J Minim Invasive Spine Surg Tech.  2019 Jun;4(1):29-32. 10.21182/jmisst.2019.00024.

Tubular Micro-Discectomy Under Local Epidural Anaesthesia: A Technical Note

• Kulkarni AG
• Sharma SB
• Kunder TS

• KMID: 2562051
• DOI: http://doi.org/10.21182/jmisst.2019.00024

Abstract

Objective
Day-care surgery maximizes utilization of healthcare and aids in early return to work. Minimally invasive spine surgery (MISS) under local epidural anesthesia is a step in this direction. The combination of minimal surgical trauma and nominal sedation results in quick recovery and early discharge. To present our experience of performing lumbar tubular micro-discectomy under local epidural anaesthesia.
Methods
A case report of 10patients operated for lumbar herniated discs under local epidural anaesthesia. The patients had radicular pain since a few months with MRI evidence of herniated nucleus pulposus and failure of 6 weeks of conservative trial before surgery. The outcomes were assessed with ODI, VAS and Mac-Nab criteria. Premedication with Dexmedetomidine, local infiltration of lignocaine and bupivacaine with bolus dose of fentanyl during root manipulation facilitated the execution of the procedure.
Results
All patients obtained dramatic pain relief postoperatively. The procedure was well tolerated except for the slight discomfort during varying degrees of nerve-root retraction. Patients were made to walk and oral diet allowed after an hour and discharge was within 24 hours of the procedure. The VAS improved from 8.4 to 2.3 and ODI from 58.2 to 22.8. Follow-up was at 1, 6, 12 and 24 weeks. No complications such as dural tear, nerve root injury etc. were seen.
Conclusion
Microtubular discectomy under local epidural anaesthesia is a feasible option in experienced hands. Apart from reducing the effects of general anaesthesia, it reduces the hospital stay and cost. It is an evolution of microtubular discectomy towards day care surgery.

Keyword

Day care spine surgery; MED in local epidural anaesthesia; Microtubular discectomy; MED; Lumbar disc herniations