COMPARISON OF ENDOSCOPIC AND MICROSURGICAL METHODS IN THE TREATMENT OF LUMBAR DISC HERNIATIONS

Sergey Arestov,Alexey Kashcheev,Artem Gushcha

doi:10.1590/s1808-185120171603182333

Sergey Arestov, Alexey Kashcheev + Show 1 more

Open Access

https://doi.org/10.1590/s1808-185120171603182333

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Abstract

ABSTRACT Objective: The development of minimally invasive spine surgery leads us to reflect on the efficiency of new methods compared with older ones. In the case of endoscopic spine surgery, we always seek to compare our results using new techniques with the results of older and trusted microsurgical techniques. Unfortunately, there are few reliable studies measuring endoscopic and microsurgical approaches. We therefore decided to compare our treatment results with those of what are, in our opinion, the best and most thorough studies found. Furthermore, we found no illustrated experience in the usability of endoscopic methods. We therefore analyzed each step of the technique used, according to the practical experience with microsurgical discectomy. Methods: We compared our two-year experience of treatment of 183 patients with lumbar disc herniations using the endoscopic technique, with data reported in the literature on microsurgical minimally invasive methods. Results: Our group achieved good to excellent results in 92.9% of cases (170 patients) compared to 90% reported in the literature. We compared the capabilities of endoscopic discectomy with microsurgical methods, and concluded that the endoscopic method is sufficient to perform any movement inside the surgical field that is microscopically possible. It is also possible to perform any type of spinal cord decompression, with better visualization provided by the endoscope. Conclusions: We conclude that endoscopic microdiscectomy is a good and reliable alternative, with better outcomes and more efficient usage of the approach space.

Highlights

According to current data from the WHO, 80-83% of adults worldwide have lumbar disc herniations
Implementing a smaller incision in most cases doesn't reflect soft and bony structures' damage. This latter fact is of primary importance when it comes to maintaining the structural mechanical stability of the spine after surgery
At the same time, the lamina is visualized on the approach plane, it is advisable to displace the center of the incision somewhat caudally, to better visualize the yellow ligament and to be able to work more comfortably in the intralaminar space

Summary

Introduction

According to current data from the WHO, 80-83% of adults worldwide have lumbar disc herniations. Given that most of these are working, middle aged-people, and that this disease prevents them from working, finding the most effective method of treatment is very important to mitigate this social problem. There is no objective data as to which surgical method should be used, and why. Most neurosurgeons worldwide currently use the more common approaches, despite their high level of invasiveness. According to the North American Spine Society (NASS), an operation is considered minimally invasive if it involves a smaller skin incision. Implementing a smaller incision in most cases doesn't reflect soft and bony structures' damage. This latter fact is of primary importance when it comes to maintaining the structural mechanical stability of the spine after surgery

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Discussion

Conclusion