Endoscopic Surgery And Dynamic Rehabilitation In Foraminal

And Extra-Foraminal Disc Herniation.

About 1002 Cases. 

Foraminal and Extra-foraminal disc herniations in the lumbar region need wide exposure and aggressive muscle retraction. To avoid this issue, the device (Endospine,Karl Storz) was designed by Dr Jean Destandau then used since 1993 (Fig 1). We organized dynamic program of rehabilitation with an early rise, walk and sportive recovery. We present the surgical technique and a large study of 1002 cases.

From February 1995 to December 2019, 1002 patients were operated on with this technique. The dynamic program is an immediate rise after surgery, a walking distance, and two rehabilitation sessions during the 2 nights long hospitalization. 1002 were operated on, 57,3% returned at work with a mean time of 3 weeks. The complication rate was low. Patients’ satisfaction was good after a survey. The efficiency of this minimal invasive technique is certain. The dynamic rehabilitation is really welcome among patients. The whole process without increasing post-operative complications.

Fig 1 

Endospine Device

Material and Methods :

The device (Endospine, Karl Storz) is composed of three tubes :

  • One for the endoscope
  • One for suction canula
  • and the largest one for classical surgical instruments.

The endoscope is a rigid and straight 0 degree endoscope. Patients were operated in kneechest positon under spinal or general anesthesia by two surgeons. General anesthesia was a fast-track program. The proper level was identifies by lateral X-Ray (Fig 2). From february 1995 to december 2019, 1011 patients were operated on with this technique (Fig 4). Data about 1002 patients have been collected because files were complete.

Files were filled by surgeons right after the surgery and 2 months after.

The mandatory informations were : age, sex, delay between symptoms and surgery, level, side, neurologic signs (motor, senstive), abolition of osteo-tendinous reflex, modality of imaging examination, modality of anesthesia, complications, work or re- tired, work accident, average time to return to work, pain killer teatment and sportive activities.

The dynamic program is a immediate rise after surgery by the patient himself without the nurse or the physiotherapist, a walking distance, and two rehabilitation sessions during the 2 nights long hospitalization with the physiotherapist (Fig 3 and 3bis). At the discharge, satisfaction forms were given to the patients. They were asked to send them back 2 months after the surgery. 563 did and were studied. Questions were about: pains, time between surgery and back-to-work time or sportive activities, informations given, quality of hospitalization and global satisfaction about the process.

Fig 2
Level and foramen identification by X-ray.

Fig 3
Video: Immediate post-operative patient after endoscopic left FDH L4L5

Fig 3 bis
Video: Other patient Day 1 after surgery left EFDH L3L4

Results :

1002 were operated on,

  • 67 % men and 33 % women
  •  55,4% on the left side
  •  44,6 % on the right operated on after an average of 18 months since the beginning of the symptoms
  • Represented levels were in 46,8 % L4-L5, 23,5 % L3-L4, 21,3 % L5-S1, 6,6 % in L2-L3 and 0,5 % in L1-L2
  • 3,3 % were a real recurrent disc herniation from the institution surgeons and from others institutions
  • 28,29% was operated under spinal anesthesia
  • 47,1 % had a motor palsy
  •  48,8 % a sensitive loss
  • 52,2 % have an abolition of the osteo-tendinous reflex according to the radiculalgia.
  • 50 % was operated with a lumbar CT scan
  • 49,8% with an MRI, 0,2 % with radiculography

55 % of the patients were workers

3 % were at work when the symptoms occured

57,3 % returned at work with a mean time of 3 weeks

Complications were divided

in 5 fluid leakages 7 nerve root lesions, 24 articular process re- sections and 7 level mistakes, 1 infection, 216 with persistant radiculalgia. 21% kept taking pain killer medication. Patients whom underwent spinal resection were not suf- fering from back pain and did not need articular fixation. Patients were followed during 12 years on average. Satisfaction forms were posted, 58% were answered. 98 % of patients were satisfied and 96,8 % estimated to be well informed and 100% walked right after the surgery and went back home in their own cars. 34 % practised sportive activities one by week or more, and went back to their sportive routine within 2 weeks.

Conclusion :

1002 were operated on, 67 % men and 33 % women, 55,4% on the left side, 44,6 % on the right operated on after an average of 18 months since the beginning of the symptoms. Represented levels were in 46,8 % L4-L5, 23,5 % L3-L4, 21,3 % L5-S1, 6,6 % in L2-L3 and 0,5 % in L1-L2. 3,3 % were a real recurrent disc herniation from the institution surgeons and from others institutions. 28,29% was operated under spinal anesthesia. 47,1 % had a motor palsy, 48,8 % a sensitive loss. 52,2 % have an abolition of the osteo-tendinous reflex according to the radiculalgia. 50 % was operated with a lumbar CT scan, 49,8% with an MRI, 0,2 % with radiculography. 55 % of the patients were workers, 3 % were at work when the symptoms occured, 57,3 % returned at work with a mean time of 3 weeks. Complications were divided in 5 fluid leakages, 7 nerve root lesions, 24 articular process resections and 7 level mistakes, 1 infection. 216 with persistant radiculalgia. 21% kept taking pain killer medication. Patients whom underwent spinal resection were not suf- fering from back pain and did not need articular fixation. Patients were followed during 12 years on average. Satisfaction forms were posted 6,58% were answered. 98 % of patients were satisfied and 96,8 % estimated to be well informed and 100% walked right after the surgery and went back home in their own cars. 34 % practised sportive activities one by week or more, and went back to their sportive routine within 2 weeks

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KARL STORZ ENDOSCOPIE France 12 rue Guynemer 78280 Guyancourt.

Thanks to Randy Crescence for his work on the videos. No conflicts of interest.