Artikel
Full-endoscopic operation of lumbar disc herniations with interlaminar and lateral transforaminal access – prospective 3-year results in 229 patients
Vollendoskopische Operation des lumbalen Bandscheibenvorfalles mit interlaminärem und lateral transforaminalem Zugang – Prospektive 3-Jahresergebnisse von 229 Patienten
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Autoren
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M. Komp
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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S. Ruetten
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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P. Hahn
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
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G. Godolias
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: A lateral access is often necessary in full-endoscopic transforaminal operation of lumbar disc herniations in order to guarantee sufficient decompression. Especially at level L5/S1 there are anatomical problems due to the pelvis. Development of a full-endoscopic interlaminar access made it possible to operate here full-endoscopically. The endoscopes available had problems with mobility, the resection of hard tissue and sufficient cleaning of the intervertebral space. The objective of this prospective study was to investigate the broadened possibilities offered by newly-developed endoscopes and instruments in the full-endoscopic operation of lumbar disc herniations.
Methods: 283 patients with lumbar disc herniations were operated in 2002 in full-endoscopic technique with lateral transforaminal and interlaminar access. 7-mm endoscopes with intraendoscopic 4.2-mm working canal and corresponding new instruments were used. Follow-up lasted 36 months. 229 patients (81%) could be followed. The following measuring instruments were used: Visual Analog Scale (VAS), German version North American Spine Society Instrument (NASS), Oswestry Low Back Pain Disability Questionnaire.
Results: There were no intraoperative complications. 5 patients developed transient dysesthesia. The mean operation time was 28 minutes. 188 patients (82%) reported having no more leg pain, 30 (13%) had occasional pain. 8 patients (3.5%) developed recurrence. These were re-operated using the same technique. The new endoscopes and instruments enable resection of hard tissue, bone and intradiscal material. The measuring instruments showed a significant, constant improvement.
Conclusions: The full-endoscopic operation of lumbar disc herniations with interlaminar and lateral transforaminal access is a sufficient and safe alternative compared to conventional procedures, taking into consideration the effectiveness and constancy of the results over several years. At the same time, it offers all the advantages of a truly minimally-invasive procedure. The new endoscopes and instruments improve the mobility, the resection of hard tissue and reduce the recurrence rate. Given the possibility of selecting an interlaminar or transforaminal access, all lumbar disc herniations within and outside the spinal canal can be full-endoscopically operated.
