title: Microendoscopic lumbar discectomy: Technique and results of 188 cases.
abstract: BACKGROUND
  Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED) utilizing tubular retractors in terms of safety and efficacy of the technique.
  
  
  METHODS
  188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging) and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN) using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5) for back and leg pain and ODI (Oswestry Disability Index). Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years.
  
  
  RESULTS
  The mean age of patients was 46 years (range 16-78 years) and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months). The mean VAS scale for leg pain improved from 4.14 to 0.76 (P < 0.05) and the mean VAS scale for back pain improved from 4.1 to 0.9 (P < 0.05). The mean ODI changed from 59.5 to 22.6 (P < 0.05). The mean operative time per level was about 50 minutes (range 20-90 minutes). Dural punctures occurred in 11 (5%) cases. Average blood loss was 30 ml (range 10-500 ml). A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement.
  
  
  CONCLUSIONS
  MED for herniated discs effectively achieves the goals of surgery with minimal access. The advantages of the procedure are cosmesis, early postoperative recovery and minimal postoperative morbidity.
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Arvind G
authors.initials: AG
authors.lastname: Kulkarni
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Anupreet
authors.initials: A
authors.lastname: Bassi
authors.affiliation: Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India.
authors.forename: Abhilash
authors.initials: A
authors.lastname: Dhruv
keywords: Herniated nucleus pulposus (HNP); micro endoscopic discectomy; minimal invasive spine surgery