Publication: Minimally invasive open lumbar discectomy: An alternative to microlumbar discectomy
Date
2009
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abstract
Background: Lumbar disc surgery has come a long way since its first description by Dandy in 19291. Evolving through
the transdural approach and a laminectomy for the removal of a disc, it now surpasses the primal technique with
essentially a minimally invasive procedure, an extradural approach without laminectomy2.
Objective: The objective of this study is to ascertain the effectiveness of Minimally Invasive Open Lumbar Discectomy
in the treatment of lumbar disc prolapse.
Materials and methods: It is a descriptive study entailing the patients with paramedian or central disc prolapse at
single or two consecutive lumbosacral levels undergoing surgery at the National Institute of Neurological and Allied
Sciences, Bansbari, Nepal, over a period of one and a half years. Patients who underwent either laminectomy or bilateral
fenestration were excluded. Results of surgery were measured prospectively in terms of primary outcome measure
(outcome at six months follow up as measured with Prolo Functional and Economic Scale) and secondary outcome
measures (radicular pain relief, mobilisation, complication, and residual disc).
Results: In the series of 137 consecutive patients, 120 fulfilled the criteria. 98.33 % of patients had an improvement
in the radicular pain and ambulation was commenced from the first post-operative day. There were three instances of
inadvertent dural tear without fascicle injury, and one instance of residual disc requiring reoperation. At 6 months, 97.5
% had good to excellent (grade 4, or 5) results reaching the premorbid states in the Prolo Functional and Economic
Scale.
Conclusion: The results of Minimally Invasive Open Lumbar Discectomy compare favourably with those of a
microlumbar discectomy, and could therefore be an alternative to the latter in resource deprived circumstances.
Key words: Disc prolapse, Minimally Invasive Open Lumbar Discectomy, Microlumbar Discectomy
Description
Devkota UP 1, Lohani S 2, Joshi RM 3
1 Consultant Neurosurgeon, 2Medical Officer, 3Registrar, National Institute of Neurological and Allied Sciences, Bansbari, Nepal