Paramedian Small Endoscopic L5-S1 Discectomy

Source: CNS 2002 Philadelphia

Introduction: Outpatient endoscopic discectomies were performed for thirty patients with large L5-S1 free fragments, during the past three years, using an atraumatic small, soft, scope (fragment delivery) technique.

Methods: The scope was fully flexible to beyond 90 degrees, as shown in Surgical Neurology, June 1998, pages 588-598. A 5 mm skin opening, just large enough for the scope, was made 1 cm off midline. Local anesthesia and IV sedation was used. The approach was made between the lamina and dilated up to use a 4.2 mm outer cannula, with the fiber-optic working channel plastic endoscope telescoping through the cannula. Micro-tools were used through the 2.5 mm scope lumen. The 30 patients ranged in age from 29 to 61, 19 males and 11 females. All had sizeable free fragments in the spinal canal at L5-S1 ruptured lateral to the dura. Open microdiscectomy/laminotomy had already been recommended in all cases. All had persistent radicular pain, numbness and/or weakness consistent with the herniation.

Results: Results were tabulated with the Macnab criteria: 26 excellent (no symptoms, no restriction of activity) 3 good (occasional symptoms), 1 poor (no improvement, required further surgery); for an overall success rate of 97%. The only ill effect was that one patient (an early case) developed a small area of mildly increased skin sensitivity which resolved in one week.

Conclusions: This technique provides a direct and non-traumatic approach for reaching and physically removing free fragments at L5-S1 without the access disruption of muscle detachment, ligament and bone removal.

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