A special device for endoscopic surgery of lumbar disc herniation

Abstract

We studied the use of an endoscopic technique for lumbar discectomy, the most frequent operation in spinal surgery. Minimal invasive procedures are cost effective and allow earlier resumption of activities, work and sports. Endoscopic procedures have become more frequent in surgery but rarely for spinal surgery. It is sometimes used in the disc itself but not in the spinal canal. The goal of this operation is to reach the disc herniation in the spinal canal through a small incision, using a special device with an endoscope. It is composed of three tubes: one for the endoscope, one for aspiration and the largest one for classical surgical instruments. A protected space is created at one end of the tubes by a special part of the device which looks like a speculum; there is also an included nerve retractor. One hundred patients were operated during the year 1993. In a follow-up, 91 patients were evaluated using Prolo's criteria. The results could be classified as excellent in 78 patients, good in nine and poor in four. Complications were rare: two discitis, four recurrences, one failure. This technique allows a smaller incision, less trauma to lumbar muscles, better identification of deep structures, soft manipulation and better release of neural structures, perfect hemostasis and no drain. Early post-operative mobilization is easy and special wound dressing allows immediate shower and intensive re-education. These excellent results must be confirmed by long term studies; nevertheless this minimal invasive technique can be considered as a safe and effective treatment of the lumbar disc herniation.