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Feasibility of endoscopic discectomy by inter laminar approach at a high volume tertiary public hospital in a developing country.

BACKGROUND
Surgical treatment for lumbar disc herniation consists of discectomy performed either open or minimally invasive techniques. Endoscopic discectomy using the tubular retractor is been increasingly used as it gives advantage of smaller incision, less tissue injury and faster recovery. The aim of this study was to check its feasibility and learning curve at a tertiary public sector hospital with a large volume load (more than 50 spine surgeries per month) with treatment provided free of cost.


METHODS
Eighty patients underwent endoscopic discectomy using tubular retractor were prospectively followed for a period of 12 months. All patients included were having disc herniation at a single level after appropriate conservative trial of 6 weeks. Patients with segmental instability or previous spine surgery were excluded. All were operated by a single senior orthopaedic surgeon. Duration of surgery, blood loss, and day of mobilization, complications and duration of hospitalisation were noted. VAS for pain, Oswestry Disability Index, SF 12 and modified MacNab criteria were used to assess the functional outcome.


RESULTS
Mean age of patients was 34.9 years (range 17 to 72 years) with sex ratio of 2.6:1. The mean VAS score improved from 8 to 1.1, Oswestry Disability Index from 52 to 20 and SF 12 scores (MCS/PCS) from 34/43 to 49.2/56. According to modified MacNab criteria there were 77.5% excellent, 13.75% good, 7.5% fair and 1.25% poor cases. Average surgical duration was 48.75 min and blood loss was 32.13 mL. There were 3 dural tears, 1 infection, 2 recurrences and 1 sensory radiculopathy.


CONCLUSIONS
Endoscopic discectomy using tubular retractor has a potential to become a gold standard in catering this patient groups. It has great feasibility and shows equivalent results to all other techniques with lesser learning curve being an added advantage.