Limited Surgical Discectomy and Microdiscectomy

Kahanovitz, Neil; Viola, Kathleen; Muculloch, John

doi:10.1097/00007632-198901000-00016

Cited by 99 publications

(42 citation statements)

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“…Disc reherniation was observed in two cases (4.4 %), a rate comparable to that reported for microscopic discectomy (2.0-4.5 %) [1,11]. Most patients after lumbar discectomy are restricted in their activities for some time by discomfort and medical advice and advised to restrict weight-bearing activities or bending over for several weeks or months [16][17][18]. However, the optimal time of restrictions and the clinical benefit of such restrictions remain unknown [19].…”

Section: Discussionmentioning

confidence: 80%

Learning curve of full-endoscopic lumbar discectomy

et al. 2012

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Purpose To report the learning curve of full-endoscopic lumbar discectomy for a surgeon naive to endoscopic surgery but trained in open microdiscectomy. Methods From July 2006 to July 2009, 57 patients underwent full-endoscopic lumbar discectomy and 66 underwent open microdiscectomy. The clinical results were evaluated with a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Spearman's coefficient of rank correlation (rho) was used to assess the learning curves for the transforaminal and interlaminar procedures of full-endoscopic lumbar discectomy. Results After full-endoscopic lumbar discectomy, the VAS and ODI results of the patients followed up were comparable with those of open microdiscectomy. A steep learning curve was observed for the transforaminal procedure, but not the interlaminar procedure. Conclusions The learning curve of the transforaminal approach was steep and easy to learn, while the learning curve of the interlaminar approach was flat and hard to master.

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Section: Discussionmentioning

confidence: 80%

Learning curve of full-endoscopic lumbar discectomy

et al. 2012

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“…In 2003, 2.1 per 1000 Medicare enrollees received a lumbar discectomy/laminectomy [92]. Although the procedure has been performed for decades, the reported proportion of postsurgical degenerative disc disease and recurrent back and leg pain in the literature has been highly variable, ranging from as low as 3% to as high as 43% [42,75].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes

Parker

Mendenhall

Godil

et al. 2015

Clinical Orthopaedics &Amp; Related Research

204

132

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Background Long-term postdiscectomy degenerative disc disease and low back pain is a well-recognized disorder; however, its patient-centered characterization and quantification are lacking. Questions/purposes We performed a systematic literature review and prospective longitudinal study to determine the frequency of recurrent back pain after discectomy and quantify its effect on patient-reported outcomes (PROs). Methods A MEDLINE search was performed to identify studies reporting on the frequency of recurrent back pain, same-level recurrent disc herniation, and reoperation after primary lumbar discectomy. After excluding studies that did not report the percentage of patients with persistent back or leg pain more than 6 months after discectomy or did not report the rate of same level recurrent herniation, 90 studies, which in aggregate had evaluated 21,180 patients, were included in the systematic review portion of this study. For the longitudinal study, all patients undergoing primary lumbar discectomy between October 2010 and March 2013 were enrolled into our prospective spine registry. One hundred fifteen patients were more than 12 months out from surgery, 103 (90%) of whom were available for 1-year outcomes assessment. PROs were prospectively assessed at baseline, 3 months, 1 year, and 2 years. The threshold of deterioration used to classify recurrent back pain was the minimum clinically important difference in back pain (Numeric Rating Scale Back Pain [NRS-BP]) or Disability (Oswestry Disability Index [ODI]), which were 2.5 of 10 points and 20 of 100 points, respectively. Results Systematic Review The proportion of patients reporting short-term (6-24 months) and long-term ([ 24 months) recurrent back pain ranged from 3% to 34% and 5% to 36%, respectively. The 2-year incidence of recurrent disc herniation ranged from 0% to 23% and the frequency of reoperation ranged from 0% to 13%. Prospective Study At 1-year and 2-year followup, 22% and 26% patients reported worsening of low back pain (NRS: 5.3 ± 2.5 versus 2.7 ± 2.8, p \ 0.001) or disability (ODI%: 32 ± 18 versus 21 ± 18, p \ 0.001) compared with 3 months. Conclusions In a systematic literature review and prospective outcomes study, the frequency of same-level disc herniation requiring reoperation was 6%. Two-year recurrent low back pain may occur in 15% to 25% of patients depending on the level of recurrent pain considered clinically important, and this leads to worse PROs at 1 and 2 years postoperatively.

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“…1,2 Microdiscectomy and minimally invasive discectomy decrease surgical exposure and trauma and have success rates of approximately 90%.…”

Section: Introductionmentioning

confidence: 99%

Microendoscopic versus Open Discectomy for Lumbar Disc Herniation: A Prospective Randomised Study

Garg

Nagraja

Jayaswal

2011

J Orthop Surg (Hong Kong)

104

100

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Purpose.To compare the outcomes of microendoscopic discectomy (MED) versus open discectomy for lumbar disc herniation. Methods. 80 men and 32 women aged 26 to 57 (mean, 37) years with a single-level disc herniation were randomised to undergo MED (n=55) or open (fenestration/laminotomy) discectomy (n=57). Patients were assessed pre-and post-operatively (at week 6, month 6, and year one). The 2 groups were compared with respect to surgical time, anaesthesia time, duration of hospital stay, intra-operative blood loss, weight of disc material removed, and selfevaluated low back pain and functional outcome (using the Oswestry low back pain disability questionnaire). Results. Surgical and anaesthesia times were significantly longer, but blood loss and hospital stay were significantly reduced in patients having MED than open discectomy. The improvement in Microendoscopic versus open discectomy for lumbar disc herniation: a prospective randomised study Bhavuk Garg, Upendra Bidre Nagraja, Arvind Jayaswal Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India Address correspondence and reprint requests to: Dr Bhavuk Garg, Department Of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 29, India. E-mail: drbhavukgarg@gmail.com 2011;19(1):30-4 the Oswestry score in both groups was significant at week one, but not at other follow-ups. The complication rate was similar in both groups. One patient with MED had a recurrence of disc herniation after 7 months and was treated with open discectomy. Conclusions. Both methods are equally effective in relieving radicular pain. MED entailed shorter hospital stay, less morbidity, and earlier return to work. Nonetheless, it is a demanding technique and should not be attempted without specific instruction and training. Journal of Orthopaedic Surgery

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Limited Surgical Discectomy and Microdiscectomy

Cited by 99 publications

References 0 publications

Learning curve of full-endoscopic lumbar discectomy

Learning curve of full-endoscopic lumbar discectomy

Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes

Microendoscopic versus Open Discectomy for Lumbar Disc Herniation: A Prospective Randomised Study

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