General Session: Endoscopic Surgery
Presented by: A.J. Deukmedjian - View Audio/Video Presentation (Members Only)
A.J. Deukmedjian(1), E. Mason(1), A. Cianciabella(1), A. Deukmedjian(1)
(1) Deuk Spine Foundation, Melbourne, FL, United States
Objective: To report standard perioperative measures and patient outcomes following outpatient Deuk Laser Disc Repair® (DLDR) surgeries of the cervical spine.
Background: Symptomatic disc injuries resulting in chronic neck pain and radicular symptoms including pain, numbness, weakness and paresthesia have been traditionally treated with cervical spine decompression and fusion. However, these procedures can result in extended recovery times, hospital stays, severe decreases in mobility, extensive post-operative pain, and the requirement of prolonged time off work, physical therapy, and narcotic use, as well as potentially severe complications from the surgical exposure or hardware implanted. Deuk Laser Disc Repair® (DLDR) has been previously reported (2012) as a safe and effective outpatient surgical option for patients that suffer from discogenic neck pain and/or radicular symptoms emanating from herniated discs and/or their effects on nerve roots.
Methods: 138 patients underwent endoscopic cervical Deuk Laser Disc Repair® from June 2008 to March 2016 by a single neurosurgeon. Estimated blood lose (EBL), disc levels operated on, duration of anesthesia, surgical times, complications, and post-operative recovery times were recorded for all patients. In addition, patient outcomes were measured with both VAS scores for neck pain and percent resolution of preoperative neck pain and radicular symptoms.
Results: Mean patient age was 45 (range, 20-86) years. Male:female ratio was 3:2. EBL, fluoro times, surgical times, duration of anesthesia, and recovery times were reported for all patients (Table 1). Pre/post-operative VAS scores for neck pain were obtained (n=138) with a mean follow-up time of 13.4 weeks. VAS scores improved from a mean pre-operative score of 7.68 ± 1.86 to a mean postoperative score of 1.65 ± 2.05 (p< 0.001). Confidence interval (95%) for VAS score reduction was found to be (5.61-6.47). Mean percent resolutions for preoperative axial pain and radicular symptoms were found to be 91.7% (n=135) and 93.6% (n=122) respectively. Single factor ANOVA revealed no significant difference in VAS score reduction among patients with 1, 2, 3, and 4 levels operated on p=0.56. Furthermore, there was no significant difference in percent resolutions of preoperative axial pain and preoperative radicular symptoms among patients with 1, 2, 3, and 4 levels operated on (p=0.65 & p=0.88). All patients were discharged home the same day as their operation. There were no emergency transfers and no postoperative complications or infections.
Conclusions: 138 cervical DLDR procedures were performed successfully with statistically significant reductions of 92-94% in preoperative complaints including neck pain and radicular symptoms. No significant differences were found in VAS score reduction and percent resolution for preoperative axial pain and radicular symptoms among single and multilevel patients. Zero complications or infections were recorded among all patients. This study indicates that Cervical Deuk Laser Disc Repair® is indeed a safe and effective surgical option for patients that suffer from axial and radicular symptoms deriving from herniated cervical discs.
Table 1. Cervical DLDR Measured Variables