J Korean Soc Spine Surg.  2009 Sep;16(3):186-193. 10.4184/jkss.2009.16.3.186.

Comparative Evaluation of Percutaneous Endoscopic Discectomy and Microdiscectomy Using Tubular Retractor System at L4-5 Level

Affiliations
  • 1Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea. ksong70@cau.ac.kr
  • 2Department of Orthopedic Surgery, Jincheon Sungmo Hospital, Chungcheongbuk-do, Korea.

Abstract

STUDY DESIGN: A prospective, non-randomized study
OBJECTIVES
To evaluate the early clinical results of percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy (MD) using a tubular retractor. SUMMARY OF THE LITERATURE REVIEW: There are few reports comparing the clinical results of different minimal invasive surgical procedures for disc herniation.
MATERIALS AND METHODS
Out of 41 patients who underwent a discectomy at the L4-5 level, 16 patients (Group I) underwent PELD and 25 patients (Group II) underwent MD. The surgical techniques were based on the patient's selection. The characteristics of the operation(operation time, time for C-arm, amount of removed disc) were compared with the clinical outcomes by evaluating the SLR (straight leg raising test), leg VAS (visual analogue scale), ODI (Oswestry Disability Index), hospital day, changes in disc height.
RESULTS
Group I showed a larger amount of disc removed and exposure time for the C-arm than group II (p<0.05). However, the hospital day was shorter in group I than in group II (p<0.05). There were no differences in the leg VAS, ODI, the change in disc height and surgery time between the two groups at the last follow up. One case in group I had a neuropraxia of the L5 root that had recovered fully at postoperative 3months. In group II, there was one case of a postoperative hematoma and 2 cases of a dural tear.
CONCLUSION
Although the early clinical outcomes were similar in both groups, group I showed a larger amount of disc removed and more exposure time to radiation but a shorter hospital stay.

Keyword

Lumbar disc herniation; Percutaneous endoscopic lumbar discectomy; Microdiscectomy; Minimally invasive surgery

MeSH Terms

Diskectomy
Follow-Up Studies
Hematoma
Humans
Leg
Length of Stay
Prospective Studies
Tears

Figure

  • Fig. 1. Measurement of the amount of removed disc using 5cc syringe. Disc materials extruded through working portal of arthroscopy was added to measure the amount of removed disc in PELD group. arrow: disc material flowed out through the working portal under surgery.

  • Fig. 2. Radiographic measurement of the disc height ratio (introduced by Mochida et al.)

  • Fig. 3. Computed tomographic scan at L4-5 level in prone position preoperatively. white lines: the preoperative trajectories for deciding entry points and angle of guide wire, arrow: the extruded disc, black square: the portion which will be removed disc in disc space to reach the true pathology (black arrow).


Cited by  2 articles

Clinical Results about More than 5 Years Followup after Open Discectomy
Jae-Wan Soh, Jae Chul Lee, Hyung-Mo Goo, Hae-Dong Jang, Byung-Joon Shin
J Korean Soc Spine Surg. 2011;18(3):140-145.    doi: 10.4184/jkss.2011.18.3.140.

Fistula Formation Between the Disc and Dura after Percutaneous Endoscopic Lumbar Discectomy - A Case Report -
Hak Sun Kim, Hyoung Bok Kim, Hoon-Jae Chung, Jea Ho Yang
J Korean Soc Spine Surg. 2018;25(4):180-184.    doi: 10.4184/jkss.2018.25.4.180.


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