Endoscopic surgery for lumbar disc herniation – the first experience

Česká verzia

Authors: K. Máca ¹; K. Ďuriš ^1,2; M. Smrčka ¹
Authors place of work: Neurochirurgická klinika, LF MU a FN Brno ¹; Ústav patologické fyziologie, LF MU, Brno ²
Published in the journal: Cesk Slov Neurol N 2019; 82(5): 541-547
Category: Původní práce
doi: https://doi.org/10.14735/amcsnn2019541

Summary

Aim: Lumbar disc herniation is the most frequent indication for spinal surgery. Open discectomy is considered as a standard surgical procedure; however, the endoscopic technique has evolved recently as an alternative method of treatment. Compared to open discectomy, the endoscopic technique has a similar effect in terms of outcome and additionally, it is beneficial for both surgeon and patient, because the endoscopic technique is a minimally invasive procedure. Department of Neurosurgery in The University Hospital Brno is the first department in the Czech Republic in which endoscopic discectomy has been implemented. The aim of this article is to present the first results and experiences with this technique, which has been used in our department since 2017.

Methods: So far, 15 patients (20– 70 years old) underwent endoscopic surgery for L4– 5 or L5– S1 herniation. Evaluation parameters were pain intensity (dorsalgia and radiculopathy) assessed by Visual Analogue Score (VAS) and limitations of common activities assessed by Oswestry Disability Index (ODI). The parameters were evaluated before surgery and after the surgery at the 6-week and 6-month time-points.

Results: In all study groups the VAS score (for both dorsalgia and radiculopathy) was significantly higher before surgery compared to the 6-week and 6-month time-points. Similar results were found in male and female subgroups, and significant improvement was observed at both the 6-week and 6-month time-points. The ODI before surgery was significantly higher in all patients before surgery compared to the 6-week and 6-month time-points. In the male subgroup, there was no significant difference between ODI before surgery and the 6-week time-point, while ODI at the 6-month time-point was significantly lower. In the female subgroup, ODI at both the 6-week and 6-month timepoints was significantly lower than before surgery. Recurrent herniation had occurred in one case and was resolved by reoperation.

Conclusion: In conclusion, endoscopic lumbar discectomy is a safe and effective option for lumbar disc herniation surgery.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

内镜治疗腰椎间盘突出症–初次经验

目的：腰椎间盘突出症是脊柱外科手术最常见的指征。开放性椎间盘切除术被认为是标准的外科手术。然而，内窥镜技术最近已经发展成为一种替代治疗方法。与开放式椎间盘切除术相比，内窥镜技术在预后方面具有相似的效果，此外，由于内窥镜技术是一种微创手术，因此对手术医生和患者均有益。布尔诺大学医院神经外科系是捷克共和国第一个实施内窥镜椎间盘切除术的科室。

这篇文章的目的是展示自2017年以来我们部门使用这项技术的第一个结果和经验。

方法：到目前为止，有15例患者（20-70岁）接受了内镜手术以治疗L4- 5或L5- S1疝。评估参数包括通过视觉模拟评分（VAS）评估的疼痛强度（背痛和神经根病）以及通过Oswestry残疾指数（ODI）评估的常见活动限制。在手术前和手术后的6周和6个月时间点评估参数。

结果：与6周和6个月的时间点相比，在所有研究组中，VAS评分（背痛和神经根病）均明显高于手术前。在男性和女性亚组中发现了相似的结果，并且在6周和6个月的时间点都观察到了显着改善。与6周和6个月的时间点相比，所有患者术前的ODI显着更高。在男性亚组中，手术前的ODI与6周时间点之间无显着差异，而6个月时间点的ODI显着降低。在女性亚组中，在6周和6个月时间点的ODI均显着低于手术前。一例复发性疝，经再次手术解决。

结论：总之，内镜腰椎间盘切除术是腰椎间盘突出症手术的一种安全有效的选择。

关键词：腰椎间盘突出症–内窥镜检查–视觉模拟评分– Oswestry残疾指数

Keywords:

endoscopy – lumbar disc herniation – Visual Analogue Score – Oswestry Disabilty Index

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