Clinical Outcomes of Hernia Nucleous Pulposus after Microendodiscectomy

Abstract

There are several options of surgical treatment of Hernia Nucleous Pulposus (HNP) such as discectomy and micro-endodiscectomy (MED). The fundamental differences between these procedures are the size of the incision, the discectomy procedure and the volume of disc taken. However, until now, there has not been any class 1 evidences explaining the efficacy of these procedures, and there is only a few studies about its safety and factors influencing its efficacy in treating HNP, especially in Indonesia. This study is aimed to assess clinical outcomes and safety of MED in HNP patients who underwent this procedure. Patient with HNP who underwent MED were followed prospectively in a period of January 2015 until December 2016. Clinical outcomes were evaluated by using Visual Analog Score (VAS) for assessing back pain and leg, and Oswestry Disability Index (ODI). The mean of pre-treatment score was compared with the mean of post-surgical treatment score by using paired t-test. Sampel were 78 HNP patients treated surgery. The average surgery duration (± SD) was 60 ± 17.1 minutes. The pretreatment score mean on VAS and ODI were 4.88 ± 1.10 and 35.21 ± 8.24. After surgical treatment, the VAS and ODI score obtained were significantly reduced to 1.53 ± 1.14 and 5.16 ± 5.52, respectively (p<0,001). A type of complication was observed, which was 5 (6.4%) cases of dural tear; no deficit in ankle dorsiflexion nor foot paresis were found. MED has been shown to be able to treat HNP with clinical outcomes similar to conventional open discectomy but with better levels of safety and effectiveness. However, this procedure still requires high quality randomized controlled trials studying about its efficacy and cost effectiveness in HNP treatment.