Volume 2 | Issue 1 | April-September 2021 | page: 06-11 | Hitesh N. Modi, Alkesh Rathod, Utsab Shrestha
Authors: Hitesh N. Modi [1], Alkesh Rathod [1], Utsab Shrestha [1]
[1] Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Senior Consultant, Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., SG Highway, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: drmodihitesh@gmail.com
Abstract
Introduction: Lumbar disc herniation (LDH) is one of the most common causes for low back pain and related disabilities. Surgery is indicated in patients who do not respond to the conservative measures for at least 6 weeks or symptoms are worsened. Microendoscopic discectomy (MED) is a well-accepted minimally invasive surgical technique with similar results compared to open surgery. The purpose of this study was to evaluate the clinical outcome, functional improvement and analyze complications during MED.
Methods: A retrospective analysis was conducted in 156 patients who were operated for single or double level LDH using MED between 2016 and 2018. All patients were evaluated for pain and disability using visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Modified MabNab’s criteria used to evaluate overall outcome of surgery. Operation time, estimated blood loss (EBL), hospital stay and time to return back to previous activities were evaluated. Complications and revisions were noted during follow-up to analyze clinical results. Paired t-test was used to evaluate statistical difference in VAS and ODI score during follow-up.
Results: All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and yearly thereafter postoperatively. Average follow-up was 25.5±9.7 months and average age was 45.0±12.7 years. Average VAS scores improved significantly from preoperative 8.7±0.8 to 2.0±1.1 postoperatively (p<0.0001). Average preoperative ODI improved significantly from 53.8±6.1 to 22.6±5.1 postoperatively (p<0.0001). Both score were maintained at the final follow-up. The average time to return to previous activity level was 35.7±14.3 days. Average operation time, EBL and hospital stay were 57.6±14.6 minutes, 36.7±13.1 mL and 2.4±0.7 days, respectively. There were total 19 (12.2%) complications and 12 (7.7%) revisions in the series. Overall clinical outcome was excellent, good, fair and poor in 73.1%, 20.5%, 5.1% and 1.3% of cases using modified MacNab’s criteria.
Conclusion: Study of 156 patients operated for single or double level LDH using MED has shown encouraging clinical results and functional outcome with similar complications reported in literature. However, less intraoperative blood loss, shorter hospital stay and early return to work are some of the advantages which favours its wide spread acceptability.
Keywords: Lumbar disc herniation; Microendoscopic discectomy; clinical outcome; Complications.
References
1. Mixter W.J. and J.S. Barr, Rupture of the Intervertebral Disc with Involvement of the Spinal Canal. New England Journal of Medicine, 1934. 211(5): p. 210-215.
2. Hahne, A.J., J.J. Ford, and J.M. McMeeken, Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976), 2010. 35(11): p. E488-504.
3. Gibson, J.N. and G. Waddell, Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976), 2007. 32(16): p. 1735-47.
4. Olmarker, K., R. Størkson, and O.G. Berge, Pathogenesis of sciatic pain: a study of spontaneous behavior in rats exposed to experimental disc herniation. Spine (Phila Pa 1976), 2002. 27(12): p. 1312-7.
5. Shapiro, S., Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery, 1993. 32(5): p. 743-6; discussion 746-7.
6. Shapiro, S., Medical realities of cauda equina syndrome secondary to lumbar disc herniation. Spine (Phila Pa 1976), 2000. 25(3): p. 348-51; discussion 352.
7. Gibson, J.N., I.C. Grant, and G. Waddell, The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976), 1999. 24(17): p. 1820-32.
8. Kahanovitz, N., K. Viola, and J. Muculloch, Limited surgical discectomy and microdiscectomy. A clinical comparison. Spine (Phila Pa 1976), 1989. 14(1): p. 79-81.
9. Katayama, Y., et al., Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech, 2006. 19(5): p. 344-7.
10. Nakagawa, H., et al., Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci, 2003. 10(2): p. 231-5.
11. Rasouli, M.R., et al., Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev, 2014(9): p. Cd010328.
12. Foley, K.T., Microendoscopic discectomy. Techniques in neurosurgery, 1997. 3: p. 301-307.
13. Hancock, M.J., et al., Diagnostic Accuracy of the Clinical Examination in Identifying the Level of Herniation in Patients with Sciatica. Spine, 2011. 36(11): p. E712-E719.
14. Acaroglu, E.R., et al., Degeneration and aging affect the tensile behavior of human lumbar anulus fibrosus. Spine (Phila Pa 1976), 1995. 20(24): p. 2690-701.
15. Gautschi, O.P., G. Hildebrandt, and D. Cadosch, [Acute low back pain–assessment and management]. Praxis (Bern 1994), 2008. 97(2): p. 58-68.
16. Rothoerl, R.D., C. Woertgen, and A. Brawanski, When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev, 2002. 25(3): p. 162-5.
17. Perez-Cruet, M.J., et al., Microendoscopic lumbar discectomy: technical note. Neurosurgery, 2002. 51(5 Suppl): p. S129-36.
18. Palea, O., M. Granville, and R.E. Jacobson, Selection of Tubular and Endoscopic Transforaminal Disc Procedures Based on Disc Size, Location, and Characteristics. Cureus, 2018. 10(1): p. e2091-e2091.
19. Zhou, Y., et al., Clinical experience and results of lumbar microendoscopic discectomy: a study with a five-year follow-up. Orthopaedic surgery, 2009. 1(3): p. 171-175.
20. Tullberg, T., J. Isacson, and L. Weidenhielm, Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study. Spine (Phila Pa 1976), 1993. 18(1): p. 24-7.
21. Jhala, A. and M. Mistry, Endoscopic lumbar discectomy: Experience of first 100 cases. Indian journal of orthopaedics, 2010. 44(2): p. 184-190.
22. Kulkarni, A.G., A. Bassi, and A. Dhruv, Microendoscopic lumbar discectomy: Technique and results of 188 cases. Indian journal of orthopaedics, 2014. 48(1): p. 81-87.
23. Than, K.D., et al., How to predict return to work after lumbar discectomy: answers from the NeuroPoint-SD registry. J Neurosurg Spine, 2016. 25(2): p. 181-6.
24. Yadav, R.I., L. Long, and C. Yanming, Comparison of the effectiveness and outcome of microendoscopic and open discectomy in patients suffering from lumbar disc herniation. Medicine (Baltimore), 2019. 98(50): p. e16627.
25. Bookwalter, J.W., 3rd, M.D. Busch, and D. Nicely, Ambulatory surgery is safe and effective in radicular disc disease. Spine (Phila Pa 1976), 1994. 19(5): p. 526-30.
26. Caspar, W., et al., The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery, 1991. 28(1): p. 78-86; discussion 86-7.
27. Teli, M., et al., Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J, 2010. 19(3): p. 443-50.
28. Garg, B., U.B. Nagraja, and A. Jayaswal, Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study. J Orthop Surg (Hong Kong), 2011. 19(1): p. 30-4.
29. Overdevest, G.M., et al., Tubular discectomy versus conventional microdiscectomy for the treatment of lumbar disc herniation: long-term results of a randomised controlled trial. J Neurol Neurosurg Psychiatry, 2017. 88(12): p. 1008-1016.
How to Cite this Article: Modi HN, Rathod A, Shrestha U | Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A
Retrospective Review of 156 Patients | Back Bone: The Spine Journal | April-September 2021;
2(1): 06-11. |
.
