Tubular strategy to minimally invasive microdiscectomy for pediatric lumbar disc herniation.

Lumbar Epidural

Tubular strategy to minimally invasive microdiscectomy for pediatric lumbar disc herniation.

J Neurosurg Pediatr. 2018 Feb 23;:1-7

Authors: Montejo JD, Camara-Quintana JQ, Duran D, Rockefeller JM, Conine SB, Blaise AM, Kahle KT, DiLuna ML

Summary
OBJECTIVE Lumbar disc herniation (LDH) within the pediatric inhabitants is uncommon and reveals distinctive traits in contrast with grownup LDH. There are restricted knowledge concerning the protection and efficacy of minimally invasive surgical procedure (MIS) utilizing tubular retractors in pediatric sufferers with LDH. Right here, the outcomes of MIS tubular microdiscectomy for the therapy of pediatric LDH are evaluated. METHODS Twelve consecutive pediatric sufferers with LDH have been handled with MIS tubular microdiscectomy on the authors’ establishment between July 2011 and October 2015. Knowledge have been gathered from retrospective chart overview and from mail or digital questionnaires. The Macnab standards and the Oswestry Incapacity Index (ODI) have been used for consequence measurements. RESULTS The imply age at surgical procedure was 17 ± 1.6 years (vary 13-19 years). Seven sufferers have been feminine (58%). Previous to surgical intervention, 100% of sufferers underwent conservative therapy, and 50% had epidural steroid injections. Preoperative low-back and leg ache, constructive straight leg increase, and myotomal leg weak point have been famous in 100%, 83%, and 67% of sufferers, respectively. The median length of signs previous to surgical procedure was 9 months (vary 1-36 months). The LDH stage was L5-S1 in 75% of sufferers and L4-5 in 25%. The imply ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ? 25 ml in 92% of sufferers (most 50 ml), and no intraoperative or postoperative issues have been famous at 30 days. The median hospital size of keep was 1 day (vary Zero-Three days). The median follow-up length was 2.2 years (vary Zero-5.eight years). One affected person skilled reherniation at 18 months after the preliminary operation and required a second same-level MIS tubular microdiscectomy to realize decision of signs. Of the 11 sufferers seen for follow-up, 10 sufferers (91%) reported wonderful or good satisfaction based on the Macnab standards on the final follow-up. Just one affected person reported a good stage of satisfaction through the use of the identical standards. Seven sufferers accomplished an ODI analysis on the final follow-up. For these 7 sufferers, the imply ODI low-back ache rating was 19.7% (SEM 2.eight%). CONCLUSIONS To the authors’ data, that is the longest outcomes research and the most important sequence of pediatric sufferers with LDH who have been handled with MIS microdiscectomy utilizing tubular retractors. These knowledge recommend that MIS tubular microdiscectomy is protected and efficacious for pediatric LDH. Bigger potential cohort research with longer follow-up are wanted to raised consider the long-term efficacy of MIS tubular microdiscectomy versus different open and MIS methods for the therapy of pediatric LDH.

PMID: 29473813 [PubMed – as supplied by publisher]

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