Endoscopic Discectomies - Nakuru Mediheal - Our experience

Résumé

Background: Various modalities of treatment from standard discectomy, microdiscectomy, percutaneous discectomy paramedian interlaminar discectomy and transforaminal endoscopic discectomy have been in use for lumbar intervertebral disc prolapse. The access to spine is kept to a minimum without stripping paraspinal muscles minimizing muscle damage by posterior interlaminar endoscopic approach. The aim of this study was to evaluate technical problems, complications, and overall results of endoscopic discectomy (Destandau technique).

Materials and Methods: 104 consecutive cases aged 18–89 years operated by endoscopic discectomy between february 2021 – September - 2022 are reported. All patients with lumbar disc prolapse and canal stenosis were included. Two special cases - excision of filum terminale and extra-dural osteoclastoma - done endoscopically has also been included. All patients had preoperative MRI and dynamic X-rays. All patients were operated by a single surgeon with the Destandau endospine system. Postoperatively, all patients were mobilized as soon as the pain subsided and discharged within 24–48 h postsurgery. Patients were evaluated for technical problems, complications, and overall results. Patients were followed up at 2, 6, and 12 weeks.

Results: The mean follow up was 3 months (range 2 months – 9 months). Open conversion was required in two patients ( one 2 level surgery, another redo case – csf leak). Minor dural punctures occurred in 2 cases and no root damage. The average surgical time was 70 min (range 45–210 min). Average blood loss was 20–30 ml. Technical difficulties encountered in initial 4-5 cases were insertion of port, image orientation, operative dissection and bleeding problems, and reaching wrong levels suggestive of a definitive learning curve. Overall 91% of patients had good-to-excellent results, with 3 patient having recurrence whom we did reoperation doing well. No patient had postoperative discitis.

Conclusion: endoscopic discectomy is minimally invasive procedure for discectomy with early encouraging results. Once definite learning curve was over and expertise is acquired, the results of this procedure are acceptable safe and effective.