P59. Giant disc herniation treated with tubular unilateral approach for bilateral decompression

BACKGROUND CONTEXT Disc herniations that obstruct the spinal canal by more than 50% are considered “Giant Disc Herniations” (GDHs). GDHs are less common than disc herniations of smaller volume, but they more frequently cause severe pain, cauda equina syndrome and neurological deficits. GDHs are challenging to treat from a surgical perspective due to their size. As a result of their surgical challenges, it is debated if minimally invasive tubular approaches are an effective and safe treatment for lumbar GDHs. PURPOSE In order to evaluate the efficacy and safety of the surgical treatment of lumbar GDHs using tubular minimally invasive surgery (MIS), we investigated the viability of the procedure. STUDY DESIGN/SETTING We conducted a retrospective study evaluating patients who had undergone tubular MIS at our clinic by our senior surgeon in the period from 01/2015 to 03/2020 due to a lumbar disc herniation. PATIENT SAMPLE A total number of 227 cases were identified. OUTCOME MEASURES Age, gender and BMI were recorded and assessed. In addition to these parameters, the presence of neurological deficits such as cauda equina syndrome were evaluated. Furthermore, the surgical time, complications, estimated intraoperative blood loss and number of surgical revisions were recorded. METHODS All procedures were performed using tubular microsurgical techniques with the assistance of a microscope. The surgical procedure was performed through an 18 mm tubular retractor. Modification of technique compared to regular tubular discectomy was that we first performed an over-the-top bilateral decompression in order to create room for the safe performance of the discectomy. RESULTS A total of 22 patients were included in the study. The patients had a mean age of 49.8 (+/-18) years. In the included cases, 59% (n=13) of the patients were male and 41% (n=9) were female. The mean BMI was 26.6 (+/- 5.4) m2/kg. The average surgery time was 109 (+/- 46) min with an average estimated blood loss of CONCLUSIONS Tubular MIS is suitable for the surgical treatment of GDHs. The rate of revision surgery was low in our cohort and the number of complications was also low. We conclude that minimally invasive “over the top” decompression for GDH is a safe and effective way of treating this pathology. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.