Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.61
Peer-review started: April 24, 2020
First decision: September 14, 2020
Revised: October 14, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: January 6, 2021
Processing time: 248 Days and 7.4 Hours
Lumbar disk herniation is caused by protrusion, extrusion, or sequestration of the intervertebral disk from its usual anatomic location, and may be asymptomatic or result in radiculopathy or non-radicular pain. Conservative treatments are sufficient to manage the condition in most patients, but surgery is indicated in cases of cauda equine syndrome, severe and progressive neurologic deficits, and no improvement after conservative treatments.
Massively prolapsed lumbar intervertebral disc (IVD) herniation has an acute onset and with severe radicular pain and these symptoms or fear of dural compression and cauda equina syndrome can require surgery. Conventional fenestration, transforaminal lumbar interbody fusion (TLIF), and minimally invasive TLIF have definite treatment efficacies and decompression effects and therefore are often used. However, endoscopic discectomy through the interlaminar endoscopic spine system (iLESSYS) Delta 6-mm working channel endoscope, which has been widely applied in the treatment of lumbar spinal stenosis, is possible. But very few studies have used this method for the treatment of prolapsed intervertebral disc herniation.
This retrospective study explored the clinical benefits of treating massively prolapsed IVD herniation with the iLESSYS Delta endoscope.
The clinical data of 37 patients that underwent surgery with the iLESSYS Delta endoscope at The Affiliated Hospital of Qingdao University were retrospectively analyzed. Intraoperative blood loss, operation time, and complications were collected. The visual analog scale (VAS), oswestry disability index (ODI), and modified MacNab criteria were determined before and at 1 d, 3 mo and 6 mo after surgery.
The mean intraoperative blood loss for the 37 patients was 20.4 ± 1.2 mL. The mean operation time was 97.3 ± 12.4 min. The VAS scores for leg decreased from 68.0 ± 7.3 to 2.5 ± 1.7 and back pain decreased from 34.4 ± 8.5 to 5.5 ± 1.9 from the measurements before operation to 6 mo after surgery. The ODI also decreased from 60.2 ± 7.3 to 17.9 ± 3.4 at 6 mo after surgery. The improvement rate of the MacNab score was 86.4%, which was considered excellent. No spinal dural injury, nerve root injury, secondary protrusion of intervertebral disc, or myeloid hypertension was found during follow-up.
We demonstrated that the iLESSYS Delta 6-mm working channel endoscope has several advantages in terms of clinical and functional benefits, complications, and low risk of residual vertebral pulp in treating patients with massively prolapsed IVD herniation.
We consider that further randomized controlled trials are necessary to determine the exact benefits of the iLESSYS Delta 6-mm working channel endoscope for a wide variety of patients.