucleolysis was the 1st choice of treatment because the soft adolescent HLD was effectively treated with chemonucleolysis, especially when the patient satisfied the chemonucleolysis indications.

Percutaneous Endoscopic Discectomy Compared to Microsurgical Discectomy: Preliminary Results

To help clarify the comparative effects of percutaneous endoscopic discectomy and microsurgical discectomy in the treatment of lumbar disc herniation, the authors studied 37 consecutive patients with discogenic symptoms who had not responded to conservative treatment. Their indications are restricted to discogenic root compression with"contained"or small"noncontained"lumbar disc. Patients with sequestrated disc, spinal stenosis, or spondylolisthesis were excluded. All patients underwent magnetic resonance imaging and if the radiological interpretation was confused with extruded migrated disc, a discogram was also obtained. Of the 37 patients, 18 underwent percutaneous endoscopic discectomy and 19, microsurgical discectomy. In order to compare the efficacy of the two methods, both groups were investigated. Disc herniations were located at L4-5(24 patients), L5-S1(11 patients), or L4-5 and L5-S1(2 patients). With regard to age and sex distribution, preoperative complaints, and clinical symptoms, there were no differences between the two groups. At the last follow-up evaluation after percutaneous endoscopic discectomy, low back pain had disappeared in three patients(17.6%), sciatica in nine(50.0%), sensory deficits in two(16.7%), motor deficits in three(42.5%), and reflex differences in one (50%). After microsurgical discectomy, low back pain had disappeared in one patient(5.6%), sciatica in nine(47.4%), sensory deficits in five(33.3%), motor deficits in six(66.7%), and reflex differences in three(75.0%). In 83.3% of patients in the percutaneous endoscopic discectomy group, the outcome was successful(excellent or good result), compared with 78.9% of those who had undergone microsurgical discectomy. One patient in the percutaneous endoscopic discectomy group suffered from discitis. For patients with"contained"or slight subligamentous lumbar disc herniations, percutaneous endoscopic discectomy offers a surgical alternative.

Microsurgical Discectomy for Treatment of Protrusion of Intervertebral Disc / 重庆医科大学学报

Objective:To study the operative technique and effect of microsurgical discectomy in removing nucleus pulposus in protruding intervertebral discs.Mothods:A 3-centimeter median incision was made and the vertebral gap and part of the upper and lower vertebral plates were unfolded.Then the ligamentum flavum and a little vertebral plate were excised and the nerve root canal was enlarged and the nucleus pulposus in protruding intervertebral discs was removed.Results:The microsurgical discectomy for removal of nucleus pulposus in protruding intervertebral discs was performed on 42 patients,which showed a recovery rate of 95%,without any complications.Conclusions:The microsurgical discectomy for removal of nucleus pulposus in protruding intervertebral discs have the following advantages: smaller incision and hurt,less hemorrhage,convenience for operation,less physiological influence on spinal column,lower cost,and earlier recovery of the patients in motion and work.