Abstract
ABSTRACT Objective: In Brazil, there are no studies comparing endoscopic treatment of lumbar disc herniation with the conventional open technique in SUS (Unified Health System) with regard to hospitalization time and complications occurring within one year, which is the objective of this study. Methods: A survey of 32 surgeries performed in 2019 (11 open and 21 endoscopic) to evaluate pain parameters before and after surgery (VAS), days of hospitalization, and complications. The data were submitted to statistical analysis (ANOVA) using the Kruskal-Wallis test. Results: Fourteen patients were female and eighteen were male, with a mean age of 41.35 years (p> 0.05 between sexes). The pre- and postoperative VAS for pain radiating to the lower limb were similar between the groups: 8.5 ± 0.82 with the open technique and 8.19 ± 1.15 with endoscopic technique. In both groups there was an improvement in the pain pattern with a significant reduction in the VAS (p < 0.05) and there was no statistical relevance between the groups in terms of pain improvement. There was statistical relevance between the groups in the comparison of days of hospitalization required, with the group submitted to endoscopic surgery having a lower number of days. The complications reported were compatible with those found in the literature (postoperative dysesthesia, new herniation). Conclusions: The endoscopic technique resulted in an important reduction in the number of days of hospitalization, a factor with a high impact on the costs of any surgical procedure, which can be a determining factor in the feasibility of minimally invasive techniques. Level of evidence IV; Therapeutic Study.
Highlights
Low back pain and sciatica are so common that about 70% of the population may experience them in varying degrees of severity and symptomology at some point in life.[1,2] One of the causes of pain and the main cause of sciatica is disc herniation, which can lead to irritation and compression of the nerve root
In Brazil, there are no studies comparing endoscopic treatment of lumbar disc herniation with the conventional open technique in SUS (Unified Health System) with regard to hospitalization time and complications occurring within one year, which is the objective of this study
In both groups there was an improvement in the pain pattern with a significant reduction in the visual analog scale for pain (VAS) (p < 0.05) and there was no statistical relevance between the groups in terms of pain improvement
Summary
Low back pain and sciatica are so common that about 70% of the population may experience them in varying degrees of severity and symptomology at some point in life.[1,2] One of the causes of pain and the main cause of sciatica is disc herniation, which can lead to irritation and compression of the nerve root. The possible treatments for lumbar disc herniation are basically conservative and surgical. Most cases of disc herniation and sciatica can be treated conservatively, leaving only the cases with more serious symptoms and neurological changes to be indicated for surgical treatment.[2]. Surgical treatment methods for disc herniation have evolved to be increasingly less invasive while maintaining efficiency or even being superior in terms of the clinical improvement of patients when compared to traditional open approach techniques.[3,4]. In addition to the learning curve,[5] another obstacle to greater adherence to minimally invasive techniques is the higher cost of performing this surgical technique as compared to the traditional open technique. The challenge today is trying to balance modern advances in surgical techniques against costs.[6,7,8,9]
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