Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Minimally invasive lumbar discectomy is a refinement of the standard open microsurgical discectomy technique. Proponents of the minimally invasive technique suggest that it improves patient outcome, shortens hospital stay, and decreases hospital costs. Despite these claims there is little support in the literature to justify the adoption of minimally invasive discectomy over standard open microsurgical discectomy. In the present study, the authors address some of these issues by comparing the short-term outcomes in patients who underwent first time, single-level lumbar discectomy at L3–4, L4–5, or L5–S1 using either a minimally invasive percutaneous, muscle splitting approach or a standard, open, muscle-stripping microsurgical approach.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective chart review of 172 patients who had undergone a first-time, single-level lumbar discectomy at either L3–4, L4–5, or L5–S1 was performed. Perioperative results were assessed by comparing the following parameters between patients who had undergone minimally invasive discectomy and those who received standard open microsurgical discectomy: length of stay, operative time, estimated blood loss, rate of cerebrospinal fluid leak, post-anesthesia care unit narcotic use, need for a physical therapy consultation, and need for admission to the hospital.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Forty-nine patients underwent minimally invasive discectomy, and 123 patients underwent open microsurgical discectomy. At baseline the groups did differ significantly with respect to age, but did not differ with respect to height, weight, sex, body mass index, level of radiculopathy, side of radiculopathy, insurance status, or type of preoperative analgesic use. No statistically significant differences were identified in operative time, rate of cerebrospinal fluid leak, or need for a physical therapy consultation. Statistically significant differences were identified in length of stay, estimated blood loss, postanesthesia care unit narcotic use, and need for admission to the hospital.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In this retrospective study, patients who underwent minimally invasive discectomy were found to have similiar perioperative results as those who underwent open microsurgical discectomy. The differences, although statistically significant, are of modest clinical significance.</jats:p></jats:sec>

Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

“…17 Unlike this German et al showed that patients who underwent minimally invasive microdiscectomies had about half the length of stay compared to patients who underwent conventional microdiscectomies (0.84 days vs. 1.43 days). 22 One main reason for this is that in rural India, many patients travel a long distance to have surgery, and many other were emergent transfers from other community hospitals. Such patients insist on staying longer before going back home.…”

Tubular microdiscectomy: techniques, complication avoidance, and review of the literature

“…Retrospective studies consistently show similar rates of overall complications and CSF leakage. 8,13,20,22 Taken together, Level I evidence suggests similar safety profiles and rates of recurrence in tubular microdiscectomy compared with standard microdiscectomy.…”

“…26 Multiple retrospective studies and a meta-analysis support similar operating times for the tubular and standard groups. 8,10,13,20,22 Therefore, Level II data suggest that operative duration may be slightly increased with tubular techniques, but this is by no means certain, because conflicting data exist.…”

“…25,26 In contrast, the study by Huang et al reported lower EBL in the tubular group, 17 a result that is supported by retrospective studies. 13,20 Level II evidence suggests that tubular microdiscectomy may be associated with similar or less blood loss than standard microdiscectomy.…”

Modern treatments for degenerative disc diseases of the lumbosacral spine. A literature review

“…German и соавт. [29], оценив результаты лечения 172 больных (45 оперированны эндоскопическим мето-дом, 123 -классическим методом), не выявили статисти-чески достоверных отличий между группами по таким параметрам, как продолжительность операции и частота послеоперационной ликвореи. Отмечено уменьшение продолжительности послеоперационного пребывания в стационаре, интраоперационной кровопотери, потребно-сти в наркотических анальгетиках в послеоперационном периоде при использовании микроэндоскопической тех-ники дискэктомии.…”