Microendoscopic Discectomy For Lumbar Disc Herniation

Part 1 Lumbar Microendoscopic DiscectomyObjective: The purpose of this study was to describe the outcome of MED technique for lumbar disc herniation and discuss security and complications.Methods: From January 2009 to lumbar 2013, 60 patients with lumbar radiculopathy due to lumbar disc herniation, who had no lumbar instability obviously, were treated by MED. There were 35 males and 25 females with a mean age of 43.5 years(range, 25 to 76 years).Results: After surgery, the patients with back or leg pain were alleviated and their ability of daily life were improved. The mean values of the preoperative and postoperative JOA for all 60 patients were 12.6 and 26.7, respectively. The mean postoperative leg VAS was 82.4, compared with 5.2 after surgery. The mean postoperative lumbar VAS was 17.8, compared with 9.6 after surgery. Clinical outcomes were determined using modified Mac Nab criteria, which revealed that 47 patients had excellent, 10 had good, 3 had fair, and no poor outcomes.Conclusions: MED for lumbar herniated disc disease can be performed microinvasive and effectively. A good grasp of the indications, avoiding the risk of surgery, doing guidance of comprehensive rehabilitation well is the key to a satisfactory effect.Part 2 Microendoscopic discectomy for L5/S1 disc herniationObjective: The purpose of this study was to describe the features and efficacy of Microendoscopic discectomy(MED)for L5-S1 disc herniation.Methods: From January 2009 to February 2014, 47 patients with lumbar radiculopathy due to L5-S1 disc herniation, who had no lumbar instability obviously, were treated by MED. There were 25 males and 22 females with a mean age of 41.5 years(range, 23 to 72 years). Among them, there were 18 patients with foraminal disc herniations, 7 patients with the central and 12 patients with the para-central disc herniations, according to the classification of Yeung. All patients were evaluated by using the Japanese Orthopedic Association(JOA) score, Visual analogue scales(VAS) of low back pain and sciatica at before surgery, 3 months postoperative and last follow-up. Macnab scores were evaluated at the last follow-up for every patient.Results: All cases were followed up from 6 months to 48 months with an average of 18±5 months. After surgery, the patients with back or leg pain were alleviated and their ability of daily life were improved. Complications included two cases of dural injury and one case of recurrence 3 weeks post operation. No other complications as nerve or main vessels injury were noted. VAS for low back pain, sciatica and JOA showed statistically significant(p<0.01)improvement in their values at 3 months postoperative and the last follow-up examination compared with preoperative scores. According to the Macnab criteria, 40 patients had excellent outcomes, 5 had good results, 2 had fair or poor outcomes and 96% individuals showed favorable result.Conclusion: MED for L5/S1 lumbar herniated disc disease can be performed simply, safely and effectively due to its larger interlaminar space.