scholarly journals Microendoscopic discectomy for recurrent disc herniations

2003 ◽  
Vol 15 (3) ◽  
pp. 1-4 ◽  
Author(s):  
Robert E. Isaacs ◽  
Vinod Podichetty ◽  
Richard G. Fessler
Keyword(s):  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Cerebrospinal Fluid Leak ◽  
Open Approach ◽  
Recurrent Disc Herniation ◽  
Previous Operation ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Microendoscopic Discectomy

Object The use of microendoscopic discectomy (MED) for the treatment of primary lumbar disc herniations has become fairly well accepted; its role in recurrent disc herniations is less clear. The reluctance of many surgeons to use this technique stems, in part, from the concern of undertaking an endoscopic discectomy in a patient in whom the anatomy is distorted from a previous operation. It appears counterintuitive to operate through a limited working area when the traditional open approach for recurrence favors wider exposure of the surgical field. Given that operating on previously exposed tissue can be associated with even greater morbidity than on virginal tissue, the authors describe their experience with performing MED for recurrent disc herniation. Methods Unilateral MED was performed in patients with classic symptoms of lumbar radiculopathy, a previous operation at that level, and findings of recurrent disc herniation on magnetic resonance imaging. The approach was similar to a standard MED. Aided by fluoroscopic guidance, a working cannula was docked on the laminofacet junction at the level of the nerve root, with care taken to ensure a slightly more lateral initial trajectory. A good decompression of the nerve root could then be achieved through the use of the endoscope with preservation of the paraspinous musculature and much of the remaining facet capsule. Ten consecutive patients undergoing the procedure were analyzed prospectively and compared with the previous 25 who underwent routine single-level MED. Use of the MED technique provided excellent visualization and decompression of the nerve root; no conversions to open procedures were necessary in either group. The average operative time in the experimental group was 98.5 minutes, with a mean blood loss of 33 ml and an approximate hospital stay of 7.3 hours. In this respect, there was no statistical difference between the two groups (analysis of variance, p = 0.39, 0.68, and 0.51, respectively). There was one cerebrospinal fluid leak in each group. Conclusions Microendoscopic discectomy for recurrent disc herniation can be safely performed without an increase in surgery related morbidity.

scholarly journals Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 710
Author(s):  
Muneyoshi Fujita ◽  
Tomoaki Kitagawa ◽  
Masahiro Hirahata ◽  
Takahiro Inui ◽  
Hirotaka Kawano ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Disc Height ◽  
Leg Pain ◽  
Height Loss ◽  
Common Disease ◽  
Low Back ◽  
Endoscopic Discectomy ◽  
Microendoscopic Discectomy

Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.

scholarly journals Endoscopic transforaminal lumbar discectomy in the treatment of multilevel disc herniations

2019 ◽  
Author(s):  
Denglu Yan ◽  
Zaiheng Zhang ◽  
Zhi Zhang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Cerebrospinal Fluid Leakage ◽  
Multiple Level ◽  
Endoscopic Procedures ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Disc Herniations

Abstract Background There were no studies in literature of multiple level lumbar disc herniation treatment by endoscopic procedures. The purpose of this study was to evaluate the efficacy of endoscopic treatment multiple level lumbar disc herniation by compare to the one level disc herniation. Methods A total of 267 patients of lumbar disc herniation who had endoscopic surgery were categorized into three different groups depending on the level number of endoscopic procedures. 78 cases had one level procedure (OL group), 54 cases had couple level procedures (CL group), and 35 cases had triple level procedures (TL group). Endoscopic discectomy procedures was performed and the clinical outcomes were recorded. Results There was no intraoperative death in this series. The hospital day were no significant difference among three groups. The operational time and blood loss were biggest in triple levels procedures and lest in one level procedure. When take into the influence the numbers of disc herniation, there were no significant difference per level among three groups. The pain index and ODI score were better than preoperational in all patients, and there were no significant difference among three groups. The disk and foramen height, and lumbar lordosis were no significant difference compare to preoperative in all patients, and there were no significant difference among three groups. All patients achieved pain free accomplished all surgery procedures, no infection, and no dural tear of cerebrospinal fluid leakage complication. Conclusions Endoscopic lumbar discectomy was effective and safe procedures in the treatment of multilevel lumbar disc herniation.

The Lumbar Shield

Neurosurgery ◽  
1978 ◽  
Vol 3 (1) ◽  
pp. 26-36 ◽  
Author(s):  
James Rodney Feild ◽  
Hugh McHenry
Keyword(s):  
Intervertebral Disc ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Operative Procedure ◽  
Gelatin Sponge ◽  
Lumbar Intervertebral Disc ◽  
Recurrent Disc Herniation ◽  
Lumbar Nerve Root ◽  
Cause Of Failure

Abstract Postoperative perineural adhesions between the lumbar nerve root and the partially removed intervertebral disc are thought to be a cause of failure of the standard operative procedure for the removal of a ruptured lumbar intervertebral disc. Attempts have been made to reduce postoperative perineural adhesions by the use of epidural muscle, fat, gelatin sponge, silicone, and steroids. The present communication introduces a new implantable silicone device, a lumbar shield. designed to: (a) provide a radiopaque marker on the dorsal perimeter of the excavated lumbar disc so that the presence or absence of a recurrent disc herniation can easily be determined on plain postoperative x-ray films, (b) provide ready access to the operative site in the event of a recurrent disc herniation. (c) prevent postoperative perineural adhesions between the lumbar dura and the nerve root and the partially removed intervertebral disc, and (d) prevent postoperative adhesions between the lumbar dura and the nerve root and the paraspinal muscles. Satisfactory results of lumbar disc surgery over the past 44 years have occurred in about 90% of routine patients. The value of the lumbar shield in 82 patients (59 routine and 23 workmen's compensation/medicolegal patients) followed for 6 months is described. A satisfactory result, i.e., relief of pain or the presence of occasional postoperative pain, occurred in 85% of routine patients at 1 month, 97% at 3 months. and 95% at 6 months.

Transdural approach for calcified central disc herniations of the upper lumbar spine

2007 ◽  
Vol 7 (3) ◽  
pp. 370-374 ◽  
Author(s):  
Jeong-Wook Choi ◽  
Jung-Kil Lee ◽  
Kyung-Sub Moon ◽  
Hyuk Hur ◽  
Yeon-Seong Kim ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Cerebrospinal Fluid Leakage ◽  
Nerve Root Injury ◽  
Central Disc ◽  
Disc Herniations ◽  
Transdural Approach

✓Disc herniations of the upper lumbar spine (L1–2 and L2–3) have a frequency of 1 to 2% of all disc herniations. During posterior discectomy after laminectomy, significant manipulation of the exiting nerve root is unavoidable because of the narrow lamina and the difficulty in mobilizing the nerve root. The authors adopted a transdural approach in patients with calcified central disc herniation at the L1–2 level to reduce the risk of nerve root injury. Four patients suffering from radiating pain together with back pain were treated using the transdural approach. Pre-operative neuroimaging studies revealed severe central disc herniation with calcification at the L1–2 level. After laminectomy or laminotomy, the incised dura mater was tacked, and the cauda equina rootlets were gently retracted. An intentional durotomy was performed over its maximal bulging of the ventral dura. After meticulous dissection of dense adhesions between the disc herniation and the dural sac, adequate decompression with removal of calcified disc fragments and osteophytes was accomplished. Clinical symptoms improved in all patients. Postoperative permanent cerebrospinal fluid leakage and pseudomeningocele were not observed, and no patient had a progressive lumbar deformity at an average follow-up of 53 months. Transient mild motor weakness and sensory change were observed in two patients postoperatively; however, these symptoms resolved completely within 1 week. The posterior transdural approach offers an alternative in central calcified upper lumbar disc herniation when root retraction is dangerous.

scholarly journals A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
A. F. Ozer ◽  
F. Keskin ◽  
T. Oktenoglu ◽  
T. Suzer ◽  
Y. Ataker ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Dynamic Stabilization ◽  
Great Effort ◽  
Type I ◽  
Invasive Approach ◽  
Segmental Instability ◽  
Recurrent Disc Herniation ◽  
Disc Herniations

Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations.

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