Functional Outcome after Endoscopic Lumbar Discectomy by Destandau's Technique: A Prospective Study of 614 Patients

Dey, Paresh Chandra; Nanda, Saurav Narayan

Abstract

STUDY DESIGN: Prospective study. PURPOSE: To investigate the efficacy of the lumbar discectomy procedure using the Destandau Endospine System by assessing the functional outcome and complication rate in 614 patients. OVERVIEW OF LITERATURE: Endoscopic Spine Surgery (Endospine) using Destandau's technique is an established treatment method of lumbar disk herniation; it was introduced in 1993 and is gaining prominence for its small skin incision and minimal tissue dissection with excellent visualization.
METHODS
Of 840 patients, we selected 614 patients, based on the strict inclusion criteria, who underwent endoscopic lumbar discectomy (ELD) between August 2008 and November 2015. The technique comprised localization of the symptomatic level followed by insertion of an endospine system device through a 15-20-mm skin and fascial incision to perform a discectomy. We evaluated results by Macnab's criteria, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) score after a minimum follow-up of 12 months and maximum up to 54 months.
RESULTS
Based on the modified Macnab's criteria, 479 patients (78.01%) exhibited excellent, 110 (17.9%) good, 19 (3.09%) fair, and 6 (0.97%) poor results. The average ODI score was improved from 64 (range, 44-86; standard deviation [SD]=9.2) to 14 (range, 2-31; SD=4.4), and the average VAS score from 7.8 (range, 6-10; SD=0.9) to 2 (range, 0-7; SD=1.2) in a year. On 1-year follow-up, 589 patients (95.9%) were completely pain-free and satisfied with the procedure.
CONCLUSIONS
ELD provides a safe, effective, and minimal access corridor for lumbar discectomy. The technique also allows early postoperative mobilization and faster return-to-work.