An affordable and feasible technique for minimally invasive tubular lumbar discectomy

Abstract. Background The benefits of minimally invasive spine surgery (MISS) are only attainable if hospitals have the financial resources to acquire the essential equipment. Our aim is to make this surgical approach readily available to those countries where unacceptably expensive materials are the main limitation for its use. Methods This retrospective study included 30 patients who underwent MISS using syringes as dilators and retractors for posterior lumbar approaches. Inclusion criteria: lumbar radicular/back pain, degenerative disc, spondylolysis, unilateral approach and a maximum of two affected spine levels. We analyzed demographic characteristics, affected radicular level, diagnosis, type and length of surgery, hospital length of stay, MacNab criteria, complications and resumption of daily activities Results 17/30 patients (56.6%) presented with S1 radicular pain that was mainly secondary to posterolateral hernia (70%; n=21) requiring one-level discoidectomy. In 6 patients (20%), discoidectomy and an IPD device were required and one patient (3.33%) underwent two-level discoidectomy. All surgeries were performed using syringes as dilators and retractors. The maximum syringe diameter used was 2 cm (20 mL syringes) in 29 patients (96.6%) and a 3 cm (60 mL syringe) in one patient. Average length of surgery was 1.5 hours and average hospital stay, 1.8 days. Based on MacNab criteria, excellent outcome was achieved in 25 patients (83.3%), good outcome in three patients (10%) and fair outcome in two cases (6.7%). Complications were observed in only five patients (16.7%). Conclusion Our innovative approach is a safe and feasible technique with excellent results at low cost, becoming an attractive surgical option in developing countries.