RESUMO
BACKGROUND: Minimally invasive spine surgery is gaining popularity. Results of currently used percutaneous posterior techniques fall short of standard open microdiscectomy. Using a posterior percutaneous technology with an anterior laparoscopic approach may improve results and still maintain the advantages of a minimally invasive procedure. METHODS: Patients with symptomatic lumbar protruded discs confirmed by computed tomography or magnetic resonance imaging were offered the procedure. Transperitoneal visualization of the retroperitoneum was supplemented with fluoroscopic guidance. A small window made to the disc allowed the percutaneous nucleotome to be inserted through the anterior annulus. The automated nucleotome aspirated the nucleus, leaving the ligaments intact. RESULTS: All patients underwent successful dissection and placement of the nucleotome. Of the 23 patients, 21 left the hospital in less than 24 hours. The initial neurologic outcome is that 20 out of 23 patients had improved symptoms or were asymptomatic. Complications were minimal. CONCLUSION: Laparoscopic lumbar discectomy is safe, and for carefully selected patients, can be an alternative to posterior microdiscectomy.
Assuntos
Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Laparoscopia/métodos , Vértebras Lombares , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Primary closure of the contaminated wound using a closed suction catheter and antibiotic or povidone-iodine irrigation is cost-effective and convenient alternative to standard open wound care with delayed primary closure. Antibiotic irrigation appeared more effective than povidone-iodine in this study, but the total number of patients studied was too small to be statistically significant.