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Neurochirurgia endoscopică a herniei discale lombare (studiu comparativ)


Author: Bodiu Aureliu
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2008
Scientific adviser: Grigore Zapuhlih
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific consultant: Stanislav Groppa
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution:

Status

The thesis was presented on the 3 September, 2008
Approved by NCAA on the 18 September, 2008

Abstract

Adobe PDF document – 0.78 Mb / in romanian

Thesis

CZU 616.34-007.43-031:611.959+616.8-089-072

Adobe PDF document 5.21 Mb / in romanian
143 pages

Keywords

lumbar disc herniation, minimally invasive discectomy, outcome, quality of life, functional disability, Destandau

Summary

Low back pain is a very common disorder. Many international surveys of low back pain report a point prevalence of 15% to 30%, a 1-month prevalence between 19% and 43%, and a lifetime prevalence of about 60% to 80%. Population surveys suggest that the patients with low back problems became younger and they show a high grade of functional disability.

The present study is based on the 150 patients with lumbar disc herniation, operated at the Institute of Neurology and Neurosurgery during the period 2005 – 2008. The goal of the research was to improve the results of surgical treatment in patients with paramedian and posterolateral lumbar disc herniation by implementing of minimally invasive endoscopic technique. Among these patients 66 (44%) were male and 84 (56%) – female, the patient’s age varied from 18 to 75 years, mean age – 41,5 years.

Corresponding to the method of the treatment all the patients were divided in 3 groups. In the patients of the 1st group – 50 patients the standard open discectomy was performed. In the patients of the second group – 50 patients the microsurgical discectomy was performed. In the patients of the third group – 50 patients minimally invasive endoscopic discectomy by Destandau was performed.

The duration of hospitalization in the patients from the I group was 8,8±0,39 days, in the children from the II group it was 8,5±0,26 days, in the III group it was 5,8±0,23 days.

Postoperative complications were recorded in 12% cases in endoscopic group, 16% - in microsurgical group and 18% - in open discectomy group. Mean rate of complication was 15,3%.

The efficiency of surgical treatment was appreciated by using several scale and questionnaires. To study the changes of the functional disability Oswestry Disability Index questionnaire was used. At the end of 6 month this index decreased from 61,8 to 20,2% in open surgery group, form 56,4 to 18,9% in microsurgical group and from 59,5 to 9,6% in endoscopic group. The analysis of results of improving the quality of life shows that the EQ-5D index was 0,74±0,01 in open surgery group, 0,76±0,01 in microsurgical group and 0,82±0,01 in endoscopic group.

Conclusion: The endoscopic system by Destandau is safe and effective for performing minimally invasive lumbar microdiscectomy. Careful attention to surgical technique will ensure that complications are minimized and will optimize patient outcomes. The benefits of minimally invasive spinal surgery were the reduced occurrence of complications, the comparable rate of recurrences, shorter hospitalization and better improvement of functional disability and quality of life.