DOI: http://dx.doi.org/10.18203/2349-2902.isj20213988

A comparative study of conventional microlumbar discectomy and endoscopic lumbar discectomies

Vyabhav Raghu, Deepak Ranade, Anil Patil, Sarang Gotecha, Prashant Punia, Ashish Chugh, Bhagirath More, Shobhit Chhabra, Dushyant Kashyap

Abstract


Background: Low back pain is fairly common in India and lumbar disc herniation is its most common specific cause. In the present study we compared three minimally invasive surgical modalities for treating lumbar disc herniation.

Methods: This prospective observational study was conducted on patients who presented to our department with low back pain with radicular symptoms. Twenty-five patients who underwent either microlumbar disectomy (MLD), percutaneous endoscopic transforaminal lumbar discectomy (PELD) or microendoscopic lumbar discectomies (MED) were compared.

Results: Of the total sample of 75 cases, it was found that male population was affected more and the degenerative disc process was more prevalent among those over 40 years of age. The MED had the shortest operative time while MLD had the longest mean duration. A comparison of the intraoperative blood loss was negligible in PELD group and 42.80 ml in MED and 63.20 ml in MLD which was strongly significant with a p<0.001. Pain scores were comparable between the patients in the three surgery groups. We observed significantly higher ODI score for patients in MLD group at in the immediate post-operative, 3 months and 6 months post-operative period.

Conclusions: MLD is the gold standard for treatment for lumbar disc disease even today due to its familiarity among neurosurgeons; however, reduced tissue destruction and cosmetic demand with equally good results if not better, endoscopy could replace MLD as the first-line treatment for LDH until lesser invasive modality comes to light.


Keywords


Low backache, Lumbar disc herniation, Surgery, Minimally invasive

Full Text:

PDF

References


Koley S, Sandhu NS. An association of body composition components with the menopausal status of patients with low back pain in Taran, Punjab, India. J Life Sci. 2009;1:129-32.

Cunha C, Silva AJ, Pereira P, Vaz R, Gonçalves RM, Barbosa MA. The inflammatory response in the regression of lumbar disc herniation. Arthritis research & therapy. 2018;20(1):1-9.

Fairbank JC, Pynsent PB. The Oswestry disability index. Spine. 2000;25(22):2940-53.

Liang ZY, Zhuang YD, Chen CM, Wang R. Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial. BMJ open. 2019;9(12):e033888.

Goda N, Ranjan A, Singh A. Evaluation of the Outcome of Lumbar Disc Surgeries: Laminectomy Discectomy, Microlumbar Discectomy and Microendoscopic Discectomy. Int J Sci Stud. 2019;6(12):213-9.

Tzaan WC. Transforaminal percutaneous endoscopic lumbar discectomy. Chang Gung Med J. 2007;30:226 34.

Markovic M, Zivkovic N, Ruetten S, Ozdemir S, Goethel D Full-Endoscopic Interlaminar Versus Microsurgical Operations in Lumbar Compressive Lesions Surgery: Prospective Randomized Trial of Overall 570 Patients. J Pain Relief. 2017;6(6).

Sinkemani A, Hong X, Gao Z-X, Zhuang S-Y, Jiang Z-L, Zhang S-D et al. Outcomes of Microendoscopic Discectomy and Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation: A Comparative Retrospective Study. Asian Spine J. 2015;9(6):833.

Ruetten S, Komp M, Merk H, Godolias G. Full-Endoscopic Interlaminar and Transforaminal Lumbar Discectomy Versus Conventional Microsurgical Technique: A Prospective, Randomized, Controlled Study. Spine. 2008;33(9):931-9.

Chen Z, Zhang L, Dong J, Xie P, Liu B, Wang Q et al. Percutaneous transforaminal endoscopic discectomy versus microendoscopic discectomy for lumbar disc herniation: Two-year results of a randomized controlled trial. Spine. 2020;45(8):493-503.

Gibson JNA, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: The future ‘gold standard’ for discectomy? – A review. The Surgeon. 2012;10(5):290-6.

Liu X, Yuan S, Tian Y, Wang L, Gong L, Zheng Y, et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results. J Neurosurg Spine. 2018;28(3):317-25.

Ruetten S, Komp M, Merk H, Godolias G. Full-Endoscopic Interlaminar and Transforaminal Lumbar Discectomy Versus Conventional Microsurgical Technique: A Prospective, Randomized, Controlled Study. Spine. 2008;33(9):931-9.