Comparative Study of Arthroscopic and Microscopic Discectomy of Lumbar Disc Herniation in Teenagers

Jae Yoon Chung; Hyoung Yeon Seo; Hyun Jong Kim

doi:10.4184/jkss.2002.9.4.322

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Chung, Seo, and Kim: Comparative Study of Arthroscopic and Microscopic Discectomy of Lumbar Disc Herniation in Teenagers

Original Article

Journal of Korean Spine Surg 2002;9(4):322-331.

Published online: 12 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.4.322

Comparative Study of Arthroscopic and Microscopic Discectomy of Lumbar Disc Herniation in Teenagers

Jae Yoon Chung, M.D., Hyoung Yeon Seo, M.D., Hyun Jong Kim, M.D.

Department of Orthopaedics, Chonnam National University Hospital, Gwangju, Korea

Address reprint requests to Jae Yoon Chung, M.D Department of Orthopaedic Surgery, Chonnam National University Hospital Hak Dong 8, Gwangju 501-757, Korea Tel : 82-62-220-6336, Fax : 82-62-225-7794, E-mail : jychung@chonnam.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare clinical results and radiologic changes after arthroscopic and microscopic discectomy of lumbar disc herniation in teenagers who have no degenerative change.

Materials and Methods

From Jan 1990 to A ug 2001. 70 lumbar disc herniations were performed in patients below 20 years old who were admitted to our department, among these 67 cases (49:male, 18:female) were evaluated for at least 1 year. Their average age was 18.1years (13 ~ 20 years). Forty- six received microscopic discectomy and 21 arthroscopic discectomy. Mean follow-up duration was 26.4 months (12~ 88 months).

Results

Clinical results and disc height change were compared between the arthroscopic and microscopic discectomy groups using the criteria of MacNab, and the relationship between disc height change and clinical results, excised disc volume, operative technique, body mass index and symptom duration were investigated. Clinically there was no significant difference between the two groups (p=0.425), and their results were the same as those of adults. A t the 1 year- follow up, disc height changes showed no correlation with the method of operation (p=0.996) or the volume of the excised disc. Postoperative disc height in teenagers of lumbar disc herniation who showed no degenerative change significantly decreased with time, but no significant relation was observed between disc height changes and clinical results, operative technique, excised disc volume, body mass index, involved disc site or symptom duration between the two groups.

Conclusion

We believe that arthroscopic discectomy is an effective method, if the patients status permits, because it has the advantages of non- invasiveness, short hospitalization period and earlier return to normal life.

Keywords: Lumbar spine, Lumbar disc herniation, A rthroscopic disc excision, Microscopic disc excision, Teenager

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Fig. 1.

Comparison of LBP score change between arthroscopic and microscopic discectomy.

Fig. 2.

Comparision of mean disc height change between arthroscopic and microscopic discectomy. (by Farfan’s method)

Fig. 3.

Comparison of changes of VAS(visual analogue scale) between arthroscopic and microscopic discectomy.

Fig. 4.

14-years-old female with Rt leg radiating pain. Preoperative MRI (A) showed the protruded disc herniation at L4-5. Lateral radiograph at 24 months follow-up after arthroscopic disc excision (C) showed decreased disc height in comparision with preoperative radiograph (B).

Fig. 5.

17-years-old male with Rt leg radiating pain and positive straight leg raising. Preoperative MRI (A) showed the extruded disc herniation at L4-5. Lateral radiograph at 26 months follow-up after microscopic disc excision (C) showed decreased disc height in comparision with preoperative radiograph (B).

Table 1.

Objective clinical results of Arthroscopic & Mircoscopic discectomy

Clinical	Degree	Arthroscopic group		Microscopic group
Clinical	Degree	Preop	Follow-up	Preop	Follow-up
SLRT	0°∼ 30°	9(42.9%)	0(0%)	21(45.7%)	1(2.1%)
	30°∼ 70°	11(52.3%)	3(14.3%)	25(54.3%)	5(10.9%)
	Normal	1(4.8%)	18(85.7%)	0(0%)	40(87.0%)
Power Muscle	Fair-Zero	0(0%)	0(0%)	4(8.7%)	0(0%)
	Good	8(38.1%)	0(0%)	20(43.5%)	0(0%)
	Normal	13(61.9%)	21(100%)	22(47.8%)	46(100%)
Sensory disturbance	Marked	1(4.8%)	0(0%)	3(6.5%	0(0%)
	Slight	8(38.1%)	2(9.5%)	22(47.8%)	5(10.9%)
	None	12(57.1%)	19(90.5%)	21(45.7%)	41(89.1%)

Table 2.

Comparison of the clinical results between Arthroscopic and Microscopic discectomy groups (by Macnab’s criteria)

Results	Arthroscopic group	Microscopic group
Excellent	14(66.7%)	25(54.3%)
Good	5(23.8%)	16(34.8%)
Fair	2(9.5%)	4(8.7%)
Poor	0(0%)	1(2.2%)

Table 3.

Comparison of mean disc height change between Arthroscopic and Microscopic discectomy (by Farfan’s method)

	Arthroscopic group	Microscopic group
Preop	53	53
Follow-up	48	46
Decreased rate	9.5%	13.2%
		(p<0.05)

Table 4.

Subjective clinical results of Arthroscopic and Microscopic discectomy

Subjective symptom	Degree	Arthroscopic group		Microscopic group
Subjective symptom	Degree	Preop	Follow-up	Preop	Follow-up
Low back pain	Continous severe	1 (4.8%)	0 (0%)	4 (8.7%)	0 (0%)
	Frequent mild	6(28.6%)	1 (4.8%)	20(43.5%)	0 (0%)
	Occasional mild	11(52.4%)	1 (4.8%)	15(32.6%)	8(17.4%)
	None	3(14.2%)	19(90.4%)	7(15.2%)	38(82.6%)
Radiating pain	Continous severe	7(33.4%)	0 (0%)	13(28.2%)	0 (0%)
	Frequent mild	10(47.6%)	2 (9.5%)	28(60.9%)	2 (4.4%)
	Occasional mild	4(19.0%)	3(14.3%)	5(10.9%)	11(23.9%)
	None	0 (0%)	16(76.2%)	0 (0%)	33(71.7%)

Table 5.

Complication of Arthroscopic and Microscopic discectomy

Complication	Athroscopic group	Microscopic group
Recurrence of previous Sx	3	4
Infection	0	0
Dural tear	0	1
Total	3(14.2%)	5(10.8%)

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