الفهرس 
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Abstract
*Lumbar disc herniation remains to be a major health problem being a source of economic loss for the individual and society. The intervertebral disc acts as an articulation between the lumbar vertebrae as a shock absorber. The disc is formed of the cartilaginous end plate, annulus fibrosus, and nucleus pulposus. Heavy weight lifting, smoking, pregnancy, and prolonged driving of motor car vehicles are factors that may predispose to herniation of nucleus pulposus between the radial fissure in the annulus Herniation of the nucleus pulposus causes radiculopathy ,that produced by combination of inflammatory, mechanical, and biochemical changes Sciatica is often the symptom of lumbar disc disease. The patient may complain of parathesia, numbness, weakness, and sudden paraplegia or bladder disturbance in acute cases. Signs, include scoliosis, limited spinal mobility, sensory deficit, motor deficit, and reflex affection. MRI is the most accurate investigation for diagnosis of lumbar disc prolapse. Conservative treatment is initially, followed by surgical treatment in patients with un-improved sciatica, incapacitating pain, cauda equine. and/ or severe motor deficit. The conventional classical open lumbar discectomy is considered the corner stone of the lumbar disc surgery. However, there are many alternative minimal invasive techniques including microdiscectomy, chemonucleolysis, arthroscopic discectomy, automated percutaneous discectomy, laser discectomy and endoscopic discectomy. In 1997, the Micro- endoscopic discectomy (MED) system was introduced. it allowed spinal surgeons to decompress a symptomatic lumbar nerve root by using an endoscopic minimally invasive surgical approach. This system offers many advantages over other minimally invasive surgical lumbar Summary 129 discectomy techniques: it reduces tissue trauma, allows direct visualization of the nerve root and disc diseases, and enables bony decompression. The aim of this study was to evaluate the clinical and radiological outcome in patients with lumbar disc prolapse treated with endoscopic discectomy from( December 2010, to January2012) included 20 patients with L4-5 and L5-S1 disc herniations, treated by micro endoscopic discectomy (MED) procedure, utilizing micro endoscopic tubular retractor system (METR’x) Patients were operated by two neurosurgeon teams at El- Mansoura New General Hospital (International previously) All the patients were subjected to full examination to select only those who met the inclusion criteria were involved in this study. Inclusion criteria: 1- Wide canal. 2- Single lateral projecting disc. 3- Only sciatica. 4- Not obese BMI(Body Mass Index) 40.Exclusion criteria: 1- Patient with recurrent lumbar disc prolapse, canal stenosis, calcified disc. 2- Patients with morbid obesity body mass index (BMI) > 40. 3- Patients indicated for spinal fixation e.g.: Isthmic spondylolisthesis Complete investigations, MRI lumbosacral spine, and plain X-ray lumbosacral spine (AP, lateral views) were done in patients follow up was:-on the 7th day, one month, 3 months postoperative and at any time when deterioration occurs. Summary 130 Postoperative clinical evaluation: using the Modified MacNab’s criteria. The results of this study of 20 patients were as the following The patient’s age was (26-52) averaged 41.75 years. Male: Female (12:8) Rt sciatica: Lt sciatica ( 9:11),with (13) patient suffering from sciatica less than 6 month and (7) from 6-12months .L4-5 level (8) patient and (12) L5 S1.The operative times were reduced with case proficiency (12-60) with an average of (90 Minutes), reduced hospital stay ranged (8-24h) (average15 hours),. Using the modified MacNab’s criteria to grade patient outcome, 12 patients (60%) were in excellent category, 7 patients (35%) were in good category, 1patients (5%) were in fair category, and no patient (0%) was in the poor category. Satisfaction results were 95% and un-satisfaction results were 5%.
*Complications in this study were, one case (5%) with discitis with severe back spasm required bed rest, antibiotics and analgesics. Two cases(10%) with dural tear, one of them; the tear was small after disc removal that required intra-operative subcutaneous free fat graft with gel foam to stop the leak and postoperative restriction to lie down in prone position, the another case was opened because the tear was large with roots prolapsed and before disc removal. Three cases(15%) with severe back spasm required analgesics and muscle relaxants. No cases with superficial wound infection. One case with failed MED; due to large dural tear . No cases of root injury. No cases of missed level because the fluoroscope was used in every case for detection of the level prior the surgery, No cases of recurrence after the endoscope .