2018, Vol. 2 Issue 2, Part A
Discectomy is a common procedure carried out for treatment of lumbar disc prolapse. In lumbar disc surgery pain is the most important indication, but neurologic symptoms and signs are also considered, although they are usually of far less functional consequence. Perhaps because they appear to be more objective than the pain related signs. We have evaluated the results of Micro-Endoscopic discectomy (MED) utilizing tubular retractors in terms of safety and efficacy of the technique. Micro-Endoscopic discectomy (MED) is term used interchangeably for describing the discectomy procedure utilizing tubular retractors either with an endoscope or a microscope and it directly deals with offending prolapsed or extruded disc fragment and decompresses the nerve root. In addition lateral and foraminal stenosis can also be tackled.
Methods and Materials: This study is a prospectively conducted study of 25 patients operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN) using 22mm port for lumbar disc herniation during the period between June 2015 and December 2016. Proforma was made in form of questionnaire and filled preoperatively or when they came for follow up while for others it was completed via telephonic conversation. The results were evaluated using ODI (Oswestry Disability Index) and VAS (Visual Analogue Scale 0-10) for back pain and leg pain.
Results: This study consists of 25 cases of lumbar disc prolapse treated by Micro-Endoscopic discectomy between the months of June 2015- December 2016. Average follow-up was 22.12±4.255 months (Range 13-29 months). 7 patients (28%) out of 25 patients turned out to be laborers. This bodes well with the incidence of lumbar disc prolapse in heavy weight lifters. Other occupations include housewife (16%), driver (12%), carpenter (8%), mason (4%) etc.
Discussion: MED introduced by Foley et al. . combines standard lumbar microsurgical techniques with an endoscope, enabling surgeons to successfully address free-fragment disc pathologic factors and lateral recess stenosis. The endoscopic approach allows even smaller incision and less tissue trauma.
Conclusion: By limiting the tissue manipulation via small incisions and minimal muscle dissection, this technique has purported to have better perioperative outcomes, including shorter hospital stays, less blood loss, less pain medicine requirement, decreased surgical site infection (SSI) rate, and quicker return to activities, than conventional open approaches.