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Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse

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Abstract

Purpose

The purpose of this study is to present a new endoscopic procedure, aiming to achieve the success rate equivalent to microsurgical discectomy, while addressing the drawbacks and limitations of other percutaneous techniques.

Methods

A series of 43 patients with uncontained lumbar disc herniation underwent surgery with irrigation endoscopic discectomy (IED). The endoscope and instruments are placed directly over the surface of the lamina through two posterior skin portals 5 mm each without any muscle retraction or dilatation. Pump irrigation is used for the opening of a potential working space. The rest of the procedure is performed endoscopically like the standard microsurgical discectomy.

Results

Outcome according to modified Macnab criteria was excellent in 78 %, good in 17 %, and poor in 5 % of patients. VAS for leg pain dropped from 78 preoperatively to 7, and the Oswestry Low-Back Pain Disability Questionnaire dropped from 76 to 19. The mean time for postoperative ambulation was 4 h, hospital stay was 8 h, and for return to work was 7 days.

Conclusions

Preliminary clinical experience with IED shows it to be as effective as microsurgical discectomy, and in comparison to other percutaneous procedures addressing noncontained herniations, a reduction in the cost, technical difficulty and surgical invasiveness has been demonstrated.

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References

  1. Perez-Cruet MJ, Fessler RG, Perin NI (2002) Review: complications of minimally invasive spinal surgery. Neurosurgery 51(Suppl 5):S26–S36

    PubMed  Google Scholar 

  2. Smith L (1964) Enzyme dissolution of the nucleus pulposus in humans. JAMA 265:137–140

    Article  Google Scholar 

  3. Hijikata S, Yamgishi M, Nakayama T, Oomon K (1975) Percutaneous discectomy: a new treatment method for lumbar disc herniation. J Toden Hosp 5:5–13

    Google Scholar 

  4. Onik G, Helms CA, Ginsberg L (1985) Percutaneous lumbar discectomy using a new aspiration probe. AJR Am J Roentgenol 144:1137–1140

    Article  PubMed  CAS  Google Scholar 

  5. Schreiber A, Suezawa Y (1986) Transdiscoscopic percutaneous nucleotomy in disc herniation. Orthop Rev 15:35–38

    PubMed  CAS  Google Scholar 

  6. Choy DSJ, Case RB, Fielding W (1987) Percutaneous laser nucleolysis of lumbar discs. N Engl J Med 317:771–772

    Article  PubMed  CAS  Google Scholar 

  7. Mathews HH (1996) Transforaminal endoscopic microdiscectomy. Neurosurg Clin N Am 7:59–63

    PubMed  CAS  Google Scholar 

  8. Lew SM, Mehalic TF, Fagone KL (2001) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 94:216–220

    PubMed  CAS  Google Scholar 

  9. Kahanovitz N, Viola K, Goldstein T, Dawson EA (1990) Multicenter analysis of percutaneous discectomy. Spine 15:713–715

    Article  PubMed  CAS  Google Scholar 

  10. Perez-Cruet MJ, Foley KT, Isaacs RE et al (2002) Microendoscopic lumbar discectomy: technical note. Neurosurgery 51(Suppl 2):S129–S136

    PubMed  Google Scholar 

  11. Foley KT, Smith MM (1997) Microendoscopic discectomy. Tech Neurosurg 3:301–307

    Google Scholar 

  12. Brayda-Bruno M, Cinnella P (2000) Posterior endoscopic discectomy (and other procedures). Eur Spine J Suppl 7:S024–S029

    Article  Google Scholar 

  13. Constantin S, Elefterios T, Joyti S (2005) Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Neurosurgery 57(4):357–360

    Google Scholar 

  14. Orlando R, Asdrubal F, Osmar A (2007) Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery 61(3):545–549

    Article  Google Scholar 

  15. Xiaotao W, Suyang Z, Zubin M, Hui C (2006) Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine 31(23):2689–2694

    Article  Google Scholar 

  16. Schick U, Döhnert J, Richter A et al (2002) Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 11(1):20–26

    Article  PubMed  CAS  Google Scholar 

  17. Jen Huang T, Wei Hsu R, Yao Li Y et al (2005) Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 23(2):406–411

    Article  Google Scholar 

  18. Nakagawa H, Kamimura M, Uchiyama S et al (2003) Microendoscopic discectomy (MED) for lumbar disc prolapsed. J Clin Neurosci 10(2):231–235

    Article  PubMed  Google Scholar 

  19. Adrian N (2005) Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery 56(4):755–762

    Article  Google Scholar 

  20. Maroon JC (2002) Current concepts in minimally invasive discectomy. Neurosurgery 51(Suppl 5):S137–S145

    PubMed  Google Scholar 

  21. Daltroy LH, Cats-Baril WL, Katz JN et al (1996) The North American spine society (NASS) lumbar spine outcome instrument: reliability and validity tests. Spine 21:741–749

    Article  PubMed  CAS  Google Scholar 

  22. Fairbank J, Pynsent P (2000) The Oswestry Disability Index. Spine 25:2940–2953

    Article  PubMed  CAS  Google Scholar 

  23. Macnab I (1971) Negative disc exploration. an analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Jt Surg Am 53:891–903

    CAS  Google Scholar 

Download references

Acknowledgments

There was no external funding for this study.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Faculty of Medicine, Cairo University, 21A Abdelaziz Al Seoud, Manial-EL Roda, Cairo, Egypt

    Hesham Magdi Soliman

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  1. Hesham Magdi Soliman
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Correspondence to Hesham Magdi Soliman.

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Soliman, H.M. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J 22, 1037–1044 (2013). https://doi.org/10.1007/s00586-013-2701-0

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  • DOI: https://doi.org/10.1007/s00586-013-2701-0

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