General Session: Endoscopic Surgery
Presented by: K. Lee - View Audio/Video Presentation (Members Only)
B. Paudel(1), H.S. Kim(1), K. Lee(2), J.S. Jang(1), J.S. Lee(1), S.H. Oh(2), ,.I.-T. Jang(3)
(1) Nanoori Hospital, Suwon, Korea, Republic of
(2) Nanoori Hospital, Incheon, Korea, Republic of
(3) Nanoori Hospital, Seoul, Korea, Republic of
Purpose of study: Indications of Percutaneous endoscopic lumbar discectomy are ever expanding with progressive understanding of lumbar disc herniation and endoscopic anatomy with advent of new surgical instruments and techniques. Proper classification for management of different types of lumbar disc herniation by percutaneous endoscopic discectomy is lacking. Based on characteristics of lumbar disc herniations as in Table 1 we are proposing a new classification “Endoscopic surgical difficulty grade/score classification” and based on remnant disc material and degree of symptom resolution after endoscopic discectomy as in Table 2 we are also proposing a new outcome measure “Endoscopic surgical success grade/score classification”. The proposed classifications are comprehensive and applicable as it has taken consideration of anatomy, special issues associated with disc. This classification will help to differentiate different types of lumbar disc herniations and guide for choosing cases according to expertise.
Material and Method: EMR records of 104 consecutive patients treated between December 2015 to May 2016 by percutaneous endoscopic discectomy for different lumbar disc herniations either by PETLD (transforaminal ,outside in) or PEILD (interlaminar , annular sealing) approach by expert endoscopic spine surgeon who have done more than 1500 endoscopic discectomy were reviewed retrospectively .We have given grade/score to each lumbar disc herniation and surgical success grade/score as in Table 1and Table 2.We have analyzed outcome of surgical management of our patients according to Endoscopic surgical success grade/score, McNab's criteria and VAS taking Endoscopic surgical difficulty grade/score as prime variable.
Results: Surgical success based on Endoscopic surgical success grade/score is 98.1%. Good to excellent result according to Mc Nab criteria is 96.1% .There is significant resolution of pain. Preoperative VAS 7.13±0.72 changed to 1.78±0.89 postoperatively (P < 0.005). Sex, herniation level, surgical difficulty grade were not associated with difference in surgical success grade and Mc Nab grade (P > 0.005). Special issues of disc herniation and diagnosis were associated with difference in Endoscopic surgical success grade/score and Mc Nab grade (P< 0.005) we had 2 complications of transient motor weakness.
Conclusion: Any types of lumbar disc herniations can be treated by percutaneous full endoscopic techniques with more than 96% of success by expert endoscopic spine surgeon (evolution of indications).The proposed classifications are comprehensive and applicable.
Endoscopic surgical difficulty grade classificatio
Table 2 Endoscopic surgical success grade classif