Treatment of 104 cases of lumbar disc herniation by microendoscopic discectomy / 中国微创外科杂志

ABSTRACT

Objective To summarize countermeasures on common problems of microendoscopic discectomy(MED). Methods Microendoscopic discectomy was performed in 104 cases of lumbar disc herniation by using the MED system(Sofamor Danek Group,USA).Frequently encountered problems during the operation were reviewed and summarized. Results Conversions to open surgery were required in 4 out of 104 cases due to bleeding or adherence.Among the rest of 100 cases,dural injury occurred in 3 cases,with 1 case accompanying leakage of cerebrospinal fluid.Of the 100 cases(115 intervertebral spaces),the average operation time was 50 min(range,30~90 min) and the average hemorrhage amount was 80 ml(range,20~400 ml) for each intervertebral space.The 100 cases were followed for 3~32 months(average,18 months).According to the Macnab criteria,the curative effects were classified as excellent in 65 cases,good in 29 cases,and fair in 6,the rate of excellent or good effects being 94.0%(94/100). Conclusions The most frequent problems during MED are bleeding and prolonged excision of the ligamenta flava.Strict adherence to technique,acquaintance with the weakness of the ligamenta flava,and familiarity with anatomic structures of the vertebral vein system and its relationship with abdominal pressure,are very important in the prevention and treatments of surgical complications.