[Accurate nerve orientation before micro endoscopic discectomy for lumber disc prolapse]

Area of Science:

• Neurosurgery
• Radiology
• Minimally Invasive Spine Surgery

Background:

• Micro endoscopic discectomy (MED) is a minimally invasive procedure for lumbar disc prolapse.
• Accurate pre-operative nerve and disc localization is crucial for MED success and safety.
• Traditional methods may have limitations in precisely guiding surgical instruments.

Purpose of the Study:

• To evaluate the safety and efficacy of computerized tomography myelography (CTM) and computerized tomography discography (CTD).
• To assess their role in accurately orientating the nerve root prior to MED.
• To determine the impact on surgical outcomes and patient recovery.

Main Methods:

• Eighty-seven patients with lumbar disc prolapse underwent MED.
• Pre-operative imaging included CTM (85 patients) and CTD (11 patients).
• Outcomes measured included Japanese Orthopaedic Association (JOA) score, numerical analogous pain score (NAPS), Odom's standard, blood loss, and time to ambulation.

Main Results:

• Significant improvement in JOA score (58.7%) and a 95.5% excellent/good outcome rate by Odom's standard.
• Low numerical analogous pain score (NAPS) post-operatively, with no significant difference from pre-operative values.
• Reduced surgical metrics: average start walking time of 2.38 days, average recovery time of 12.1 days, small incision size (1.86 cm), short surgical time (72.2 min), and minimal blood loss (47.5 ml).

Conclusions:

• CTM and CTD are effective in accurately orientating the diseased disc and nerve root before MED.
• This pre-operative imaging guidance reduces the risk of nerve damage, operative time, and blood loss.
• The use of CTM and CTD is recommended for improving outcomes in MED procedures.