A Clinical Study of Microsurgery of Herniated Lumbar Disc.
- Author:
Jung Kyo LEE
1
;
Young Soo KIM
Author Information
1. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
"Failed disc" syndrome;
Microsurgery of herniated lumbar disc
- MeSH:
Diskectomy;
Early Ambulation;
Epidural Space;
Female;
Hemostasis;
Humans;
Lighting;
Male;
Microsurgery*;
Pain, Postoperative;
Pathology;
Spine;
Tomography, X-Ray Computed
- From:Journal of Korean Neurosurgical Society
1984;13(4):735-741
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The lumbar discectomy has steadily improved since its introduction by Mixter and Barr in 1934. The results of standard discectomy are good, but surgeons must still contend with the "failed disc" syndrome. This is most likely caused by excessive damage to the contents of the epidural space during surgery. The application of microsurgical techniques to lumbar discectomy greatly minimizes disruption of the integrity of normal anatomy. Meticulous hemostasis may help to speed the process of convalescene, and the retention of epidural fat around the nerve root may help to prevent adhesions, which is a common cause of late, "failed disc" syndrome. High resolution computerized tomography of the lumbar spine provides an accurate means of preoperatively assessing both bony and soft tissue pathology of the spine, including nerve roots and the thecal sac. The author reviewed 84 cases of microsurgery of herniated lumbar discs at Yonsei University, Severance hospital and Young Dong hospital from April, 1982 to August, 1982 to August, 1983. Conclusions: 1) Among 84 patients, the ratio of male to female was 1.63:1(52pts:32pts) and cases in the 3rd and 4th decades were 60.7% of the total. 2) The most frequent level of herniation was L4-5 intervertebral space(73%), left side. 3) In preoperative studies, a spinal CT scan was taken in 78pts(93%), and in 31pts(37%), a spinal CT scan alone was taken. The accuracy of spinal CT scan was 100%. 4) Of operative findings, 50 lesions(60%) were identified as protruding discs and 34 lesions(18.1%) as ruptured ones. 5) Among 84 cases, 31pts(37%) received flavotomy and 53pts(63%) received flavectomy or small partial hemilaminectomy. 6) The advantages of microsurgery of herniated lumbar discs were magnified vision and brilliant illumination, precise identification of structures in deep fields(including nerve root and its related structures), a marked advantage to dissect the adhered nerve root to its surrounding structures, its capacity to preserve the integrity of normal tissue, and meticulous hemostasis. This resulted in marked reduction in immediate postoperative pain, early ambulation and early discharge. 7) 100% of microsurgery for herniated lumbar disc disclosed from good to excellent results. 8) After microsurgery, no cases needed re-operation and there were no recurrent disc herniations.
