Comparison of outcomes between conventional lumbar fenestration discectomy and minimally invasive lumbar discectomy: an observational study with a minimum 2-year follow-up

Journal of Orthopaedic Surgery and Research

Anish T S²  Vivek Mathew¹  C S Vikraman¹  Shiju A Majeed¹ 

[1] Department of Orthopedics, Government Medical College, Trivandrum, India;Department of Community Medicine, Government Medical College, Trivandrum 695011, India

关键词: MLD;    Minimally invasive lumbar discectomy;    Fenestration discectomy;   

Others  :  814390
DOI  :  10.1186/1749-799X-8-34

 received in 2012-04-10, accepted in 2013-09-09,  发布年份 2013

【 摘 要 】

Background

Different surgical techniques for lumbar discectomy are in vogue. This study compares the outcomes of two techniques for lumbar discectomy, viz. micro lumbar discectomy (LD) and conventional fenestration discectomy.

Materials and methods

Sixty-six patients who had single-level 'virgin’ lumbar disc herniation with unilateral radicular symptoms were included. Of these, 39 had undergone MLD while 27 had undergone fenestration. Outcomes were measured using the visual analogue scale (VAS) for back and leg pain, Japanese Orthopedic Association (JOA) score, Roland-Morris score (RM) improvement and North American Spine Society (NASS) score. All quantitative data were summarised using mean and standard deviation, and qualitative data using proportions. Significance of differences across the two groups in terms of mean scores was assessed using independent sample t test, and the improvement within the same groups was measured using paired t test. Multiple linear regression analysis was done to assess independent predictors of improvement.

Results

The MLD group showed statistically better outcomes with regard to improvement in JOA score at 6 weeks, 6 months and 2 years. Mean (SD) VAS for lower back ache at 6 weeks, 6 months, and 2 years was better for the MLD group. But the difference noted in VAS for leg pain was not statistically significant across the groups (P = 0.133). The improvement noted in JOA at 2 years postoperatively compared to the preoperative score was 13.67 (2.89) in the MLD group and 12.11 (3.30) in the macrodiscectomy group (P = 0.046).

The mean (SD) RM improvement for the MLD group was 79.24% (8.96%) vs 71.72% (16.53), P = 0.02, in the macrodiscectomy group. Mean NASS score for the MLD group was 2.74 vs 2.96 in the conventional group (P = 0.407).

The type of surgery was the significant predictor of improvement in JOA score (P = 0.046) even after adjusting for age, sex, level of lesion and the initial JOA score. MLD as the surgical procedure (P = 0.002) and a lower initial JOA score (P = 0.006) were found significantly contributing to the RM improvement.

Conclusion

The study shows that both MLD and fenestration give comparable results at short-term follow-up. There is statistically significant improvement in MLD with regard to improvement in JOA, VAS and RM scores at 2 years. However, the difference is not large and may not be clinically significant.

【 授权许可】

   
2013 Majeed et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Love JG: Root pain resulting from intraspinal protrusion of vertebral discs: diagnosis and treatment. J Bone Joint Surg 1939, 19:776-80.
• [2]Caspar W: A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 1977, 4:152.
• [3]Williams RW: Micro lumbar disectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine 1978, 3:17582.
• [4]Japanese Orthopaedic Association: Japanese Orthopaedic Association Assessment Criteria Guidelines Manual. Tokyo: JOA; 1996:46-49.
• [5]Roland MO, Morris RW: A study of the natural history of back pain. Part 1: development of a reliable and sensitive measure of disability in low back pain. Spine 1983, 8:141-144.
• [6]Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH: The North American Spine Society Lumbar Spine Outcome Assessment Instrument: reliability and validity tests. Spine 1996, 21:741-749.
• [7]Katayama Y, Matsuyama Y, Yoshihara H, Sakai Y, Nakamura H, Nakashima S, Ito Z, Ishiguro N: Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech 2006, 19(5):344-347.
• [8]Huang TJ, Hsu WW, Li YY, Cheng CC: Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 2005, 23(2):406-411.
• [9]Kelly RE, Dinner MH, Lavyne MH, Andrews DW: The effect of lumbar disc surgery on postoperative pulmonary function and temperature. Spine 1993, 18(2):287-290.
• [10]Acharya KN, Senthil Nathan TS, Kumar JR, Menon KV: Primary and revision lumbar discectomy: a three-year review from one center. Indian J Orthop 2008, 42:178-781.
• [11]Findlay G, Hall B, Musa BS, Oliveira MD, Fear SC: A 10-year follow-up of the outcome of lumbar microdiscectomy. Spine 1998, 23(10):1168-1171.
• [12]Henriksen L, Schmidt K, Eskesen V, Jantzen E: A controlled study of microsurgical versus standard lumbar discectomy. Br J Neurosurg 1996, 10(3):289-294.
• [13]Porchet F, Bartanusz V, Kleinstueck FS, Lattig F, Jeszenszky D, Grob D, Mannion AF: Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry. Eur Spine J 2009, 18(Suppl 3):360-366.
• [14]Tureyen K: One-level one-sided lumbar disc surgery with and without microscopic assistance: 1-year outcome in 114 consecutive patients. JNS Spine 2003, 99(3):247-250.