Microendoscopic Discectomy for Lumbar Disc Herniation

Wu, Xiao‐Tao; Zhuang, Suyang; Mao, Zubin; Chen, Hui

doi:10.1097/01.brs.0000244615.43199.07

Cited by 165 publications

(59 citation statements)

References 10 publications

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“…Several recent prospective RCTs have compared OD to tubular retractor-based MED33343536 and success rates have been found to be similar. Our results are comparable to results of MED by Wu et al .,37 in which the mean VAS scale changes were significant and ODI changed from 48% to 23%. In our series, there was one wound infection at a rate of 0.5%, discitis rate of 0% and a durotomy rate of 5%.…”

Section: Discussionsupporting

confidence: 89%

Microendoscopic lumbar discectomy: Technique and results of 188 cases

Kulkarni

Bassi

Dhruv

2014

IJOO

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Background:Discectomy performed open or with an operating microscope remains the standard surgical management. Tubular retractor system is being increasingly used. Potential benefits include less muscle and local damage, better cosmesis, decreased pain and operative time and faster recovery after surgery. We have evaluated the outcome of micro endoscopic discectomy (MED) utilizing tubular retractors in terms of safety and efficacy of the technique.Materials and Methods:188 consecutive patients who underwent surgery for herniated disc using the tubular retractors between April 2007 and April 2012 are reported. All patients had a preoperative MRI (Magnetic Resonance Imaging) and were operated by a single surgeon with the METRx system (Medtronic, Sofamor-Danek, Memphis, TN) using 18 and 16 mm ports. All patients were mobilized as soon as pain subsided and discharged within 24-48 hours post surgery. The results were evaluated by using VAS (Visual Analog Scale 0-5) for back and leg pain and ODI (Oswestry Disability Index). Patients were followed up at intervals of 1 week, 6 weeks, 3 months, 6 months, 12 months and 2 years.Results:The mean age of patients was 46 years (range 16-78 years) and the sex ratio was 1.5 males to 1 female. The mean followup was 22 months (range 8-69 months). The mean VAS scale for leg pain improved from 4.14 to 0.76 (P < 0.05) and the mean VAS scale for back pain improved from 4.1 to 0.9 (P < 0.05). The mean ODI changed from 59.5 to 22.6 (P < 0.05). The mean operative time per level was about 50 minutes (range 20-90 minutes). Dural punctures occurred in 11 (5%) cases. Average blood loss was 30 ml (range 10-500 ml). A wrong level was identified and later corrected in a case of revision discectomy. Four patients with residual disc-herniation had revision MED and three patients with recurrent disc herniation later underwent fusion. One patient had wound infection which needed a debridement.Conclusion:MED for herniated discs effectively achieves the goals of surgery with minimal access. The advantages of the procedure are cosmesis, early postoperative recovery and minimal postoperative morbidity.

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Section: Discussionsupporting

confidence: 89%

Microendoscopic lumbar discectomy: Technique and results of 188 cases

Kulkarni

Bassi

Dhruv

2014

IJOO

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“…There was a strong centre-method interaction for the operation duration indicating that only at the index centre a temporal advantage for the operation duration could be achieved. The operation duration reported in the literature for a standard microdiscectomy ranging from 54 to 70 min was compatible to our findings for the MC procedures at both centres and even the MAPN procedure at the transfer centre [10,12,25,36,39]. For an endoscopic procedure using a tubular system Nakagawa reported a duration of 79 min [26].…”

Section: Discussionsupporting

confidence: 89%

“…Regarding the clinical results as sum VAS and Oswestry Score Wu et al [39] found in a study of 821 patients a mean postoperative OSW of 23%, compared to 48% before surgery for a minimal invasive procedure. The VAS dropped on an average from 78 mm preoperatively to 23 mm postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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

Franke

Greiner-Perth²,

Boehm

et al. 2009

Eur Spine J

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A Prospective randomised controlled study was done to determine statistical difference between the standard microsurgical discotomy (MC) and a minimally invasive microscopic procedure for disc prolapse surgery by comparing operation duration and clinical outcome. Additionally, the transferability of the results was determined by a bicentric design. The microscopic assisted percutaneous nucleotomy (MAPN) has been advocated as a minimally invasive tubular technique. Proponents have claimed that minimally invasive procedures reduce postoperative pain and accelerate the recovery. In addition, there exist only a limited number of well-designed comparison studies comparing standard microdiscotomy to a tubular minimally invasive technique that support this claim. Furthermore, there are no well-designed studies looking at the transferability of those results and possible learning curve phenomena. We studied 100 patients, who were planned for disc prolapse surgery at two centres [50 patients at the developing centre (index) and 50 patients at the less experienced (transfer) centre]. The randomisation was done separately for each centre, employing a blockrandomisation procedure with respect to age and preoperative Oswestry score. Operation duration was chosen as a primary outcome parameter as there was a distinguished shortening observed in a preliminary study at the index centre enabling a sound case number estimation. The following data were compared between the two groups and the centres with a 12-month follow-up: surgical times (operation duration and approach duration), the clinical results, leg and back pain by visual analogue scale, the Oswestry disability index, length of hospital stay, return to work time, and complications. The operation duration was statistically identical for MC (57.8 ± 20.2 min) at the index centre and for MAPN (50.3 ± 18.3 min) and MC (54.7 ± 18.1 min) at the transfer centre. The operation duration was only significantly shorter for the MAPN technique at the index centre with 33.3 min (SD 12.1 min). There was a huge clinical improvement for all patients regardless of centre or method revealed by a repeated measures ANOVA for all follow-up visits Separate post hoc ANOVAs for each centre revealed that there was a significant time-method (MAPN vs. MC) interaction at the index centre (F = 3.75, P = 0.006), whereas this crucial interaction was not present at the transfer centre (F = 0.5, P = 0.7). These results suggest a slightly faster clinical recovery for the MAPN patients only at the index centre. This was due to a greater reduction in VAS score for back pain at discharge, 8-week and 6-month follow up (P \ 0.002). The Oswestry-disability scores reached a significant improvement compared to the initial values extending over the complete follow-up at both centres for J. Franke and R. Greiner-Perth contributed equally to this work. both methods without revealing any differences for the two methods in either centre. There was no difference regarding complications. The results demonstrate...

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“…Various studies have reported on outcomes of MD[2122] and TD[142324] and proved them to be better to open discectomy[213252627282930] but only few have compared outcomes of MD with TD. [3132]…”

Section: Discussionmentioning

confidence: 99%

“…The field of view through the endoscope is limited which makes it difficult to expose and decompress the nerve root. [121416] As we gained experience, even residual discs, initially operated by open or endoscopic discectomy were managed through tubular access.…”

Section: Discussionmentioning

confidence: 99%

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

Bhatia

Chhabra

Mohapatra

et al. 2016

J Craniovert Jun Spine

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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.

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Microendoscopic Discectomy for Lumbar Disc Herniation

Cited by 165 publications

References 10 publications

Microendoscopic lumbar discectomy: Technique and results of 188 cases

Microendoscopic lumbar discectomy: Technique and results of 188 cases

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

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

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