Modified Microsurgical and Standard Lumbar Discectomy ; Comparative Study

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.

Microsurgical Operation of Herniated Lumbar Disc

The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduces the overall surgical trauma suffered by the patient. A very small exposure of only about 2-3cm skin incision is necessary. No laminectomy is done. Flavotomy and an approach through interlaminar space is usually sufficient to remove the herniated disc by the microsurgical technique. Diagnosis is primarily made by spinal computed tomography(CT) scan. Between April and September 1982, 23 microlumbar discectomies were performed. Excellent recovery was 87% and good 13%. We have described our microsurgical technique and discussed its advantages.