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[Application of adjustable oblique position for microendoscopic discectomy]
Huan Wang1, Xue-yong Liu, Lei Li
1Department of Orthopaedic Surgery, the Second Affiliated Hospital, China Medical University, Shenyang 110004, China. spinewh@sohu.com
Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]
|October 1, 2005
Summary
The adjustable oblique position in microendoscopic discectomy (MED) offers better patient endurance and reduced operating time compared to the prone position. This technique also minimizes airway resistance, improving patient outcomes.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
- Surgical Positioning
Background:
- Microendoscopic discectomy (MED) is a minimally invasive technique for treating lumbar disc herniation.
- Patient positioning is crucial for surgical success and patient comfort during MED.
- Traditional prone positioning may lead to complications such as increased airway resistance and patient discomfort.
Purpose of the Study:
- To compare the efficacy and safety of the adjustable oblique position versus the prone position in microendoscopic discectomy (MED).
- To evaluate the advantages of the adjustable oblique position in MED procedures.
Main Methods:
- A comparative study of 128 patients undergoing MED between August 2000 and August 2002.
- Patients were divided into two groups: 47 in prone position and 81 in adjustable oblique position.
- Key metrics recorded included operating time, blood loss, patient endurance, and airway resistance.
Main Results:
- The adjustable oblique position group demonstrated statistically significant improvements in operating time, blood loss, and patient endurance compared to the prone group.
- Prone positioning was associated with higher rates of patient discomfort (rib arch pain, dizziness, nausea) and increased airway resistance.
- The adjustable oblique position resulted in fewer complications, primarily minor shoulder pain or temporary peroneal nerve issues.
Conclusions:
- The adjustable oblique position offers significant advantages for MED, including reduced intra-abdominal pressure and epidural bleeding.
- This position facilitates greater lumbar flexion, increases interlaminar and posterior intervertebral space, and improves visualization of neural structures.
- Enhanced patient comfort, surgeon ergonomics (ability to sit), and improved operative conditions make the adjustable oblique position a superior choice for MED.