Results of arthrospine assisted percutaneous technique for lumbar discectomy

Abstract

Background: Avaialable minimal invasive arthro/endoscopic techniques are not compatible with 30 degree arthroscope which orthopedic surgeons uses in knee and shoulder arthroscopy. Minimally invasive "Arthrospine assisted percutaneous technique for lumbar discectomy" is an attempt to allow standard familiar microsurgical discectomy and decompression to be performed using 30° arthroscope used in knee and shoulder arthroscopy with conventional micro discectomy instruments.

Materials and methods: 150 patients suffering from lumbar disc herniations were operated between January 2004 and December 2012 by indiginously designed Arthrospine system and were evaluated retrospectively. In lumbar discectomy group, there were 85 males and 65 females aged between 18 and 72 years (mean, 38.4 years). The delay between onset of symptoms to surgery was between 3 months to 7 years. Levels operated upon included L1-L2 (n = 3), L2-L3 (n = 2), L3-L4 (n = 8), L4-L5 (n = 90), and L5-S1 (n = 47). Ninety patients had radiculopathy on right side and 60 on left side. There were 22 central, 88 paracentral, 12 contained, 3 extraforaminal, and 25 sequestrated herniations. Standard protocol of preoperative blood tests, x-ray LS Spine and pre operative MRI and pre anaesthetic evaluation for anaesthesia was done in all cases. Technique comprised localization of symptomatic level followed by percutaneous dilatation and insertion of a newly devised arthrospine system devise over a dilator through a 15 mm skin and fascial incision. Arthro/endoscopic discectomy was then carried out by 30° arthroscope and conventional disc surgery instruments.

Results: Based on modified Macnab's criteria, of 150 patients operated for lumbar discectomy, 136 (90%) patients had excellent to good, 12 (8%) had fair, and 2 patients (1.3%) had poor results. The complications observed were discitis in 3 patients (2%), dural tear in 4 patients (2.6%), and nerve root injury in 2 patients (1.3%). About 90% patients were able to return to light and sedentary work with an average delay of 2 weeks and normal physical activities after 2 months.

Conclusion: Arthrospine system is compatible with 30° arthroscope and conventional micro-discectomy instruments. Technique minimizes approach related morbidity and provides minimal access corridor for lumbar discectomy.

Keywords: Arthroscope; IV Disc displacement; Interventional disc; arthrospine; disc; discectomy; endoscopic surgical procedures; facetectomy; herniated; laminotomy; radiculopathy.

Figure 1

(a) Sagittal magnetic resonance imaging T2W lumbosacral spine showing prolapsed intervertebral disc (PIVD) at L5S1 level. (b) Axial magnetic resonance imaging T2W showing PIVD L5-S1. (c) Postoperative axial magnetic resonance imaging. (d) Patient positioning. (e) Localization with 18 G spinal needle. (f) Confirmation of correct placement by IITV image. (g) Skin and fascial incision. (h) Dilatation with Arthrospine dilator. (i) Sliding of arthrospine tube over dilator. (j) Dilator is withdrawn and Arthrospine tube is held in place. (k) Arthrospine working insert with scope and sheath is snug fit over Arthrospine tube. (l) IITV Confirmation of correct placement of Arthrospine tube. (m) Nibbling of superior lamina to gain entry into canal. (n) Laminotomy diagrammatic. (o) Endoscopic view of interlaminar window on mannequin. (p) Endoscopic view of interlaminar window. (q) View of endoscopic laminotomy. (r) Endoscopic view of extruded disc. (s) Disc removal by disc forceps. (t) Endoscopic view of decompressed nerve root. (u) Incision after subcuticular closure. (v) Arthrospine assisted discectomy instrumentation. (w) Arthrospine system. (a) Arthrospine dilator, (b) Dural and nerve root retractor, (c) Arthrospine tube, (d) Arthrospine working insert, (e) Arthrpscope sheath