A 10-Year Follow-Up Study on Long-Term Clinical Outcomes of Lumbar Microendoscopic Discectomy

Abstract

Object The aim of this study was to determine the 10-year clinical outcomes of microendoscopic discectomy (MED), a surgical procedure for the treatment of lumbar disc herniation (LDH).

Methods A total of 151 patients with LDH were treated with MED and followed postoperatively for up to 10 years. The modified MacNab criteria were used to examine the clinical outcomes. In a subset of patients (n=107), the disc-height ratio was measured radiographically according to the Mochida’s method.

Results Based on the modified MacNab criteria, 120 (79%) patients were rated as excellent, 20 (12.9%) as good, 7 (4.6%) as fair, and 5 (3.5%) as poor. Only 5 patients (3.5%) required additional surgery due to a recurrence of herniation. Other complications included intraoperative dural lacerations (5 patients) and spondylodiscitis (3 patients). Mochida’s method showed an average disc-height ratio of 76.25%. Approximately 67% of the patients were able to maintain their primary occupations.

Conclusion The 10-year follow-up study showed that the long-term clinical outcomes of MED are satisfactory and better than those of the traditional discectomy procedure. The MED procedure is both feasible and efficacious for the treatment of LDH.

Keywords

endoscopy-assisted ­microsurgery - minimally invasive surgery - endoscopy - outcome

• References

• 1 Casal-Moro R, Castro-Menendez M, Hernandez-Blanco M , et al. Long-term outcome after microendoscopic diskectomy for lumbar disk herniation: a prospective clinical study with a 5-year follow-up. Neurosurgery 2011; 68: 1568-1575
• 2 Yorimitsu E, Chiba K, Toyama Y , et al. Long-term outcomes of standard discectomy for lumbar disc herniation: A follow-up study of more than 10 years. Spine 2001; 26: 652-657
• 3 Loupasis GA, Stamos K, Katonis PG , et al. Seven- to 20-year outcome of lumbar discectomy. Spine 1999; 24: 2313-2317
• 4 Morgan-Hough CV, Jones PW, Eisenstein SM. Primary and revision lumbar discectomy. A 16-year review from one centre. J Bone Joint Surg 2003; 85: 871-874
• 5 Smith MM, Foley KT. Microendoscopic discectomy (MED): the first 100 cases. Neurosurgery 1998; 43: 702
• 6 Foley KT, Smith MM. Microendoscopic discectomy for far lateral lumbar disc herniations. Neurosurgery 1998; 43: 716
• 7 Matsumoto M, Hasegawa T, Ito M , et al. Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the committee on spinal endoscopic surgical skill qualification of Japanese orthopaedic association. J Orthop Sci 2010; 15: 92-96
• 8 Lyson T, Mariak Z, Jadeszko M , et al. Results of Destandau microendoscopic lumbar discectomy. Neurol-Neurochir-Pol 2008; 42: 105-111
• 9 Smith JS, Ogden AT, Shafizadeh S , et al. Clinical outcomes after microendoscopic discectomy for recurrent lumbar disc herniation. J Spinal Disord Tech 2010; 23: 30-34
• 10 Salame K, Lidar Z. Minimally invasive approach to far lateral lumbar disc herniation: technique and clinical results. Acta Neurochir 2010; 152: 663-668
• 11 Liu WG, Wu XT, Guo JH , et al. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol 2010; 33: 780-786
• 12 Kim KT, Park SW, Kim YB , et al. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine 2009; 34: 2674-2678
• 13 McGirt MJ, Eustacchio S, Varga PA , et al. Prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 2009; 34: 2044-2051
• 14 Sommerstein R, Jung HH, Knoblauch C. Cerebral venous sinus thrombosis as a complication of a microendoscopic discectomy. Eur Neurol 2011; 65: 72-73
• 15 Nakagawa H, Kamimura M, Uchiyama S , et al. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 2003; 10: 231-235
• 16 Huang TJ, Hsu RW, Li YY , et al. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 2005; 23: 406-411
• 17 Muramatsu K, Hachiya Y, Morita C. Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love’s method. Spine 2001; 26: 1599-1605
• 18 Schick U, Dohnert J, Richter A , et al. Microendoscopic lumbar discectomy versus open surgery: An intraoperative EMG study. Eur Spine J 2002; 11: 20-26
• 19 Ikuta K, Arima J, Tanaka T , et al. Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis. J Neurosurg Spine 2005; 2: 624-633
• 20 Rong LM, Xie PG, Shi DH , et al. Spinal surgeons’ learning curve for lumbar microendoscopic discectomy: a prospective study of our first 50 and latest 10 cases. Chin Med J 2008; 121: 2148-2151
• 21 Isaacs RE, Podichetty V, Fessler RG , et al. Microendoscopic discectomy for recurrent disc herniations. Neurosurg Focus 2003; 15: E11
• 22 Oertel JMK, Mondorf Y, Gaab MR. A new endoscopic spine system: the first results with “Easy GO”. Acta Neurochir 2009; 151: 1027-1033