Abstract

Study Design: Endoscopic technique for lumbar discectomy has been used by the author since 1993. The technique is discribed and the results of 1562 patients are presented Material and Methods: The goal of this operation is to reach the disc herniation in the spinal canal, using a special device with an endoscope, through a small incision. The device is composed of three tubes: one for the endoscope, one for suction and the largest one for classical surgical instruments. 1562 patients were operated on between April 1999 and December 2001. In order to permit a valid analysis of the results, a prospective study was begun. Before the operation, each patient was given a questionnaire and an explanation of what exactly was being asked. The questionnaire was to be filled out either when the patient returned to work or, if not, two months after surgery. It is to be noted that after three months results were considered “poor” if the patient did not return to work within this period, even if he or she was able to return to work later. Prolo's criteria were used. Results: Of the 1562 patients, 1028 questionnaires were returned showing excellent results in 980 cases, good in 6, moderate in 1 and poor in 40. The complications observed were: discitis in 5 cases; reoccurrence in 54, of which 44 needed a second surgery; dural tear in 25; nerve root lesion in 7; and resection of articular process in 36. Of the 746 patients who were working before the operation, 706 were able to return to work with an average delay of 4 weeks. In answer to the questions on global satisfaction and on the accuracy of the information given before surgery, 1005 responded as satisfied and 989 felt the information given to be accurate. Conclusions: This minimally invasive technique allows a smaller incision, less trauma to lumbar muscles, better identification of the nerve root in the foramen, perfect hemostasis and no drain. Early post-operative mobilisation is easy and special wound dressing allows immediate shower and intensive reeducation.This endoscopic technique gives dramatically better results than an external approach and allows earlier resumption of professional and personal activities.