title: Microendoscopic discectomy for lumbar disc herniation with bony fragment due to apophyseal separation.
abstract: The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation with a bony fragment due to apophyseal separation. Eighteen patients with low back pain and unilateral sciatic pain due to lumbar disc herniation with a bony fragment were treated by MED using the unilateral approach (15 males and three females; mean age, of 28.9 years; mean follow-up period, 21.1 months); 18 age-and sex-matched patients with lumbar disc herniation without a bony fragment treated by MED served as the control group. The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA scores; maximum score, 29 points). Evaluation of the results revealed that good surgical outcomes equivalent to those in the control group were obtained in the subjects of LDH with a bony fragment (JOA scores; 14.1+/-3.5 in the patient group vs.15.4+/-2.6 in the control group before surgery; 26.3+/-1.8 in the patient group vs. 26.9+/-1.3 at follow-up after the surgery). Although the mean surgical time was significantly longer in the patient group, there were no intra- or postoperative complications in either group. We conclude that MED using the unilateral approach is a feasible minimally invasive surgical option for patients of lumbar disc herniation with an apophyseal bony fragment.
authors.affiliation: Department of Advanced Therapy for Spine and Spinal Cord, School of Medicine, Keio University, Tokyo, Japan. morio@sc.itc.keio.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Matsumoto
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.forename: T
authors.initials: T
authors.lastname: Tuji
authors.forename: K
authors.initials: K
authors.lastname: Ishii
authors.forename: H
authors.initials: H
authors.lastname: Takaishi
authors.forename: M
authors.initials: M
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Chiba
authors.forename: Y
authors.initials: Y
authors.lastname: Toyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D016103:Spinal Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome