Full-Videoendoscopic Interlaminar Surgery for the Treatment of Lumbar Disc Herniations—A Series of 50 Cases

Abstract

The present study aims to describe the results of full-videoendoscopic surgery through the interlaminar route for central lumbar disc herniation in a series of 50 cases in Brazil.

This is a retrospective single-center study. With the aim of describing safety, the present study reports the complication and revision rates. The clinical results were collected with the visual analogue scale (VAS) and with the Oswestry Disability Index (ODI) (a questionnaire to evaluate functional disability) at the preoperative visit and at 6 months postsurgery.

The average surgical time was 20 minutes (range: 9–40 minutes), and 100% of the procedures were performed in an outpatient setting. The mean VAS scores improved from 9.4 to 1.1 (p < 0.001), and the mean ODI scores decreased from 69 to 9 points in the last follow-up (p < 0.001). There was 1 case (2%) with hernia recurrence, 1 case with intraoperative root injury (2%), and 2 cases (4%) that required lumbar fusion due to a preexisting instability. No infections were observed.

The full-videoendoscopic surgery is a modern option for treating lumbar disc herniation. In the present study, we have observed that the use of this technique for the removal of fragments affecting the vertebral canal presented satisfactory clinical results, low complication rates, and that it has demonstrated its feasibility in an outpatient setting without prolonged hospitalization.

Resumo

O objetivo do presente estudo é descrever os resultados do uso da cirurgia totalmente videoendoscópica para a retirada de hérnias centrais, utilizando a rota interlaminar em uma série de 50 casos no Brasil.

Estudo não comparativo de série de casos com análise retrospectiva de dados coletados prospectivamente em um único centro. Com o intuito de descrever a segurança, foram relatadas as complicações e também as reoperações e recidivas observadas durante o seguimento. Para a realização da análise de resultados clínicos, foram utilizados como instrumentos a escala visual analógica (EVA) e o índice Oswestry de incapacidade (ODI, na sigla em inglês) (questionário para a quantificação de incapacidade funcional) antes e 6 meses após a cirurgia.

O tempo médio de cirurgia foi de 20 minutos (entre 9 e 40 minutos), com 100% dos pacientes tendo alta hospitalar no mesmo dia do procedimento. A média da EVA melhorou de 9,4 para 1,1 (p < 0,001), e a média do ODI caiu de 69 para 9 pontos no último acompanhamento (p < 0,001). Houve recidiva de hérnia em 1 caso (2%), 1 lesão intraoperatória (2%) de raiz, e necessidade de artrodese lombar em 2 casos (4%). Não ocorreu nenhum caso de infecção.

A cirurgia totalmente videoendoscópica é uma opção moderna para a retirada de hérnia de disco lombar. No presente trabalho, vimos que a utilização desta técnica para a retirada de fragmentos acometendo o canal vertebral gerou ótimos resultados de resolução clínica, com baixas complicações, e demonstrou ser factível em modelo ambulatorial sem internação hospitalar prolongada.

Keywords

endoscopy - intervertebral disc displacement - minimally invasive surgical procedures - lumbar spine

Palavras-chave

endoscopia - deslocamento do disco intervertebral - procedimentos cirúrgicos minimamente invasivos - coluna vertebral

• References

• 1 Yasargil MG. Microsurgical Operation of Herniated Lumbar Disc. In: Wüllenweber R, Brock M, Hamer J, Klinger M, Spoerri O. , organizadorers. Lumbar Disc Adult Hydrocephalus [Internet]. Springer Berlin Heidelberg; 1977 [citado 30 de agosto de 2016]. p. 81–81. (Advances in Neurosurgery). Disponível em: http://link.springer.com/chapter/10.1007/978-3-642-66578-3_16
• 2 Hijikata S, Yamagishi M, Nakayama T, Oomori K. Percutaneous nucleotomy. A new treatment method for lumbar disc herniation. J Toden Hosp. 1975; 5: 39-44
• 3 Castro Id, Santos DP, Christoph DH, Landeiro JA. The history of spinal surgery for disc disease: an illustrated timeline. Arq Neuropsiquiatr 2005; 63 (3A): 701-706
• 4 McAfee PC, Phillips FM, Andersson G. , et al. Minimally invasive spine surgery. Spine 2010; 35 (26, Suppl) S271-S273
• 5 McAfee PC, Garfin SR, Rodgers WB, Allen RT, Phillips F, Kim C. An attempt at clinically defining and assessing minimally invasive surgery compared with traditional “open” spinal surgery. SAS J 2011; 5 (04) 125-130
• 6 Biasi P, Roso L, Manfroi G. , et al. Chiari IV Malformation, the Lückenschädel and Sagittal Craniosynostosis Association: Case Report and Literature Review. Arq Bras Neurocir. 2015; 35 (01) 74-77
• 7 Giannetti A, Guimarães R, Crosara P. Acesso transesfenoidal aos adenomas hipofisários: do microscópio ao endoscópio. Arq Bras Neurocir Braz Neurosurg [Internet]. 29 de março de 2016 [citado 31 de agosto de 2016]; Disponível em: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0036-1580737
• 8 Magalhães M, Ferreira V. Síndrome compressiva de múltiplos nervos na dermatopolimiosite: relato de caso. Arq Bras Neurocir. 2016; 35 (01) 85-88
• 9 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27 (07) 722-731
• 10 García CM. Endoscopia lumbar póstero lateral con sistema YESS: reporte preliminar. Coluna/Columna 2009; 8 (02) 192-196
• 11 Ruetten S. The Full-endoscopic Interlaminar Approach for Lumbar Disc Herniations. In: M.D HMM, organizador. Minimally Invasive Spine Surgery [Internet]. Springer Berlin Heidelberg; 2006 [citado 30 de agosto de 2016]. p. 346–55. Disponível em: http://link.springer.com/chapter/10.1007/3-540-29490-2_38
• 12 Ruetten S, Komp M, Godolias G. Full-endoscopic interlaminar operation of lumbar disc herniations using new endoscopes and instruments. Orthop Prax 2005; 10: 527-532
• 13 Alvarenga MAM, Vargas AAR, de Lima MSX, Kallef PR. Descrição da técnica cirúrgica minimamente invasiva vídeo totalmente endoscópica interlaminar para tratamento de hérnia de disco lombar. Arq Bras Neurocir. 2014; 33 (03) 202-206
• 14 Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978; 37 (04) 378-381
• 15 Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine 2007; 32 (04) 481-486
• 16 SBOT, SBN. Hérnia de Disco Lombar no Adulto: Tratamento Cirúrgico. Diretrizes Clínicas Na Saúde Supl AMB ANSS. 2011 ;1–8.
• 17 Kotilainen E, Valtonen S. Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir (Wien) 1993; 125 (1-4): 120-126
• 18 Johnsson KE, Redlund-Johnell I, Udén A, Willner S. Preoperative and postoperative instability in lumbar spinal stenosis. Spine 1989; 14 (06) 591-593
• 19 Zander T, Rohlmann A, Klöckner C, Bergmann G. Influence of graded facetectomy and laminectomy on spinal biomechanics. Eur Spine J 2003; 12 (04) 427-434
• 20 Choi G, Lee SH, Raiturker PP, Lee S, Chae YS. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery 2006; 58 (1, Suppl): ONS59-ONS68 , discussion ONS59–ONS68
• 21 Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien) 1995; 133 (3-4): 107-111
• 22 Balderston RA, Gilyard GG, Jones AA. , et al. The treatment of lumbar disc herniation: simple fragment excision versus disc space curettage. J Spinal Disord 1991; 4 (01) 22-25
• 23 Türeyen K. One-level one-sided lumbar disc surgery with and without microscopic assistance: 1-year outcome in 114 consecutive patients. J Neurosurg 2003; 99 (3, Suppl) 247-250
• 24 Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 2005; 30 (22) 2570-2578
• 25 Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 2008; 33 (09) 931-939
• 26 Ruetten S, Komp M, Merk H, Godolias G. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 2009; 22 (02) 122-129
• 27 Righesso O, Falavigna A, Avanzi O. Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery 2007; 61 (03) 545-549 , discussion 549
• 28 Majeed SA, Vikraman CS, Mathew V. , S AT. Comparison of outcomes between conventional lumbar fenestration discectomy and minimally invasive lumbar discectomy: an observational study with a minimum 2-year follow-up. J Orthop Surg Res 2013; 8: 34
• 29 Smith JS, Shaffrey CI, Sansur CA. , et al; Scoliosis Research Society Morbidity and Mortality Committee. Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine 2011; 36 (07) 556-563
• 30 Ramirez LF, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals. Neurosurgery 1989; 25 (02) 226-230 , discussion 230–231
• 31 Davis RA. A long-term outcome analysis of 984 surgically treated herniated lumbar discs. J Neurosurg 1994; 80 (03) 415-421
• 32 Hellbusch LC, Helzer-Julin M, Doran SE. , et al. Single-dose vs multiple-dose antibiotic prophylaxis in instrumented lumbar fusion--a prospective study. Surg Neurol 2008; 70 (06) 622-627 , discussion 627
• 33 Shaffer WO, Baisden J, Fernand R, Matz PG. Antibiotic Prophylaxis in Spine Surgery. In: Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care. NASS Evidence-Based Clinical Guidelines Committee; 2013
• 34 Weinstein JN, Lurie JD, Tosteson TD. , et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine 2008; 33 (25) 2789-2800
• 35 Huang T, Tian Z, Li M. , et al. Sequestrectomy versus microdiscectomy in the treatment of lumbar disc herniation: a meta-analysis. Int J Clin Exp Med 2015; 8 (05) 7261-7269
• 36 Choi G, Lee SH, Nicolau RJ. Discectomia endoscópica percutânea lombar (DELP). Coluna/Columna 2008; 7 (02) 177-182
• 37 Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A. Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: A meta-analysis. Int J Surg 2016; 31: 86-92
• 38 Allen RT, Garfin SR. The economics of minimally invasive spine surgery: the value perspective. Spine 2010; 35 (26, Suppl): S375-S382
• 39 Anderson DG, Wang P. Value analysis of minimally invasive spine surgery. Semin Spine Surg 2014; 26 (01) 52-55
• 40 Deluzio KJ, Lucio JC, Rodgers WB. Value and cost in less invasive spinal fusion surgery: lessons from a community hospital. SAS J 2010; 4 (02) 37-40
• 41 Lucio JC, Vanconia RB, Deluzio KJ, Lehmen JA, Rodgers JA, Rodgers W. Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy 2012; 5: 65-74