SURGICAL OUTCOME OF PERCUTANEOUS ENDOSCOPIC INTERLAMINAR LUMBAR DISCECTOMY TECHNIQUE

Abstract

Background: Minimally invasive lumbar surgeries are becoming more popular and a routine around the world. Although good surgical outcomes have been reported for the endoscopic approach to treat lumbar disc herniation (LDH), the procedure still appears to be relatively difficult so operative failures and complications may be occurred. Objective: To assess the outcome of lumbar spinal endoscopic discectomy by Destandaeu technique as minimally invasive approach in Al Azhar experience. Patients and Method: Thirty five consecutive patients proved to have lumber disc prolapse, were treated with percutaneous endoscopic lumbar discectomy through interlaminar approach discectomy by Destandau's technique using Endospine Karl Storz system between September 2017 and October 2019 at the Neurosurgery Department, Al-Azhar University Hospitals. All patients included in this study have lumbar disc prolapse fulfilled the following criteria: Unilateral Radicular pain correlated with MRI finding, failure of conservative measures for at least 6 weeks, single level disc prolapse, and disc prolapse was central or paracentral. Follow up for 6 months postoperative and Clinical outcomes were assessed by using Visual Analogue Scale (VAS) score (for Mean pre- and postoperative pain score measurement) and Oswestry Disability Index (ODI), Patients Satisfaction measured by Modified Macnab Criteria at 6 months postoperative, Time of return to work, Recurrence or persistence of symptoms which need revision open surgery. Results: The mean age was 37.5 years, the mean operative time was 90 minutes, and the mean length of follow-up was 5 months. The mean hospital stay for endoscopic discectomy was 36 hours. There was a significant reduction in the severity of back pain and lower limb symptoms measured by (VAS) (ODI) in 87% (30 patients) at 6 months. The recurrence rate was 8.5% (3 patients) and persistent symptoms without improvement occurred in 5.7 % (2 patients) who subsequently underwent revision surgery. Most Patients returned to their previous occupation after surgery at a mean time of 35 days. Conclusion: Endoscopic discectomy by Destandau's technique for lumbar disc prolapse in properly selected patients was safe and minimally invasive technique.