CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
Absratct:
Introduction: Lumbar disc herniation is one of the most common reason of sciatica.
More than 90% of lumbar disc herniation improves with non-surgical treatment, still lumbar vertebral
discectomy is one of the most commonly performed procedures in spinal surgeries.
Surgery of lumbar disc herniation has evolved from wide laminectomy and transdural resection of
prolapsed disc in 1909 to standard laminotomy and technically demanding procedures like
microdiscectomy, micro-endoscopic discectomy and percutaneous endoscopic discectomy at present
era.
Two commonly performed technique of lumbar disc herniation surgery in India : Conventional
open discectomy
Microdiscectomy
Microdiscectomy has indeed become the “gold standard” for treating disc prolapse when surgery is
indicated.
Advantage of minimaly invasive discectomy includes:
• Cosmetic small skin incision
• Short hospital stay.
• Less blood loss during surgery
• Reduced risk of infection and postoperative pain
• Diminished reliance on pain medications after surgery
Material and methods:
Prospective longitudinal study
Sample size: 30 Patients
Place of Study: Central Institute of Orthopaedics
Each patient followed up for atleast 3 months
Inclusion criteria:
CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
A single lumbar disc herniation, with Predominance of radicular over lumbar pain.
Cauda equine syndrome due to lumbar disc herniation.
Residual disabling pain despite 6—8 weeks of conservative treatment
Severe paralysis as bilateral foot drops due to lumbar disc herniation
Exclusion criteria:
Lumbar canal Stenosis Secondary to degenerative changes at the index level.
Previous spine operation.
Patient with clinical findings that do not correlate with the radiological Finding.
Inflammatory back pain
Spine tumour
Approach
Under general anaesthesia, the patient is to be placed in prone position with hip flexed.
Skin and subcutaneous tissue is infiltrated with saline-adrenaline(1:100000).
The appropriate level is first confirmed under image intensifier with a guide wire.A small skin incision
measuring about 3 cm is made over the site, after infiltration.
A guide wire is inserted between the laminae corresponding to involved level of discectomy, level is
confirmed with c arm, sequential dilatation done with series of concentric tubular dilators.
A final tubular retractor with detachable tapered blade inbuilt illumination is threaded over the guide
wire.
Inferior part of proximal lamina is thinned and removed using Kerrison Rongeours.
Ligamentum flavum was incised and excised. Nerve root is identified and retracted medially.
Extruded disc fragment is removed. Loose fragments of disc are removed from the disc space with the
help of straight and angled pituitary rongeurs. Nerve root is freed completely by 1cm.
Result:
The study was conducted at Central Institute of Orthopaedics (CIO), Vardhman Mahavir Medical College
and Safdarjung Hospital, New Delhi during the period of November’16– March’18.
The patients were followed up for a period of 3 months.
For their functional outcome Modified Oswestry low back pain disability questionnaire scoring was used
The following observations were noted:
CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
Age:
Mean age in our study came out to be 41 years.
Sex distribution:
Males were found to be more commonly affected (76.7%) whereas females constitute 23.3% of the
study population
CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
LEVEL OF VERTEBRAE INVOLVED:
L4 –L5 (43.33%) > L5-S1 (30%) >L3-L4 (26.66%)
CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
PAIN (VISUAL ANALOGUE SCALE):
Mean pre-op VAS: 9.23 +/- 0.68
Mean post-op VAS: (2 WEEKS)- 4.17+/- 0.95
(1month)-1.73+/-0.64
(2 month)- 1.20 +/- 1.73
(3months)-0.90 +/- 2.11
Modified Oswestry Disability low back pain questionnaire Index Score:
Pre-op: 74.93 +/- 6.45
Post-op: 2 WEEKS- 55.40 +/-12.27
(1 month)- 36.47 +/- 8.73
(2 month)- 31.13 +/- 5.03
(3 month)- 30.73 +/- 5.16
CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
Orthopaedic complications:
Out of 30 patients operated,
Three patients (10%) developed orthopaedic complications.
one (3.33%) developed superficial infection of stitch line.
two patients (6.67%) developed recurrence of symptoms
CLINICAL OUTCOMES OF LUMBAR DISC HERNIATION TREATED BY
MINIMALY INVASIVE DISCECTOMY WITH TUBULAR RETRACTOR
Conclusions
Minimaly invasive discectomy not only improved the clinical outcomes such as less hospital stay, early
rehabilitation, early resumption of daily activities but also has cosmetically benefit to patient as it leaves
small scar of incision.
It gives consistent excellent results and is associated with no significant complications.
The main advantage of this procedure is its small incision, less blood loss and more cosmetically sound
less reliance on pain medication.
