PDF herunterladen
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(01): 048-053
DOI: 10.1055/s-0039-1700822
Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Discectomia endoscópica transforaminal lombar: Resultados clínicos e complicações[*]

Artikel in mehreren Sprachen: português | English
Leonardo Yukio Jorge Asano 
1   Faculdade de Medicina do ABC, Santo André, SP, Brasil
,
João Paulo Machado Bergamaschi
2   Clínica Kennedy, São Paulo, SP, Brasil
,
Álvaro Dowling
2   Clínica Kennedy, São Paulo, SP, Brasil
,
Luciano Miller Reis Rodrigues
1   Faculdade de Medicina do ABC, Santo André, SP, Brasil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

20. September 2018

22. Januar 2019

Publikationsdatum:
28. Februar 2020 (online)

   Lizenzen und Reprints

Resumo

Objetivo Avaliar os resultados clínicos e funcionais da discectomia endoscópica transforaminal lombar.

Materiais e Métodos De agosto de 2015 a janeiro de 2017, 101 pacientes portadores de hérnia de disco lombar refratária ao tratamento clínico foram submetidos a discectomia endoscópica. Por meio de avaliação clínica pela Escala Visual Analógica e análise funcional pelo questionário Oswestry Disability Index, os pacientes foram analisados no período pré-operatório, no pós-operatório imediato, com 1 mês, 3 meses, 6 meses e 1 ano após a cirurgia.

Resultados A média de idade dos participantes foi de 48.1 anos. Os níveis discais mais acometidos foram L4-L5, seguidos de L5-S1. Um total de 29 pacientes foram abordados em 2 níveis discais. Após 1 mês de seguimento pós-operatório, a média das pontuações nos questionários (EVA e ODI) diminuiu significativamente (p < 0.001).

Conclusão A discectomia endoscópica transforaminal lombar mostrou ser uma alternativa segura, eficaz e minimamente invasiva para o tratamento de hérnia de disco lombar. O procedimento tem vantagens, como curto período de internação hospitalar, cirurgia realizada sob anestesia local e sedação, retorno precoce às atividades diárias, e baixa taxa de complicações.

Palavras-chave

hérnia de disco - discectomia percutânea - endoscopia - procedimentos cirúrgicos minimamente invasivos

* Trabalho Desenvolvido na Faculdade de Medicina do ABC, Santo André, SP, Brasil.


 

  • Referências

  • 1 Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999; 354 (9178): 581-585
    CrossrefPubMedGoogle Scholar
  • 2 Papageorgiou AC, Croft PR, Ferry S, Jayson MI, Silman AJ. Estimating the prevalence of low back pain in the general population. Evidence from the South Manchester Back Pain Survey. Spine 1995; 20 (17) 1889-1894
    CrossrefPubMedGoogle Scholar
  • 3 Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine 2008; 33 (22) 2464-2472
    CrossrefPubMedGoogle Scholar
  • 4 Spangfort EV. The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand Suppl 1972; 142: 1-95
    CrossrefPubMedGoogle Scholar
  • 5 Mixter WJ, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934; 211: 208-215
    Google Scholar
  • 6 Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years' experience. Clin Orthop Relat Res 1989; (238) 9-23
    PubMedGoogle Scholar
  • 7 Kambin P, Schaffer JL. Percutaneous lumbar discectomy. Review of 100 patients and current practice. Clin Orthop Relat Res 1989; (238) 24-34
    PubMedGoogle Scholar
  • 8 Foley KT, Smith MM. Microendoscopic Discectomy. Tech Neurosurg 1997; 3: 301-307
    Google Scholar
  • 9 Jhala A, Mistry M. Endoscopic lumbar discectomy: Experience of first 100 cases. Indian J Orthop 2010; 44 (02) 184-190
    CrossrefPubMedGoogle Scholar
  • 10 Yeung AT. Minimally Invasive Disc Surgery with the Yeung Endoscopic Spine System (YESS). Surg Technol Int 1999; 8: 267-277
    PubMedGoogle Scholar
  • 11 Maroon JC. Current concepts in minimally invasive discectomy. Neurosurgery 2002; 51 (5, Suppl) S137-S145
    PubMedGoogle Scholar
  • 12 Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damage through microsurgical approach. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O. , editors. Advances in Neurosurgery. Berlin: Springer-Verlag; 1977: 74-77
    Google Scholar
  • 13 Kraemer R, Wild A, Haak H, Herdmann J, Krauspe R, Kraemer J. Classification and management of early complications in open lumbar microdiscectomy. Eur Spine J 2003; 12 (03) 239-246
    CrossrefPubMedGoogle Scholar
  • 14 Acharya KN, Nathan TS, Kumar JR, Menon KV. Primary and revision lumbar discectomy: a three-year review from one center. Indian J Orthop 2008; 42 (02) 178-181
    CrossrefPubMedGoogle Scholar
  • 15 Kulkarni AG, Bassi A, Dhruv A. Microendoscopic lumbar discectomy: Technique and results of 188 cases. Indian J Orthop 2014; 48 (01) 81-87
    CrossrefPubMedGoogle Scholar
  • 16 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27 (07) 722-731
    CrossrefPubMedGoogle Scholar
  • 17 Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 2008; 33 (09) 931-939
    CrossrefPubMedGoogle Scholar
  • 18 Chae KH, Ju CI, Lee SM, Kim BW, Kim SY, Kim HS. Strategies for Noncontained Lumbar Disc Herniation by an Endoscopic Approach : Transforaminal Suprapedicular Approach, Semi-Rigid Flexible Curved Probe, and 3-Dimensional Reconstruction CT with Discogram. J Korean Neurosurg Soc 2009; 46 (04) 312-316
    CrossrefPubMedGoogle Scholar
  • 19 Kaushal M, Sen R. Posterior endoscopic discectomy: Results in 300 patients. Indian J Orthop 2012; 46 (01) 81-85
    CrossrefPubMedGoogle Scholar
  • 20 Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J 2016; 25 (01) 134-143
    PubMedGoogle Scholar
  • 21 Choi KC, Lee JH, Kim JS. , et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery 2015; 76 (04) 372-380 , discussion 380–381, quiz 381
    CrossrefPubMedGoogle Scholar
  • 22 Wang H, Huang B, Li C. , et al. Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery. Clin Neurol Neurosurg 2013; 115 (10) 1987-1991
    CrossrefPubMedGoogle Scholar
  • 23 Wu XB, Fan GX, Gu X. , et al. Learning curves of percutaneous endoscopic lumbar discectomy in transforaminal approach at the L4/5 and L5/S1 levels: a comparative study. J Zhejiang Univ Sci B 2016; 17 (07) 553-560
    PubMedGoogle Scholar
  • 24 Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J 2013; 22 (04) 727-733
    CrossrefPubMedGoogle Scholar