Comparison between Results of Microdiscectomy and Open Discectomy in Management of High-Level Lumbar Disc Prolapse
DOI:
https://doi.org/10.3889/oamjms.2019.679Keywords:
High-level lumbar disc prolapse, Microdiscectomy, Open discectomyAbstract
AIM: This work aims to compare between results of microdiscectomy and open discectomy in management of high-level lumbar disc prolapse.
METHODS: This is a controlled randomised study, where patients having upper lumbar disc herniations were evaluated preoperatively both clinically and radiologically, randomisation was planned to perform open discectomy in odd number patients and to perform microdiscectomy in even number patients, patients were evaluated and followed up for deficits and outcomes.
RESULTS: We operated ten patients in this study, five cases were operated upon with microdiscectomy, and five cases were operated upon with open discectomy, the median age of presentation in this study was 44 years, there were five males and five females, postoperative pain improvement was better in microdiscectomy. Hospital stay, blood loss, bone loss and postoperative complications were less in microdiscectomy.
CONCLUSION: Microdiscectomy allows good surgical visualisation and is less traumatic to the involved tissues. The results of this study indicated that microsurgery reduces hospitalisation time, improves the overall surgery-related outcome. The main differences between the two procedures were the length of the incision and blood loss. We found that lumbar microdiscectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Kambin P, Savitz MH. Arthroscopic microdiscectomy: an alternative to open disc surgery. The Mount Sinai journal of medicine, New York. 2000; 67(4):283-7.
Sanderson SP, Houten J, Errico T, Forshaw D, Bauman J, Cooper PR. The unique characteristics of "upper" lumbar disc herniations. Neurosurgery. 2004; 55(2):385-9. https://doi.org/10.1227/01.NEU.0000129548.14898.9B PMid:15271245
Lee SH, Choi S. L1-2 Disc Herniations: Clinical Characteristics and Surgical Results. Journal of Korean Neurosurgical Society. 2005; 38(3):196-201.
Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine. 2004; 29(16):E326-32. https://doi.org/10.1097/01.BRS.0000134591.32462.98 PMid:15303041
Choi JW, Lee JK, Moon KS, Hur H, Kim YS, Kim SH. Transdural approach for calcified central disc herniations of the upper lumbar spine. Journal of Neurosurgery: Spine. 2007; 7(3):370-4. https://doi.org/10.3171/SPI-07/09/370 PMid:17877277
Krauss WE, Edwards DA, Cohen-Gadol AA. Transthoracic discectomy without interbody fusion. Surgical neurology. 2005; 63(5):408-9. https://doi.org/10.1016/j.surneu.2004.06.026 PMid:15883057
Saberi H, Isfahani AV. Higher preoperative Oswestry Disability Index is associated with better surgical outcome in upper lumbar disc herniations. European Spine Journal. 2008; 17(1):117-21. https://doi.org/10.1007/s00586-007-0527-3 PMid:17972115 PMCid:PMC2365528
Choon SL, Chang JH, Sung WL, Yung TK, Dong HL, Mi YL. Eur Spine J Volume. 2009; 18:1637-1643. https://doi.org/10.1007/s00586-009-1060-3 PMid:19533182 PMCid:PMC2899393
Summers B, Mishra V, Jones JM. The flip test: a reappraisal. Spine. 2009; 34(15):1585-9. https://doi.org/10.1097/BRS.0b013e3181aa1bf0 PMid:19564769
Tokuhashi Y, Ajiro Y, Umezawa N. Follow-up of patients with delayed union after posterior fusion with pedicle screw fixation. Spine. 2008; 33(7):786-91. https://doi.org/10.1097/BRS.0b013e31816956f7 PMid:18379406
Ahn Y, Lee SH, Lee JH, Kim JU, Liu WC. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta neurochirurgica. 2009; 151(3):199-206. https://doi.org/10.1007/s00701-009-0204-x PMid:19229467
Shin DA, Kim KN, Shin HC. The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. Journal of Neurosurgery: Spine. 2008; 8(1):39-43. https://doi.org/10.3171/SPI-08/01/039 PMid:18173345
German JW, Adamo MA, Hoppenot RG, Blossom JH, Nagle HA. Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy. Neurosurgical focus. 2008; 25(2):E20. https://doi.org/10.3171/FOC/2008/25/8/E20 PMid:18673050
Kanayama M, Hashimoto T, Shigenobu K, Oha F, Yamane S. New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial. Journal of Neurosurgery: Spine. 2005; 2(4):441-6. https://doi.org/10.3171/spi.2005.2.4.0441 PMid:15871484
Porchet F, Bartanusz V, Kleinstueck FS, Lattig F, Jeszenszky D, Grob D, Mannion AF. Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry. European spine journal. 2009; 18(3):360-6. https://doi.org/10.1007/s00586-009-0917-9 PMid:19255791 PMCid:PMC2899328
Ryang YM, Oertel MF, Mayfrank L, Gilsbach JM, Rohde V. Standard open microdiscectomy versus minimal access trocar microdiscectomy: results of a prospective randomized study. Neurosurgery. 2008; 62(1):174-82. https://doi.org/10.1227/01.NEU.0000311075.56486.C5 PMid:18300905
Schneider C, Krayenbühl N, Landolt H. Conservative treatment of lumbar disc disease: patient's quality of life compared to an unexposed cohort. Acta neurochirurgica. 2007; 149(8):783-91. https://doi.org/10.1007/s00701-007-1114-4 PMid:17624490
Wu X, Zhuang S, Mao Z, Chen H. Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine. 2006; 31(23):2689-94. https://doi.org/10.1097/01.brs.0000244615.43199.07 PMid:17077737
Harrington JF, French P. Open versus minimally invasive lumbar microdiscectomy: comparison of operative times, length of hospital stay, narcotic use and complications. min-Minimally Invasive Neurosurgery. 2008; 51(01):30-5. https://doi.org/10.1055/s-2007-1004543 PMid:18306129
Righesso O, Falavigna A, Avanzi O. Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery. 2007; 61(3):545-9. https://doi.org/10.1227/01.NEU.0000290901.00320.F5 PMid:17881967
Arts MP, Peul WC, Brand R, Koes BW, Thomeer RT. Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546]. BMC musculoskeletal disorders. 2006; 7(1):42. https://doi.org/10.1186/1471-2474-7-42 PMid:16696861 PMCid:PMC1475863
Cole IV JS, Jackson TR. Minimally invasive lumbar discectomy in obese patients. Neurosurgery. 2007; 61(3):539-44. https://doi.org/10.1227/01.NEU.0000290900.23190.C9 PMid:17881966
Schizas C, Tsiridis E, Saksena J. Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Operative Neurosurgery. 2005; 57(suppl_4):ONS-357. https://doi.org/10.1227/01.NEU.00000176650.71193.F5 PMid:16234685
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Amr Abdelmonam Abdelaziz Mostafa Elkatatny, Tarek M. Hamdy, Khaled Mamoun Moenes (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0