Background and purpose: Endoscopic methods are increasingly used in spine surgery, including the operative treatment of lumbar disc herniation. In this study we present a clinical series of 45 patients with lumbar disc prolapse who were operated on endoscopically with ENDOSPINE instrumentation (Karl STORZ GmbH and Co. KG), using the Destandau technique.
Material and methods: Between 2005 and 2006 endoscopy was used in 76 operations of lumbar disc prolapse and in 45 patients the entire procedure was performed endoscopically. All procedures were carried out from a posterior approach using a 4 mm Hopkins 0 degrees -telescope placed in the working insert equipped with channels for suction tube, operative instruments and nerve root retractor. The outcome was assessed using modified McNab criteria both directly and three months (in 35 patients) postoperatively.
Results: Good to excellent outcome was achieved in 89% of patients, which is consistent with results reported by experienced authors and comparable with results of "classic" microdiscectomy. Five patients reported no improvement and 3 of them were subsequently reoperated using the open surgical approach. In 3 patients the dural sac was lacerated but none of the tears exceed a few millimetres in length and they were not associated with neural injury. They were easily repaired endoscopically with a patch of "Tachocomb" tissue sealant.
Conclusions: Destandau microendoscopic discectomy (MED) is a novel, safe and effective method that minimizes invasiveness of the surgical approach. Results achieved with this method are comparable to those achieved with "classic" microdiscectomy.