A PRELUDE TO SMALL GUIDED LUMBAR ENDOSCOPIC DISCECTOMY

Source: IITS 2005, San Diego

Abstract:
Thorough planning for a precise small-guided endoscopic approach to lumbar disc pathology is of the utmost importance. To achieve this, Enhanced Discography of the affected levels is performed. A CT scan is done which includes focal cuts at the affected levels as well as full thickness abdominal cuts called “wide views” with the presence of different metallic markers.

This combined clinical-radiological study allows determining the size and location of the herniation and the presence of fissures usually with greater accuracy than the MRI. It also provides a route map for the guide-wire passage.

A retrospective analysis of 122 preoperative mappings performed in the past two years was done. A Radiologist independent from the surgical team, performed the radiological evaluation.

The patient population was comprised as follows: 91 males (75%) and 31 females (25%) with an age range from 15 to 65 years and an average 38.86 years. 93 % and 88 % of the patients presented to consult with lower back pain and radiculitis symptoms respectively. The physical examination showed objective sings of radiculopathy in 76 % of the cases.

Internal disc derangement and fissuring was shown in 70% of the cases of post-contrast CT, which were not noted on MRI. When comparing Enhanced Discography with MRI, the size and location of the herniation was demonstrated with greater accuracy in 48% of the cases. The lumbar disc analysis provided important additional information in all cases.

Conclusion: Enhanced Discography provided more accurate information than MRI in 78% of the population regarding disc herniation characteristics and disc derangement/ fissuring. This clinical-radiological study is essential to the pre-operative planning and decision process in order to provide precise treatment of the specific pathology through small-guided lumbar endoscopic discectomy.