Uniportal Dual Mode Dry-Saline Endoscopy for Lumbar Disc Herniation

Abstract

Objective: Posterior dry medium endoscopic lumbar discectomy techniques have been successfully used to treat lumbar disc prolapse. A drawback of these techniques is repeated blood staining of the scope tip while working close to the surgical target. To address this drawback, we modified the design of the previous Arthrospine system and made it compatible for use in air and saline medium to treat lumbar, cervical, and thoracic disc prolapse. Herein, we describe the operative technique and results of lumbar discectomy in a dual (air/saline) medium using this system.Methods: Eighty patients underwent endoscopic discectomy using the Arthrospine Duo system for lumbar disc prolapse. The procedure was conducted through a muscle dilatation approach using 5-mm and 10-mm dilators. The Arthrospine Duo tube was passed over a 10-mm dilator, the working insert was adjusted over the tube in a press-fit manner, and endoscopic discectomy was performed using a 30° arthroscope and conventional microdiscectomy instruments in an air or saline medium.Results: As per the modified MacNab criteria, 80% (n=64) of patients had excellent, 12.5% (n=10) good, 6.25% (n=5) fair, and 1.25 patients (n=1) had poor results. The leg pain visual analogue scale improved from 7.87±0.68 to 1.3±0.67 at 2 years of follow-up. As complications, dural tears and transient paraesthesia occurred in 4 patients (5%) each, nerve root injury in 1 patient (1.25%), and superficial wound infection in 5 patients (6.25%).Conclusion: The uniportal Arthrospine Duo system can be used in air/saline medium and is an excellent minimally invasive option for lumbar discectomy.