MICRODISCECTOMY FOR LUMBAR DISC USING CASPAR RETRACTOR
*Dr. Md. Moshiur Rahman, Dr. S.I.M. Khairun Nabi Khan, Dr. Robert Ahmed Khan, Dr. Md Rokibul Islam, Dr. K. M. Ziaur Rahman and Prof. Mainul Haque Sarker
Background: Caspar retractor is being used by many neurosurgeons over the years for microdiscectomy in lumbar disc prolapse surgery. Microdiscectomy and minimally invasive discectomy decrease surgical exposure and trauma and have success rates of approximately 90%. Minimal access spinal technologies aim primarily at minimizing the trauma associated with surgical exposure of the spine. This technique offers a small incision, excellent magnification, gentle handling of the nerve root, and good exposure. The outcome of surgery depends on the correct level diagnosis and patient selection. Objective: The main aim of the study is to assess the surgical outcome of microdiscectomy for lumbar disc prolapse using Caspar retractor. Method: This is a retrospective study. A total 650 cases were observed in a private hospital, Dhaka, Bangladesh. Male was 433 and female 217. Study period was 2009 to 2017. Minimum follow up period was 2 years. More than one level surgery was in 24 cases. Inclusion criteria was back pain with sciatica which was not relieved by conservative treatment for 8 weeks. Patients having cauda equina syndrome was excluded from the study. Results: Immediately after surgery all patients were pain free. 32 patients needed revision surgery. 14 patients had iatrogenic dural tears. 6 patients had discitis. Wrong level exploration was in 16 patients in whom the nerve root was not tight, and the next level found pathological intra-operatively. There was no direct nerve root injury though 3 patients had weak extensors of toes after surgery which was recovered over 2-3 months probably due to traction injury. Conclusion: Microdiscectomy in lumbar disc surgery using Casper retractor through a paramedian incision has many advantages including short hospital stay, less tissue trauma and early recovery. Surgical outcome of this procedure depends on clinical correlation and the correct level surgery.
Keywords: Lumbar, Microdiscectomy, disc, Surgery, Caspar.
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