Minimally invasive surgery in treatment of lumbar disc herniation

摘要

Lumbar discectomy is still considered the gold standard in surgical management ofsymptomatic disc herniation after conservative treatment has failed. Along with conventionalsurgical techniques, different methods with minimal damage to neuromuscular spine structureshave been developed and introduced in the last 20 years, all with the purpose to reducethe postoperative back pain. Advantages of the minimally invasive spine surgery include thepossibility of performing procedures under local anaesthesia, reduced hospital stay, limitedblood loss with consecutively reduced fibrous tissue development, a quick return to work andeveryday activities. From the economical point of view, this kind of treatment is considered tobe a cost-effective intervention. Percutaneous laser disc decompression (PLDD), tubular retractorsystem and selective endoscopic discectomy (SED) are minimally invasive methodsused in the treatment of lumbar disc hernia that have been used in Croatia from 2008 in theDepartment of neurosurgery of Sestre milosrdnice University Hospital Center. PLDD is basedon a laser beam causing reduction of the intradisc mass and therefore intradisc pressure. Thetubular retractor system combines reliability of conventional microsurgical methods with advantagesof minimally invasive techniques and is based on preventing detachment of paraspinousmuscles and consequently preserving spine stability. SED includes specially designed endoscopesthat provide excellent visualisation and enable pain cause removal with preservingthe 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 benefitsof minimally invasive spine surgery for lumbar disc hernia treatment.