Lumbar microdiscectomy: subperiosteal versus transmuscular approach and influence on the early postoperative analgesic consumption

Abstract

Conventional lumbar microdiscectomy requires subperiosteal dissection of the muscular and tendineous insertions from the midline structures. This prospective, randomized, single center trial aimed to compare a blunt splitting transmuscular approach to the interlaminar window with the subperiosteal microsurgical technique. Two experienced surgeons performed first time lumbar microdiscectomy on 125 patients. The type of approach and retractor used was randomized and both patients and evaluator were blinded to it. In 59 patients a speculumcounter-retractor was inserted through a subperiosteal (SP) route and in 66 patients an expandable tubular retractor was introduced via a transmuscular (TM) approach. In both groups the mean age was 51 years, the male gender prevalent (61%) and the distribution of the operated levels was similar. The outcome measures were VAS for back and leg pain, ODI and the postoperative analgesic consumption was scored by the WHO 3-class protocol. A postsurgical VAS (0-1) was defined as excellent, VAS (2-4) as satisfactory result. In this study the patients scored from 1 to 3 points daily according to the class of drugs taken.Furthermore, a 1/3 point (class 1), 2/3 point (class 2) and 1 point (class 3) was added for each on-demand drug intake. Recovery from radicular pain was excellent (SP 68%, TM 76%) or satisfactory (SP 23%, TM 21%). Recovery from back pain was excellent (SP 58%, TM 59%) or satisfactory (SP 37%, TM 37%). Postoperative mean improvement ODI was: SP 29% and TM 31%. Postoperative mean analgesic intake: SP 4.8 points, TM 2.6 points (P = 0.03). Lumbar microdiscectomy improves pain and ODI irrespective of the type of approach and retractor used. However, the postsurgical analgesic consumption is significantly less if a tubular retractor is inserted via a transmuscular approach.

Recovery of muscle strength after microdiscectomy for lumbar disc herniation: a prospective cohort study with 1-year follow-up

“…The surgical method used in this study, microdiscectomy, seems to be the preferred method in many publications [13][14][15][16][17], and has fewer complications than other methods [18]. This study shows that 75% of the patients with limb paresis due to herniated lumbar disc had full recovery 12 months after micro discectomy.…”

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial

“…Operation duration was chosen as primary endpoint e, as it is an objective parameter in order to perform a sound case number estimation using the results of our preliminary studies and results of recently published data comparing minimal invasive procedures to the conventional microsurgical technique [4,13,34].…”

A meta-analysis of interlaminar minimally invasive discectomy compared to conventional microdiscectomy for lumbar disk herniation

“…A total of 1886 titles and abstracts were preliminarily reviewed, of which 11 studies [11][12][13][14][15][16][17][18][19][20][21] eventually satisfied the eligibility criteria (Fig. 1).…”