Lumbar Disc Herniation
Conditions
Keywords
lumbar disc herniation, endoscopic discectomy, open discectomy, comparative study, Translaminar, surgery
Brief summary
This study is aimed to compare between the results of conventional lumbar discectomy and the newly used technique in our department; endoscopic lumbar discectomy in neurosurgery department Assiut university hospitals, so that we can offer our patients the best service in an updated and minimally invasive way.
Detailed description
Lumbar discectomy is one of the most common operation performed worldwide for lumbar-related symptoms. Lumbar disc herniation accounts for only 5% of all low back pain problems but is the most common cause of radiating nerve root pain, sciatica. Mixter and Barr described the first surgical procedure to remove the herniated lumbar disc in 1934 through a laminectomy and durotomy, with later enhancement by Semmes, who described approaching the herniated disc through hemilaminectomy and retraction of the dural sac. This became popularized as the classical discectomy technique. During the latter half of the 19th century, more techniques were developed to remove the herniated disc with minimal invasiveness. The first herniated disc excision using a microscope (microdiscectomy) was performed by Yasargil in 1977, which was the standard surgical procedure at the time In 1993, Mayer and Brock and then in 1997, Smith and Foley described endoscopic discectomy techniques. With these minimally invasive techniques, authors demonstrated decreased soft tissue manipulation, operative time, blood loss, and hospital stay, allowing early recovery. In this study we try to evaluate clinical and radiological outcomes of percutaneous endoscopic translaminar discectomy at our hospital.
Interventions
Removal of single level lumbar disc herniation through conventional discectomy.
Removal of single level Lumbar disc herniation using endoscope.
This system will be used to remove herniated disc in endoscopic group
Sponsors
Study design
Eligibility
Inclusion criteria
* single level, postero-lateral, denovo lumbar disc herniation including those with migrated and/or sequestrated discs. * L4,5 &L5,S1 disc prolapse * Failure of conservative management after 12 weeks.
Exclusion criteria
* central, far lateral, recurrent and/or multiple level disc herniation. * Lateral recess stenosis or spondylolisthesis. * presence of neurological deficit.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Improvement of Preoperative low back pain and radicular pain. | Up to ten months post operative. | Improvement of preoperative low back pain and radicular pain.Clinical outcomes will be measured using Visual Analogue Scale. |
| Functional Improvement | Up to ten months post operative. | Functional Improvement using modified MacNab's criteria |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Blood loss | intraoperative. | Amount of blood loss intraoperative. |
| lumbo-sacral MRI | Up to six months | Demonstration of any disc herniation recurrence. |
| Hospital stay. | up to one week. | Time spent in hospital post operative. |
| Wound length | Intraoperative | Length of incision needed by surgeon to complete each approach |
| Operative time | Intraoperative | duration of operation |
| Periprocedural complication. | Up to two weeks. | Such as neurological deficit, Cerebro-Spinal fluid (CSF) leak, wound infection...etc. |