Assessment and Selection of the Appropriate Individualized Technique for Endoscopic Lumbar Disc Surgery
Study Design. Prospective study.
Objective. The purpose of this study was to assess the clinical outcome of three endoscopic lumbar disc techniques: selective endoscopic discectomy (SED), intracanal transforaminal endoscopy (ITE), and an interlaminar endoscopy (ILE).
Summary of Background Data. A number of percutaneous endoscopic procedures for lumbar disc herniation have recently been developed. Although the clinical results are good, considerations regarding proper selection of the appropriate technique still remain.
Methods. Excision of lumbar disc herniations was performed on 400 consecutive patients using SED, ITE, or ILE. The selection of the most convenient endoscopic approach to target the herniation was based on location of herniation, degree of migration, and bony access conditions. Pain was scored using a visual analog scale (VAS) and disability using the Oswestry Disability Index (ODI). Patient outcomes were graded as excellent, good, fair, and poor.
Results. There were 245 men and 155 women, with a mean (SD) age of 46 (13.9) years. SED technique was performed in 344 patients, ITE in 35, and ILE in 21. Patients were followed for a mean (SD) of 5.4 (2.5) years (range 0.5–10 years). The overall follow-up rate was 97.5 %. Results were graded as excellent in 264 (66 %) patients, good in 99 (24.75 %), fair in 27 (6.75 %), and poor in 10 (2.5 %). At follow-up, there were no significant differences in the mean VAS scores, ODI scores, and percentages of patients in the categories of excellent/good results according to the surgical procedure. VAS and ODI scores were significantly lower in patients in the excellent/good group than in those in the fair/poor group (P < 0.05).
Conclusion. Choosing the most suitable endoscopic technique for every single case together with accurate preoperative access planning allows reaching a 90.75 % rate of excellent and good results in endoscopic surgery regardless of the herniation type or the adverse anatomic conditions.
KeywordsVisual Analog Scale Visual Analog Scale Score Nucleus Pulposus Oswestry Disability Index Lumbar Disc
The authors thank Marta Pulido, MD, for editing the manuscript.
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