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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Conventional | Active Comparator | Patients in this arm will have conventional open lumbar discectomy operation. |
|
| Endoscopic | Active Comparator | Patients in this arm will have Percutaneous Endoscopic Translaminar lumbar discectomy operation using Easy Go system Endoscopy |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Conventional open lumbar discectomy | Procedure | Removal of single level lumbar disc herniation through conventional discectomy. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Improvement of Preoperative low back pain and radicular pain. | Improvement of preoperative low back pain and radicular pain.Clinical outcomes will be measured using Visual Analogue Scale. | Up to ten months post operative. |
| Functional Improvement | Functional Improvement using modified MacNab's criteria | Up to ten months post operative. |
| Measure | Description | Time Frame |
|---|---|---|
| Hospital stay. | Time spent in hospital post operative. | up to one week. |
| Periprocedural complication. | Such as neurological deficit, Cerebro-Spinal fluid (CSF) leak, wound infection...etc. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mohammad T Ahmed, Professor | Head of Neurosurgery Department, Assiut University Hospitals | Study Chair |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 17443505 | Background | Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse. Cochrane Database Syst Rev. 2007 Apr 18;2007(2):CD001350. doi: 10.1002/14651858.CD001350.pub4. | |
| 18500517 | Background | Gotfryd A, Avanzi O. A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations. Int Orthop. 2009 Feb;33(1):11-7. doi: 10.1007/s00264-008-0559-2. Epub 2008 May 24. |
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| ID | Term |
|---|---|
| D007405 | Intervertebral Disc Displacement |
| ID | Term |
|---|---|
| D013122 | Spinal Diseases |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
| D006547 | Hernia |
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| Percutaneous Endoscopic Translaminar lumbar discectomy. | Procedure | Removal of single level Lumbar disc herniation using endoscope. |
|
| Easy Go system Endoscopy | Device | This system will be used to remove herniated disc in endoscopic group |
|
| Up to two weeks. |
| Blood loss | Amount of blood loss intraoperative. | intraoperative. |
| lumbo-sacral MRI | Demonstration of any disc herniation recurrence. | Up to six months |
| Operative time | duration of operation | Intraoperative |
| Wound length | Length of incision needed by surgeon to complete each approach | Intraoperative |
| 25485257 | Background | Evaniew N, Khan M, Drew B, Kwok D, Bhandari M, Ghert M. Minimally invasive versus open surgery for cervical and lumbar discectomy: a systematic review and meta-analysis. CMAJ Open. 2014 Oct 1;2(4):E295-305. doi: 10.9778/cmajo.20140048. eCollection 2014 Oct. |
| 25695066 | Background | Jiang W, Sun B, Sheng Q, Song X, Zheng Y, Wang L. Feasibility and efficacy of percutaneous lateral lumbar discectomy in the treatment of patients with lumbar disc herniation: a preliminary experience. Biomed Res Int. 2015;2015:378612. doi: 10.1155/2015/378612. Epub 2015 Jan 28. |
| D020763 |
| Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |