Microscopic Assisted Fenestration as a Minimal Invasive Technique for Lumbar Discectomy

Background: Microsurgical discectomy is the gold standard technique widely used for discectomy. Newer percutaneous microdiscectomy is a less invasive procedure with comparable clinical outcomes and potential advantages over standard microdiscectomy claiming less blood loss, less postoperative pain, shorter hospitalization and earlier return to work. These new techniques require lots of expertise, in addition to expensive equipments which are not available at every center. Objective: The aim of this study is to evaluate the outcome of microscopic assisted fenestration for single level lumbar discectomy as a minimally invasive surgery (MIS). Patients and Methods: This study included twenty four patients operated by fenestration discectomy. Pre- and postoperative and follow up scores for three months based on visual analogue scales (VAS, 0 to 10) for low back pain, and leg pain were recorded. Operative complications were also noted. The MIS parameters in this study were the operative time, amount of bleeding, length of surgical incision and duration of postoperative hospitalization. All data were summarized using mean and standard deviation. Results: According to the average VAS, leg and back pain improved from 8.48, 4.8 preoperatively to 0.93 and 2.3 respectively after three months. The average length of surgical incision was 4.4 cm, operative time was 108 min, amount of bleeding was 77 ml and postoperative hospitalization was 1.4 days. Complications were recorded in three patients; in the form of intraoperative incidental durotomy in two patients, with no postoperative cerebrospinal fluid (CSF) leak, and superficial wound infection in one patient which was properly managed by repeated dressing. Conclusion: fenestration lumbar discectomy is a safe and effective surgical option in treatment of lumbar disc prolapse, with comparable results to other less invasive percutaneous techniques.