Abstract

Study Design: Three different kind of minimally invasive techniques were used to treat all kind of lumbar disc herniation. Objectives: The goal was to evaluate the effectiveness of three different kind of lumbar disc herniation with three different kind of techniques. Summary of Background data: The lumbar disc herniation is a benign evolution disease and about 90 to 95% of the patient can be treated with the conservative measures. However, when the surgical treatment surgical is indicated there is a great controversy about of the best technique. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive spine surgery techniques (MISST) remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available). However, with the fast technological development (diagnostic and instrumental),the MISST continuous fascinating the spine specialists. The author selected three different kind of MISST to treat all kind of lumbar disc herniation with the objective of to minimize the aggression and to maximize the clinical result. Methods: Basically, there are two different kind of lumbar disc herniation (LDH): contained and non contained. The non contained disc herniation is subdivided in: foraminal and extraforaminal, central and centro lateral. Since 2000 we have been doing coblation assisted percutaneous disc decompression (NucleoplastyTM) to treat contained LDH. Transforaminal endoscopic technique (YESS) for foraminal and extraforaminal non contained LDH and interlaminar endoscopic technique (Endospine) for extruded and sequestred LDH. Conclusion: Our study began in 2000 and it will finish in the end of 2007. After which a definitive study about the clinical outcome will be done. However, the preliminary results of the first 400 patients treated with these techniques are encouraging and seems to be better if compared with the macro or the microdiscectomia.