Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network

Abstract

Study Design: Retrospective cohort study. Objective: We evaluated the effectiveness of minimally invasive (MIS) tubular discectomy in comparison to conventional open surgery among patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We performed an observational analysis of data that was prospectively collected. We implemented Minimum Clinically Important Differences (MCIDs), and we adjusted for potential confounders with multiple logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity (SAVES) protocol. Results: Three hundred thirty-nine (62%) patients underwent MIS tubular discectomy and 211 (38%) underwent conventional open discectomy. There were no significant differences between groups for improvement of leg pain and disability, but the MIS technique was associated with reduced odds of achieving the MCID for back pain (OR 0.66, 95% CI 0.44 to 0.99, P < 0.05). We identified statistically significant differences in favor of MIS for each of operating time (MIS mean (SD) 72.2 minutes (30.0) vs open 93.5 (40.9)), estimated blood loss (MIS 37.9 mL (36.7) vs open 76.8 (71.4)), length of stay in hospital (MIS 73% same-day discharge vs open 40%), rates of incidental durotomy (MIS 4% vs open 8%), and wound-related complications (MIS 3% vs open 9%); but not for overall rates of reoperation. Conclusions: Open and MIS techniques yielded similar improvements of leg pain and disability at up to 12 months of follow-up, but MIS patients were less likely to experience improvement of associated back pain. Small differences favored MIS for operating time, blood loss, and adverse events but may have limited clinical importance.

Intradiscal Gelified Ethanol Nucleolysis versus Endoscopic Surgery for Lumbar Disc Herniation Radiculopathy

“…Minor extradiscal leakages of Discogel were noted in the Discogel Group in 5/19 patients without any need for clinical management; all noted extra-discal leakages were related to reflux during the removal of the trocar. The safety of both Discogel injection in the intervertebral disc and tubular discectomy was consistent with the reported rates of numerous systematic reviews and clinical studies [ 13 , 23 , 24 , 25 , 28 , 29 ]. High-quality sophisticated imaging guidance with digital rotational angiography suite contributed to easier trocar insertion whilst clearly improving visibility and augmenting safety of intradiscal injections; state-of the art angiography suites provide significantly better visibility and guidance options when compared to c-arm X-ray machines.…”

Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country

“…9%). [ 8 ] The horizon of MISS broadened with the introduction of ED. [ 9 ] In the transforaminal endoscopic approach, the discectomy and decompression are performed through intervertebral foramen between exiting and traversing nerve roots, while in the interlaminar approach, the trajectory of the working cannula is placed more sagittally, medial to the facet joint.…”

Timing of Recovery After Surgery for Patients With Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network

“…We have previously noted similar attrition in Canadian Spine Outcomes and Research Network among patients with DCM and patients with other pathologies, which is suboptimal. 4,10,[23][24][25] However, these losses still left us with 70% of eligible participants and a relatively large sample size of 330. Interestingly, our finding of 98% or greater completion of PROMs vs 73% completion of clinician-reported mJOA scores at 2 years suggests that getting surgeons to complete follow-up outcome measures may in fact be more challenging than getting patients to complete them.…”