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Abstract
Objectives
To compare the surgical results of microendoscopic discectomy using a tubular retractor with those of a conventional discectomy for lumbar herniated nucleus pulposus.
Summary of Literature Review
Minimally invasive approaches to the lumbar spine have been attempted with success over the past 25 years.
Materials and Methods
This study examined 36 cases who underwent lumbar discectomy using a tubular retractor and microendoscopy (Group A) and 30 cases who underwent a conventional discectomy (Group B). The operating time, intraoperative blood loss, postoperative hospital stay were recorded. The clinical results were assessed using the Korea Version Oswestry Disability Index (KODI), and the radiological results were evaluated from changes in disc height.
Results
The patients in Group A had a longer operation time(mean, 95.56±23.57 minutes vs 81.17±35.30 minutes, p=0.062), less intraoperative blood loss (mean, 58.61±97.08 cc vs 161.00±88.64 cc, p=0.001) and a shorter hospitalization stay (mean, 8.22 ±4.99 days vs 17.33±10.98 days, p=0.001) than group B. There was significant improvement in the mean KODI score for Group A; 6.36±7.18 and Group B; 5.97±5.14. However, there was no significant difference in the pain improvement (mean, 1.14 ±1.15 vs 1.30±1.06, p=0.559) and walking index (mean, 0.25±0.44 vs 0.30±0.47, p=0.656). In terms of social life, Group A had better results (mean, 0.20±0.48 vs 0.67±1.01, p=0.018). The disc height according to radiography decreased from 8.44±1.98 mm to 7.40±1.59 mm in Group A and 9.07±1.93 mm to 7.67±1.90 mm in Group B, but there were no statistical differences in the changes in disc height between the two groups (p=0.143).
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Fig. 1.
Endoscopic findings. (A) Laminotomy is done under tubular retractor and microendoscopy. (B) Endoscopic discectomy is doing.
Fig. 2.
A 22 year-old woman with HNP L4-5. (A) Preoperative MRI shows herniated nucleus pulposus at L4-5. (B) Immediate postoperative computed tomographs shows hematoma compression at laminotomy area and spinal canal.
Table 1.
The results of operative procedures.
Table 2.
Clinical and radiological results
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