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KMID : 0616619970030010145
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Journal of Soonchunhyang Medical College
1997 Volume.3 No. 1 p.145 ~ p.156
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Comparative Study of Microdiscectomy and Automated Percutaneous Discectomy in Lumbar Disc Herniation
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Abstract
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A retrospective study of operative results were carried out in a series of 164 patients who were performed microdiscectomy and 57 patients performed automated percutaneous lumbar discectomy (APLD) for herniated lumbar discs between January 1, 1990 and June 30, 1996 at the Department of Neurosurgery, Soonchunhyang University Hospital. The operative results were analysed, and the correlation between preoperative clinicoradiological factors and postoperative clinical results were statistically assessed.
The major results were as follows :
1. Of 164 microdiscectomy cases, 102 were males and 62 were females, mean age was 42.4 years and incidence was the highest in the 5th decade, and of 57 APLD cases, 43 were male and 14 female, mean age was 32.2 years and incidence was the highest in the 3rd decade.
2. The preoperative symptoms and signs were lumbago(98.2%), radiating pain(96.3%), positive straight leg raising test(77.4%), motor weakness(27.4%), claudication(13.4%) & voiding difficulty(2.4%) in microdiscectomy cases, and lumbago(98.2%), radiating pain(98.2%), positive straight leg raising test(70.2%) & motor weakness(17.5%) in APLD cases.
3. Number of operated levels were performed 226 in microdiscectomy and 74 in APLD. The most commonly operated levels of two groups were L4-5 level.
4. Operative results
1) The overall success rates by Prolo´s scale were 87.1% in microdiscectomy and 80.7% in APLD, respectively.
2) In younger age group (below 30 years) and in non-compensatory group, success rates were significantly higher in microdiscectomy.
3) As to protrusion and degeneration on MRI, clinical results of moderate protrusion and degeneration of discs in microdiscectomy were statistically significant, and those of mild protrusion and degeneration of discs in APLD were also statistically significant.
4) The most common cause of failure was inappropriate removal of disc material in microdiscectomy and sequestered discs in APLD.
According to the above results, there were no differance in overall success rates between microdiscectomy and APLD. But clinical results seem to be influenced by the age, existence of compensation, and by the degree of protrusion and degeneration of discs as prognostic factors. If the selection of operative procedure between microdiscectomy and APLD for herniated lumbar disc is carefully done with clinical and radiologic findings of patients, good outcome might be achieved.
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KEYWORD
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