Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

Authors

  • Prakash U. Chavan Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra
  • Mahendra Gudhe Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra
  • Ashok Munde Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra
  • Balaji Jadhav Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20174703

Keywords:

Transforaminal percutaneous Endoscopic lumbar discectomy, Microdiscectomy

Abstract

Background: The objective of the study was to compare surgical outcome of micro-discectomy with transforaminal percutaneous endoscopic lumbar discectomy for single level lumbar disc herniation in Indian rural population.

Methods: Retrospective comparative study was designed during the period of October 2012 to June 2015, patients in the age group of 22-75 years with unremitting sciatica with/without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression as revealed on MRI, with single level lumbar disc herniation who underwent either microdiscectomy or TPELD were included in the study. Patients were assessed on visual analogue scale (VAS) for back and leg pain, modified macnabs criteria, the Oswestry Disability Index (ODI).

Results: Group I (MD) included 44 patients and Group II (TPELD) included 20 patients. Significant improvement was seen in claudication symptom post-operatively in both MD and TPELD. Mean operating time was significantly shorter in MD group (1.11 hrs vs. 1.32 hrs; p<0.01). According to modified MacNab's criteria, outcome were excellent (81.8%), good (9.09%) and fair (9.09%) in MD. Similarly, in TPELD, 80%, 15% and 5% patients had excellent, good and fair outcome respectively. In both groups, no one had a poor outcome. Thus, overall success rate was 100% in the study.

Conclusions: TPELD and MD have comparable post-operative outcome in most of the efficacy parameters in Indian rural patients undergoing treatment of single level lumbar disc herniation. Additionally, TPELD offers distinct advantages such as performed under local anaesthesia, preservation of structure, lesser post-operative pain and early mobilization and discharge from hospital.

Author Biographies

Prakash U. Chavan, Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra

Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtara

Mahendra Gudhe, Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra

Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtara

Ashok Munde, Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra

Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtara

Balaji Jadhav, Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtra

Shriniwas Orthopaedic Nursing Home, Nanded, Maharashtara

References

Apostolides PJ, Jacobowitz R, Sonntag VK. Lumbar discectomy microdiscectomy: “the gold standard”. Clin Neurosurg. 1996;43:228-38.

Kelly A, Griffith H, Jamjoom A. Results of day-case surgery for lumbar disc prolapse. Br J Neurosurg. 1994;8(1):47-9.

Lorish TR, Tanabe CT, Waller FT, London MR, Lansky DJ. Correlation between health outcome and length of hospital stay in lumbar microdiscectomy. Spine. 1998;23(20):2195-200.

Silvers HR. Microsurgical versus standard lumbar discectomy. Neurosurgery. 1988;22(5):837-41.

McCulloch JA. Focus issue on lumbar disc herniation:macro and microdiscectomy. Spine. 1996;21(24 Suppl):45S-56S.

Kambin P, Brager M. Percutaneous Posterolateral Discectomy.Anatomy and Mechanism. Clin Orthop. 1987;223:145-54.

Kambin P, Gellman H. Percutaneous Lateral Discectomy of the Lumbar Spine:A Preliminary Report. Clin Orthop. 1983;174:127-32.

Kambin P, Sampson S. Posterolateral Percutaneous Suction-Excision of herniated lumbar intervertebral discs. Report of Interim results. Clin Orthop. 1986;207:37-43.

Kambin P, Schaffer J. Percutaneous Lumbar discectomy. Review of 100 patients and current practice. Clin Orthop. 1989;238:24-34.

Dahl B, Gehrchen PM, Kiaer T, Blyme P, Tondevold E, Bendix T. Nonorganic pain drawings are associated with low psychological scores on the preoperative SF 36 questionnaire in patients with chronic low back pain. Eur Spine J. 2001;10:211-4.

Epstein NE, Hood DC, Bender JF. A comparison of surgeons assessment to patient's self analysis (short form 36) after far lateral lumbar disc surgery. An outcome study. Spine. 1997;22:2422-8.

Mayer HM, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg. 1993;78(2):216– 25.

Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25(22):2940-52.

Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg. 1971;53(5):891–903.

Hoogland T, van den Brekel-Dijkstra K, Schubert M, Miklitz B. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine. 2008;33:973-8.

Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine. 2004;29:E326-32.

Lau D, Han SJ, Lee JG, Lu DC, Chou D. Minimally invasive compared to open microdiscectomy for lumbar disc herniation. J Clin Neurosci. 2011;18(1):81-4.

Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH. Comparison of percutaneous endoscopic lumbar discectomy and open lumbar micro discectomy for recurrent disc herniation. J Korean Neurosurg. 2009;46(6):515–21.

Ozgen S, Naderi S, Ozek MM, Pamir MN. Findings and outcome of revision lumbar disc surgery. J Spinal Disord. 1999;12:287-92.

Manchikanti L, Pampati V, Baha AG, Fellows B, Damron KS, Barnhill RC. Contribution of facet joints to chronic low back pain in postlumbar laminectomy syndrome: a controlled comparative prevalence evaluation. Pain Physician. 2001;4:175-80.

Ryang YM, Oertel MF, Mayfrank L, Gilsbach JM, Rohde V. Standard open microdiscectomy versus minimal access trocar microdiscectomy:results of a prospective randomized study. Neurosurgery. 2008;61:174–82.

German JW, Adamo MA, Hoppenot RG, Hoppenot RG, Blossom JH, Nagle HA. Perioperative results following lumbar discectomy:comparison of minimally invasive discectomy and standard microdiscectomy. Neurosurg Focus. 2008;25:E20.

Palmer S. Use of a tubular retractor system in microscopic lumbar discectomy:1 year prospective results in 135 patients. Neurosurg Focus. 2002;13:E5.

Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM, et al. Microendoscopic Lumbar Discectomy: Technical Note. Neurosurgery. 2002;51:S129-36.

McLoughlin GS, Fourney DR. The learning curve of minimally-invasive lumbar microdiscectomy. Can J Neurol Sci. 2008;35:75–8.

Nowitzke A. Assessment of the learning curve for Lumbar Microendoscopic Discectomy. Neurosurgery. 2005;56:755-62.

Downloads

Published

2017-10-25

Issue

Section

Original Research Articles