Review article
Minimally invasive surgery in treatment of lumbar disc herniation
Krešimir Rotim
; Clinics for neurosurgery, CHC Sisters of mercy, Zagreb
Marta Borić
; Clinics for neurosurgery, CHC Sisters of mercy, Zagreb
Tomislav Sajko
; Clinics for neurosurgery, CHC Sisters of mercy, Zagreb
Abstract
Lumbar discectomy is still considered the gold standard in surgical management of
symptomatic disc herniation after conservative treatment has failed. Along with conventional
surgical techniques, different methods with minimal damage to neuromuscular spine structures
have been developed and introduced in the last 20 years, all with the purpose to reduce
the postoperative back pain. Advantages of the minimally invasive spine surgery include the
possibility of performing procedures under local anaesthesia, reduced hospital stay, limited
blood loss with consecutively reduced fibrous tissue development, a quick return to work and
everyday activities. From the economical point of view, this kind of treatment is considered to
be a cost-effective intervention. Percutaneous laser disc decompression (PLDD), tubular retractor
system and selective endoscopic discectomy (SED) are minimally invasive methods
used in the treatment of lumbar disc hernia that have been used in Croatia from 2008 in the
Department of neurosurgery of Sestre milosrdnice University Hospital Center. PLDD is based
on a laser beam causing reduction of the intradisc mass and therefore intradisc pressure. The
tubular retractor system combines reliability of conventional microsurgical methods with advantages
of minimally invasive techniques and is based on preventing detachment of paraspinous
muscles and consequently preserving spine stability. SED includes specially designed endoscopes
that provide excellent visualisation and enable pain cause removal with preserving
the healthy part of the disc. Although all these methods are used in the everyday practice,
there is still a lack of controlled prospective studies for evidence-based conclusions on benefits
of minimally invasive spine surgery for lumbar disc hernia treatment.
Keywords
PLDD; SED; surgical techniques; tubular retractors
Hrčak ID:
70138
URI
Publication date:
1.6.2011.
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