Article
Fullendoscopic operations of lumbar disc prolapses: prospective 12-months results of patients treated with new endoscopes and instruments
Die vollendoskopische Operation des lumbalen sequestrierten Bandscheibenvorfalls: prospektive 12-Monatsergebnisse von mit neuentwickelten Optiken und Instrumenten operierten Patienten
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Authors
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M. Komp
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
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S. Ruetten
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
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G. Godolias
- Ressort Wirbelsäulenchirurgie und Schmerztherapie, Klinik für Orthopädie am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke, St. Anna-Hospital Herne
| Published: | May 4, 2005 |
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Outline
Text
Objective
In transforaminal fullendoscopic operations of lumbar disc herniations a far lateral access is often required to achieve a sufficient decompression of the ventral epidural space. Anatomical problems arise at the level L5/S1 due to the iliac crest. Therefore an interlaminar access was developed. The conventional endoscopes and instruments had very narrow limits in the mobility and possibility to resect hard tissue and to clean the intervertebral space sufficiently. The aim of this prospective study was to investigate the extended possibilities of the new endoscopes and instruments with regard to the efficacy of decompression.
Methods
512 patients with lumbar disc herniations have been treated in 2002 and 2003 in a fullendoscopic technique using a lateral or interlaminar access. A 7-mm endoscope with 4 mm-working canal and new designed instruments were used. Follow-up lasted at least 12 months. 415 patients (81%) could be followed.
Results
No intraoperative complication occurred. 9 patients reported a transient dysasthesia postoperatively. The average operation time was 28 minutes. A sufficient decompression could be achieved in all cases. 340 patients (82%) reported no more leg pain after surgery, 58 patients (14%) had transient persistence in the first 6 weeks. 8 patients (2,1%) showed a recurrent herniation, 7 of those were reoperated in the same technique.
Conclusions
As a minimally invasive technique wich efficacy of decompression is equal to an open procedure we see advantages over conventional operations of lumbar disc herniations. Within the inclusion criterias these techniques are sufficient and safe. The technical developments on endocopes and instruments lead to a decrease of recurrence, increase of mobility as well as the possibility of resection of hard tissue and sufficient cleaning of the intervertebral space. The technical progress in combination with the chosen approaches extends the spectrum of indications with regard to fullendoscopic bony decompression and fusion.
