WCMISST, June 2008

Purpose: Access to central and paracentral disc herniations is very limited. In conventional open surgery, important bone removal and soft tissue resection must occur in order to access the pathology. This increases the likelihood of long-term spinal instability and post-surgical failed back syndrome. The purpose of the following study is to demonstrate that the use of a small working channel scope with a double access approach allows precise, focused treatment, with no bone or soft tissue removal and no muscle cutting, showing statistical results that are better than with open, invasive approaches.

Methods: A retrospective analysis from 2002 through 2007 was performed. Cases with an L5/S1 paracentral free fragment/s was/were no included in the present study since they can be better treated with an intralaminar approach. The results were reported utilizing the MacNab criteria. The study population included 184 patients, 66% males and 34% females; age range between 13 and 83 years (mean=36 years). The levels affected the most were: L4/L5 (54%), L5/S1 (43%) and L3/L4 (3%). The mean follow-up time was 6 months.

Results: The analysis showed the following results: Excellent: 42.93% (n=78), Good: 48.36% (n=89), Fair: 7.06% (n=13), Poor: 2.17% (n=4). The overall success rate was: 90.75%. No complications were reported.

Conclusions: No-access-trauma double approach lumbar spine surgery for central and paracentral herniations is not just a viable alternative to open surgery, but has proven to be highly successful, avoiding the deleterious long-term effects of considerable bone removal and soft tissue resection and retraction.