COMPARATIVE STUDY OF EFFICIENCY OF DESTANDAU ENDOSCOPIC DISCECTOMY AND OPEN MICROSURGICAL DISCECTOMY FOR LUMBAR DISC HERNIATION
https://doi.org/10.14531/ss2005.1.63-68
Abstract
Objectives. To estimate efficiency, safety and traumatizing impact of endoscopic discectomy in comparison with traditional microsurgical discectomy.
Material and methods. A total of 330 patients underwent Destandau endoscopic discectomy and 964 – open microsurgical discectomy. The operative times, terms of patient postoperative bed and hospital stays, postoperative dynamics of neurologic deficiency, surgical complications and frequency of herniation recurrences were estimated in both groups. Pain intensity was assessed with the 10-score Visual Analog Scale (VAS), and functional activity – with the Oswestry Disability Index (ODI).Results of surgical treatment were estimated in 8–10 days, 6 and 12 months after operation.
Results. VAS and ODI data have not revealed essential distinctions in pain regression dynamics after endoscopic and open surgeries. Surgical complications after endoscopic intervention were not more often, than after microsurgical discectomy. Damage of dura mater occurred in 2.4 % of cases, and increase in neurologic deficiency (hypoesthesia) – in 0.6 %. Herniation recurrences have evolved in 3.0 % of cases after endoscopic discectomy and in 4.7 % – after open microsurgical one.
Conclusion. Destandau endoscopic surgery is a low invasive method of effective treatment for lumbar disc herniations, which by its technical opportunities and results is competitive with classical open microsurgical discectomy.
About the Authors
Aleksandr Evgenyevich Simonovich
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
Sergey Petrovich Markin
Novosibirsk Research Institute of Traumatology and Orthopaedics
Russian Federation
Russian Federation
References
1. Алексеев Г.Н., Любимов А.Н., Борисова Н.Г. и др. Пункционная лазерная вапоризация пульпозного ядра как минимально-инвазивный метод хирургического лечения поясничного остеохондроза с компрессионно-радикулярным дискогенным синдромом // Современные минимально-инвазивные технологии: Тез. докл. VI Международного симпозиума. СПб., 2001. С. 290–291.
2. Зорин Н.А., Кирпа Ю.И., Сабодаш В.А. Пункционное лазерное выпаривание секвестрированных грыж межпозвонковых дисков // Украинский нейрохир. журн. 2002. №1 (9). С. 65–67.
3. Леу Х. Чрескожная эндоскопическая спинальная хирургия: эволюция и перспективы // Хирургия позвоночника. 2004. № 4. С. 87–88.
4. Педаченко Е.Г., Танасейчук А.Ф., Хижняк М.В. и др. Эндоскопическая портальная микрохирургия при грыжах шейных дисков // III съезд нейрохирургов России: Тез. докл. СПб., 2002. С. 619–620.
5. Сак Л.Д., Зубаиров Е.Х. Малоинвазивная хирургия позвоночника: первый опыт перкутанных артроскопических трансспинальных экстрадуральных герниоэктомий в России // Повреждения мозга: Тез. докл. Международного симпозиума. СПб., 1999. С. 259–260.
6. Caspar W. A new surgical procedure for lumbar disk herniation causing less tissue damage through a microsurgical approach // Adv. Neurosurg. 1977. Vol. 4. P. 74–80.
7. Caspar W., Campbell B., Barbier D., et al. The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure // Neurosurgery. 1991. Vol. 28. P. 78–87.
8. Destandau.J. A special device for endoscopic surgery of lumbar disc herniation // Neurol. Res. 1999. Vol. 21. P. 39–42.
9. Ebeling U., Reichenberg W., Reulen H.J. Results of microsurgical lumbar discectomy. Review on 485 patients // Acta Neurochir. 1986. Vol. 81. P. 45–52.
10. Foley K.T., Smith M.M. Microendoscopic discectomy // Techn. Neurosurg. 1997. Vol. 3. P. 301–307.
11. Hijikata S., Yamagishi M., Nakayama T., et al. [Percutaneous nucleotomy: A new treatment method for lumbar disc herniation] // J. Toden Hospital. 1975. Vol. 5. P. 39–42. (Japanese).
12. Kambin P., O’Brien E., Zhou L., et al. Arthroscopic microdiscectomy and selective fragmentectomy // Clin. Orthop. 1998. Vol. 347. P. 150–167.
13. Onik G., Mooney V., Maroon J.C., et al. Automated percutaneous discectomy: a prospective multi-institutional study // Neurosurgery. 1990. Vol. 26. P. 228–233.
14. Pappas C.T., Harrington T., Sonntag V.K. Outcome analysis in 654 surgical treated lumbar disc herniations // Neurosurgery. 1992. Vol. 30. P. 862–866.
15. Smith L. Enzyme dissolution of the nucleus pulposus in humans. JAMA. 1964. Vol. 187. P. 137–140.
16. Williams R.W. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc // Spine. 1978. Vol. 3. P. 175–182.
Review
For citations:
Simonovich A.E., Markin S.P. COMPARATIVE STUDY OF EFFICIENCY OF DESTANDAU ENDOSCOPIC DISCECTOMY AND OPEN MICROSURGICAL DISCECTOMY FOR LUMBAR DISC HERNIATION. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2005;(1):063-068. (In Russ.) https://doi.org/10.14531/ss2005.1.63-68
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