Microdiscectomy or tubular discectomy: Is any of them a better option for management of lumbar disc prolapse

Abstract

Objectives:Various types of minimally invasive techniques have been developed for the treatment of lumbar disc herniation. The original laminectomy was refined into microdiscectomy (MD). MD is the gold standard in management of lumbar disc herniation and is used as a yardstick for comparison with newer procedures such as tubular discectomy. So far, no studies have been reported in Indian population comparing tubular discectomy and microdiscectomy. The aim of this study was to compare immediate postoperative and 1-year outcome of patients undergoing tubular discectomy with those undergoing MD and to evaluate the learning curve as well as complication rates of tubular discectomy.Materials and Methods:Forty-six patients of MD and 102 (48 early and 54 late) patients of tubular discectomy (TD) were operated at Indian Spinal Injuries Centre, which is a tertiary level center between July 2009 and January 2012. They were studied for the following data: Baseline characteristics, visual analog scale (VAS) for leg pain and back pain, Oswestry Disability Index (ODI) scores, length of hospital stay, time taken to return to work, duration of surgery, intra- and post-operative complications, and reoperation rates.Results:The VAS score for leg pain, back pain, and ODI scores showed improvement in both groups during the 1st year after surgery. Time taken to return to work and mean hospital stay was shorter in case of TD as compared to MD group. The mean duration of surgery was 34 min shorter for conventional MD. The incidence of dural tear was 6.5% in MD group and 10.4% in early TD and decreased to 7.4% in late TD group.Conclusion:This study revealed that rate of recovery is significantly faster for TD as compared to conventional MD. In contrast, we encountered fewer complications in MD approach as compared to TD which although were not statistically significant and which also decreased as we gained experience.

Comparison of the application value of two commonly used minimally invasive spinal surgery in the treatment of lumbar disc herniation

“…In the past 10 years, due to the rapid development of medical devices and the strong demand of patients, spinal endoscopy has developed rapidly (4). At present, traditional open surgery has been gradually replaced by minimally invasive spinal surgery, which has the advantages of small incision, less pain, quick recovery, and short length of hospital stay (5).…”

Comparison of the Minimally Invasive Tubular Transmuscular Approach with the Conventional Microsurgical Approach for Microsurgical Treatment of Lumbar Disk Herniation: A Prospective Randomized Study

“…24 In contrast to our average length of hospital stay of 5 days for both study groups, which is below our expected/estimated length of stay in hospital of 6 days, an earlier publication from Cahil et al describe a significantly shorter hospital stay for patients operated via Metrx (0.9 days) compared with patients of the CM group (1.5 days). 28 Though the most potential clinically relevant advantage to be expected from the Metrx is the shorter postoperative hospital stay and an earlier ability to resume work, due to the faster postoperative pain relief with less access trauma, 29 it is not clear why our study could not reproduce these results. Regarding occupational reintegration after surgical treatment of lumbar disk herniation via Metrx, there is no information in the literature.…”

Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis

“…1). Thirty-seven studies met the selection criteria for the purposes of the present review, which included 17 RCTs [13,14,[25][26][27][38][39][40][41][42][43][44][45][46][47][48][49] and 20 cohort studies [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69].…”

“…Complications were calculated from 4945 patients with a mean follow-up duration of 19.9 months from the 20 cohort studies [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69], including 2530 OD/MD patients with a mean follow-up duration of 20.2 months, 999 MED patients with a mean follow-up duration of 37.8 months, 514 PELD patients with a mean follow-up duration of 19.1 months, 540 PLDD patients with a mean follow-up duration of 17 months, and 362 tubular discectomy patients with a mean follow-up duration of 10.3 months (Tables 2, 3). Studies reporting OD/MD, MED, PELD, PLDD, and tubular discectomies had overall complication rates (pooled mean) of 7.6%, 6.2%, 9.1%, 3.5%, and 11.6%, respectively.…”