เปรียบเทียบผลการผ่าตัดโรคหมอนรองกระดูกสันหลังทับเส้นประสาทแบบส่องกล้องและแบบแผลเปิดในโรงพยาบาลระยอง

Phattareeya Pholprajug

Authors

Phattareeya Pholprajug Rayong Hospital

Abstract

Background : Lumbar disc herniation is one of the most common disease of lumbar spine. The treatment options are medication, physical therapy and surgical management. Many patients met the indication of surgery or the failure of conservative treatment, and need the surgical treatment for decompression lumbar nerve root from disc herniation and reduction of pain. There are several techniques of lumbar discectomy including open discectomy, open microscopic discectomy, microendoscopic discectomy (MED) and full endoscopic discectomy which is the least invasive surgery of lumbar spine surgery and become more popular among spine surgeon about last two decades.

Methods : January 2018 -September 2022, a total of 43 consecutive patients who had undergone open lumbar discectomy (23 patients) and endoscopic discectomy(20 patients) with lumbar disc herniation of L3/4, L4/5 or L5/S1 in our institute were retrospectively reviewed. Intraoperative and postoperative outcomes including operative time, blood loss, length of hospital stay and time to ambulation are retrospective collect in both groups. Clinical outcomes were assessed with Oswestry Disability Index (ODI), Visual Analog Scales (VAS) back and leg, EQ5D score, EQ5D scale and satisfaction score at 6 months in endoscopic group and 1 year in both groups.

Results : Total 23 patients in open group; 20 patients in endoscopic group were compared. Endoscopic group show lower intraoperative blood loss (10ml and 50ml; p<0.001), shorter length of hospital stay (3 days and 6 days; p<0.001) and shorter time to ambulation (1 day and 2 days; p<0.001), however, longer operative time (105 mins and 75mins; p<0.001). In clinical results revealed reduction VAS (back ang leg) and ODI, as well as, improve EQ5D score and EQ5D scale 1 year postoperative in both groups with good to excellent satisfaction score.

Conclusion : Advantages of endoscopic discectomy overcome open discectomy in lumbar disc herniation. Reduction of intraoperative blood loss, shorter length of hospital stay, and early ambulation are gained. Improvement of clinical score at 6 months and 1year postoperative. However, the surgical procedure need a special training and high learning curve, also.

Author Biography

Phattareeya Pholprajug, Rayong Hospital

Office of Medical Service

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