General Session: Endoscopic Surgery
Presented by: H.-K. Tsou
H.-K. Tsou(1), S.-C. Shen(1), Y.-T. Shih(2), H.-T. Chen(3), C.-L. Tang(1), R.-H. Lin(1)
(1) Taichung Veterans General Hospital, Functional Neurosurgery Division, Neurological Institute, Taichung, Taiwan, Republic of China
(2) Jen-Ai Hospital, Department of Neurosurgery, Taichung, Taiwan, Republic of China
(3) China Medical University Hospital, Department of Orthopaedic Surgery, Taichung, Taiwan, Republic of China
Background: To provide timely and accurate medical analysis, surgical strategy, safety and clinical outcome for full endoscopic discectomy for L5-S1 under intravenous sedation and to recognize the prevalence of anatomical anomaly on lumbosacral segments from our case series.
Methods: From October 2004 to July 2017, 301 cases of disc herniations at the L5-S1 level were treated using full endoscopic discectomy through the interlaminar or transforaminal approach by a single neurosurgeon. We retrospectively evaluated the clinical data, including preoperative and postoperative visual analog scale (VAS) scores for low back pain and leg pain, shoulder or axilla approach, lumbosacral bony anomaly, ruptured disc, calcified disc, recurrent disc herniation management and long-term outcome.
Results: All operations were performed under IV sedation while all of the patients were kept conscious. None of them were conversed to other surgical techniques. The prevalence of disc herniation was 62% (187/301) over left side and 38% (114/301) over right side. The prevalence of lumbar sacralization and sacral lumbarization were 4.6% (14/301) and 5.6% (17/301). The prevalence of ruptured and severe calcified disc was 17.9% (54/301) and 3.0% (9/301). The prevalence of pediatric disc herniation was 1% (3/301). Postoperative VAS scores of all patients were significantly improved compared to preoperative status. Seven cases of recurrent disc herniation at the same site were treated with repeated endoscopic surgery and five cases of recurrent disc herniation at the same site were treated with major operation. No failed surgery or complication was recognized.
Conclusions: Percutaneous endoscopic surgery under IV sedation has advantages in enhancing safety and reducing surgical complications. Anatomical anomaly on lumbosacral segments should be recognized preoperatively to avoid incorrect level surgery. L5-S1 endoscopic discectomy using the interlaminar or transforaminal approach is safe and excellent clinical outcome with minimal invasive treatment.