Double tractors swing microendoscopic discectomy technique for multi-segmental lumbar disc herniation

Objective To evaluate the effect of double tractors swing microendoscopic discectomy technique in multisegmental lumbar disc herniation.Methods From December 2006 to November 2009,153 patients with multisegmental lumbar disc herniation

Spinal surgeons＇ learning curve for lumbar microendoscopic discectomy： a prospective study of our first 50 and latest 10 cases

Background Microendoscopic discectomy （MED） is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons＇ learning curve. Methods Fifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each： A-E. The control group F was ten MED patients treated later by the same medical team （September-October 2006）. All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure. Results Operation times by group were： A, （107±14） minutes; B, （85±13） minutes; C, （55±19） minutes; D, （52±12） minutes; E, （51±13） minutes; and F, （49±15） minutes. Blood loss were： A, （131±73） ml; B, （75±20） ml; C, （48±16） ml; D, （44±17） ml; E, （45±18） ml; and F, （45±16） ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment （JOA） score of each group in improvement rate immediately and one year after operation were as follows （in percentage）： A, （79.8±8.8）/（89.8±7.7）; B, （78.6±8.5）/（88.5±7.8）; C, （80.8±11.3）/（90.8±6.7）; D, （77.7±11.4）/（88.9±9.3）; E, （84.0±8.7）/（89.6±9.0）; and F, （77.8±11.6）/ （86.9±8.4）. Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups. Conclusions Spinal surgeons performing MED become proficient after 10-20 operations, when their skill becomes fairly sophisticated. Patients＇ improvement rate is the same regardless of surgeons＇ phase of learning curve.

Comparison of safety and efficiency of microendoscopic discectomy with automatic nerve retractor and with nerve hook

This study compares the safety and efficiency of two techniques in microendoscopic discectomy(MED)for lumbar disc herniation.The two techniques are MED with automatic nerve retractor and MED with nerve hook which had been widely used for many years.The former involves a newly developed MED device which contains three parts to protect nerve roots during operation.Four hundred and twenty-eight patients underwent MED treatments between October 2010 and September 2015 were recruited and randomized to either intraoperative utilization of automatic nerve retractor(n紏315,group A)or application of nerve hook during surgery(n=113,group B).Operation time and intraoperative bleeding volume were evaluated.Simultaneously,Visual Analogue Scales(VAS)and muscle strength grading were performed preoperatively,and 1,2,3 days,1,2 weeks,3 and 6 months postoperatively.No dramatic difference of pain intensity was observed between the two groups before surgery and 6 months after surgery(P>0.05).The operation time was shorter in group A(30.3061.89 min)than that in group B(59.4163.25 min).Group A(67.83613.14 ml)experienced a significant decrease in the amount of blood loss volume when compared with group B(100.04615.10 ml).There were remarkable differences of VAS score and muscle strength grading after postoperative 1,2,3 days,1,2 weeks and 3 months between both groups(P≤0.05).MED with automatic nerve retractor effectively shortened operation time,decreased the amount of bleeding,down-regulated the incidence of nerve traction injury.