Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study

Schick, Uta; Döhnert, J; Richter, Andreas; König, Alexander; Vitzthum, Hans-Ekkehart

doi:10.1007/s005860100315

Cited by 138 publications

(89 citation statements)

References 21 publications

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“…11-14,30, [32][33][34][35]37 However, because these studies involved small numbers of patients in single institutions, it remains unclear whether MED is truly a safer technique than open discectomy. Despite the clinical importance of understanding the risk for adverse surgical comorbidities, few nationwide studies have examined these issues by directly comparing MED and open discectomy.…”

mentioning

confidence: 99%

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

Ohya¹,

Oshima²,

Chikuda³

et al. 2016

FOC

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OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups. RESULTS A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score–matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43–0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09–0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p < 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy. CONCLUSIONS The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.

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confidence: 99%

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

Ohya¹,

Oshima²,

Chikuda³

et al. 2016

FOC

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“…A comparative study of METRx with conventional microdiscectomy showed a significant faster return to work for the new procedure [12]. Furthermore, an intraoperative EMG-study done by Schick demonstrated that the transmuscular route damages the paraspinal muscles less than the subperiostal approach [14]. This is in accordance with the observation of Kim et al, which reported a decrease of the cross sectional area of spinal muscles on MRI after open pedicle screw fixation, but no decrease after use of percutaneous pedicle screw osteosynthesis [8].…”

Section: Discussionmentioning

confidence: 99%

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

2008

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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.

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“…Many studies have reported a better and more rapid recovery with the minimal muscular manipulation during spinal surgery. The MED has been associated with reduced paraspinal muscle damage compared to the conventional subperiosteal approach using a serological marker such as CPK-MM 18) , or intraoperative electromyography evaluations 17) . Brock et al 4) reported that compared to the conventional subperiosteal approach, the transmuscular approach required reduced amounts of analgesics during the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

Park

Kwon

Won

et al. 2010

J Korean Neurosurg Soc

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Objective :The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. Methods : Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). Results : The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. Conclusion : Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain. KEY WORDS :Lumbar spine˙ Muscle sparing technique˙ Microdiscectomy˙ Minimally invasive surgery.

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Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study

Cited by 138 publications

References 21 publications

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

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

Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

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