Standard Lumbar Discectomy Versus Microdiscectomy - Differences in Clinical Outcome and Reoperation Rate

Abstract

Microdiscectomy (MD) is accepted nowadays as the operative method of choice for lumbar disc herniation, but it is not rare for neurosurgeons to opt for standard discectomy (SD), which does not entail the use of operating microscope. In our study, differences in disc herniation recurrence and clinical outcome of surgical treatment of lumbar disc herniation with and without the use of operating microscope were assessed. Our study included 167 patients undergoing lumbar disc surgery during a three-year period (SD, n=111 and MD, n=56). Clinical outcome assessments were recorded by patients via questionnaire forms filled out by patients at three time points. Operation duration, length of hospital stay and revision surgeries were also recorded. According to study results, after one-year follow up there was no statistically significant difference between the SD and MD groups in functional outcome. However, we recorded a statistically significant difference in leg pain reduction in favor of the MD group. According to the frequency of reoperations with the mean follow up period of 33.4 months, there was a statistically significant difference in favor of the MD group (SD 6.3% vs. MD 3.2%). There appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome. However, we choose MD over SD because it includes significantly lower recurrent disc herniation rate and higher reduction of leg pain.

Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse in tertiary care hospital in South India

“…Thus our study shows excellent result with patients scoring less than 20% just at 14-week follow-up. This outcome is comparable to the results obtained by Kovacevic et al, where the mean preoperative ODI was 55.1±19.13 which reduced to 22.4±16.14 at 3-month follow up [20] . In Shrestha et al's study preoperative ODI was less to start with at 37.87±8.76 which went down to 7.78±7.7 at follow up [21] .…”

“…Contrary to our study, Aziz et al had a predominantly male population at 69.20% with 30.80% being female [7] . The mean age of patients in the microdiscectomy group was 44.8 years in Kovacevic et al's study group [20] which is almost similar to our study group, but the male to female ratio is different from our study with 60.70% male and 30.30% female population. The mean duration of low back pain is 10.13 months in our study group, with 36.67% having left-sided radiculopathy, 26.67% having right-sided radiculopathy and 36.67% with bilateral radiculopathy.…”

“…The most common level of disc herniation is at L4/L5 with 80% of the participants having intervertebral disc prolapse at L4/L5 in our study group whereas the most common level of disc herniation was at the level of L5/S1 lumbar vertebrae in Kovacevic et al's study group [20] Similar to our study, in Aziz et al' s [7] and Shrestha et al' s [21] study groups, the majority had herniation at L4/L5 level. On MRI finding, majority with 60.00% of the participants are found to have disc extrusion, 33.33% participants have disc protrusion and 6.67% participants have sequestration.…”

“…Average duration of surgery was 75 min with a range of 45-100 min, average blood loss was 200 mL with a range of 70 ml -350 ml in Aziz et al's [7] study. The mean duration of hospital stay was 6.7±3.1 (range: 4-11) days in Kovacevic et al's study with 68.7% having duration of surgery less than one hour and 31.3% had greater than onehour duration of surgery [20] . The Oswestry Disability Questionnaire, which evaluates the social and physical restrictions caused by low back pain, has decreased drastically showing good improvement postoperatively.…”

“…The potential benefits of microscopic discectomy are less muscle and tissue damage resulting in better cosmesis with less pain and operative time and faster recovery after surgery and less peridural scar tissue formation [7,18] . However, there appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome [19] . The current study is an attempt to identify the advantages of microscopic lumbar discectomy in terms of duration of surgery, blood loss, complications and functional outcomes as measured by Oswestry Disability Index (ODI) over a 14-week period after the surgery.…”