Microendoscopic Discectomy for Lumbar Disc Herniations: A Series of 389 Cases/Lomber Disk Herniasyonlarinda Mikroendoskopik Diskektomi Yontemi: 389 Olgu Serisi

• Published in: Medical journal of Bakirköy Vol. 19; no. 3; p. 263
• Main Authors: Bozyigit, Bulent, Abbasoglu, Bilal, Unluer, Caner, Ulku, Goktug, Tacyildiz, Abdullah Emre, Kertmen, Huseyin Hayri
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.09.2023
• Subjects: Care and treatment; Discectomy; Endoscopy; Hernia; Intervertebral disk; Intervertebral disk displacement; Microsurgery; Patient outcomes; Statistics; Turkey
• ISSN: 1305-9319
• DOI: 10.4274/BMJ.galenos.2023.2023.3-4

Objective: Lumbar disc herniation is one of the discogenic causes of lower back pain. Patients with severe nerve root compression or progressive neurologic deficit who do not respond to conventional treatments require surgical intervention. These surgical treatments include minimally invasive and traditional methods. In this study, we have presented the clinical data of patients who underwent microendoscopic discectomy (MED)-a minimally invasive method. Methods: The surgical and clinical data of 389 adult patients who were operated through MED by a single surgeon between 2017 and 2022 were retrospectively evaluated. Parameters such as perop-postop visual analog scale (VAS), follow-up time, duration of hospitalization, and amount of intraoperative blood loss were examined. Results: Of the 389 patients included in our study, 169 were female and 220 were male, and their mean age was 42.78 years. L4-L5 (n=205, 51.6%), L5-S1 (n=185, 46.8%), L3-L4 (n=4, 1%), and L2-L3 (n=2, 0%) were the most frequently operated levels, showing a sequentially decreasing frequency. Bilateral surgery was performed in two patients. Recurrence was observed in 11 patients (2.8%). Cerebrospinal fluid was detected in 2 (0.5%) patients. The mean pre- and post-op VAS scores were calculated as 7.45 and 1.14, with a significant difference of p<0.001. The mean blood loss during surgery was calculated as 9.6[+ or -]5.8 mL, and the postoperative hospital stay was 17.2[+ or -]8.5 hours. Conclusion: MED was comparable to conventional methods in terms of symptom relief, recurrence rate, recovery time after surgery, and intraoperative blood loss. Keywords: Lumbar disc herniation, microendoscopic discectomy, minimally invasive spinal surgery Amac: Lomber disk herniasyonu bel agrisinin diskojenik sebeplerinden biridir. Konvansiyonel tedavilere yanit alinmayan, ciddi sinir koku basisi bulgulari veya ilerleyici norolojik defisiti bulunan hastalara cerrahi mudahale gerekmektedir. Cerrahi tedavide, geleneksel yontemlerin yaninda minimal invaziv yontemler de mevcuttur. Bu calismada, minimal invaziv yontem olan mikroendoskopik diskektomi (MED) ile ameliyat edilmis hastalarin klinik verilerinin sunulmasi amaclanmistir. Gerec ve Yontem: 2017 ve 2022 yillari arasinda tek cerrah tarafindan, MED yontemi ile ameliyat edilmis 389 eriskin hastanin cerrahi ve klinik verileri retrospektif olarak degerlendirildi. Perop-postop vizuel analog skala (VAS), takip suresi, hastanede yatis suresi ve introperatif kan kaybi miktari gibi parametreler detayli bir sekilde incelendi. Bulgular: Calismamiza dahil edilen 389 hastanin 1 69'u kadin 220'si erkek hastaydi ve hastalarin yas ortalamasi 42,78 idi. L4-L5 (n=205, %51,6), L5-S1 (n=185, %46,8), L3-L4 (n=4, %1) ve L2-L3 (n=2, %0,5), azalan siklikla, en sik ameliyat edilen seviyelerdi, iki hastada cift tarafli ameliyat yapildi. On bir hastada nuks izlendi (%2,8). iki (%0,5) hastada BOS (beyin omurilik sivisi) gelisi oldu. Ortalama pre- op ve post-op VAS skoru 7,45 ve 1,14 olarak hesaplandi ve aradaki fark anlamli bulundu (p<0,001). Cerrahi sirasinda kan kaybi ortalama 9,6[+ or -]5,8 mL olarak hesaplandi. Ameliyat sonrasi hastanede kalma suresi 17,2[+ or -]8,5 saatti. Sonuc: MED semptomlarin giderilmesi, nuks orani, cerrahi sonrasi iyilesme suresi, cerrahi sirasindaki kan kaybi acisindan konvansiyonel yontemlerle karsilastirilabilecek derecede basarili bulunmustur. Anahtar Kelimeler: Lomber disk herniasyonu, mikroendoskopik diskektomi, minimal invaziv spinal cerrahi