Preparative Analysis for Precision Lumbar Endoscopic Disc Surgery

Source: CNS 2001 San Diego, California

Introduction: Thirty patient files, from the past two years, were randomly selected for review. These were all patients who subsequently underwent an endoscopic discectomy for herniated disc, as well as specific intradiscal thermal treatment, where indicated.

Methods: Contrast was placed into the disc through an 18 gauge needle. Access positional analysis and subsequent CT scanning with markers provided mapping data. The radiologic evaluation was done independently from the surgical team. Patient ages varied from 16 to 63, with 18 male and 12 female. Sixteen patients had primary signs and symptoms on the right and fourteen on the left side. In all cases, the patients symptoms were reproduced with the procedure.

Results: In twenty-two of the thirty patients, the disc herniation was shown better than on MRI; and in twenty-one of the thirty, fissuring and internal disc changes (potentially treatable endoscopically) were demonstrated which were not noted on MRI; twenty-six of the thirty had either the disc herniation shown better or fissuring and internal changes shown better.

Conclusions: Contrast analysis provided important additional information in all cases. In 86.67% of the cases reviewed (26 of the 30), contrast analysis and mapping were essential to the pre-operative planning and decision process needed for precise, focused treatment of the specific pathology.

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