Micro-Endoscopic Discectomy versus Open Discectomy: A Struggle for Better Clinical Outcomes

Authors

  • Ammar Anwer Department of Neurosurgeries, 1,5University of Lahore Teaching Hospital,
  • Ijaz Hussain Wadd
  • Abdul Ghafoor
  • Javaria Siddiq
  • Malik Muhammad Yasin
  • Jamshaid Farooq

DOI:

https://doi.org/10.36552/pjns.v26i3.784

Keywords:

Lumbar Disc Herniation, Open Discectomy, Micro-Endoscopic Discectomy

Abstract

Objective:  The objective of the current study was to compare the clinical outcomes of a micro-endoscopic discectomy with an open discectomy.

Materials & Methods:  This Quasi-experimental study was conducted in the Department of Neurosurgery, Alrazi Healthcare, Lahore, and Ammar Medical Complex, Lahore. The sample consisted of 40 patients with lower back pain with radiation to the lower limbs. A lumbar disc single-segment hernia was diagnosed based on magnetic resonance imaging (MRI) findings. Independent sample t-test was used to explore the difference in outcomes and level of pain between group A and group B. Chi-square test was used to compare the recovery rate of patients in both groups.

Results:  A significant difference between the two groups in terms of surgery duration (t = 15.977, P = .000), blood loss during surgery (t = -10.256, P = .000), length of incision (t = -58.355, P = .000), and hospital stay after surgery (t = -4.687, P = .000) was found. The overall recovery rate for the micro-endoscopic Discectomy group was 95% whereas, in the open discectomy group, it was 90%.

Conclusion:  Micro-endoscopic discectomy is superior to open discectomy in terms of lesser surgical trauma, lesser blood loss, lesser hospital stay, earlier return to work, and higher pain resolution.

References

Ohtori S, Yamashita M, Yamauchi K, Inoue G, Koshi T, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S, Takaso M, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Nakamura J, Takahashi K. Low back pain after lumbar discectomy in patients showing endplate modic type 1 change. Spine (Phila Pa 1976) 2010; 35: E596-E600.

Oktay K, Ozsoy KM, Dere UA, Cetinalp NE, Arslan M, Erman T, Guzel A. Spontaneous regression of lumbar disc herniations: A retrospective analysis of 5 patients. Niger J Clin Pract. 2019; 22: 1785-1789.

Aprígio RM, Caramanti RL, Santos FOR, Maia IPT, Filipe FMR, de Moraes DF, da Silva EC, Nogueira FM. Intradural disc herniation at the L1-L2 level: A case report and literature review. Surg Neurol Int, 2019; 10: 196.

Echt M, Holland R, Mowrey W, Cezayirli P, De la Garza Ramos R, Hamad M, Gelfand Y, Longo M, Kinon MD, Yanamadala V, Chaudhary S, Cho SK, Yassari R. Surgical Outcomes for Upper Lumbar Disc Herniations: A Systematic Review and Meta-analysis. Global Spine J, 2021; 11 (5): 802-813.

Takahashi H, Aoki Y, Inoue M, Saito J, Nakajima A, Sonobe M et al. Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale. BMC Musculoskeletal Disorders, 2021; 22 (1).

Yang X, Zhang Q, Hao X, Guo X, Wang L. Spontaneous regression of herniated lumbar discs: Report of one illustrative case and review of the literature. Clin Neurol Neurosurg. 2016; 143: 86-89.

Pang JY, Tan F, Chen WW, Li CH, Dou SP, Guo JR, Zhao LY. Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation. World J Clin Cases, 2020; 8 (14): 2942-2949.

Macki M, Hernandez-Hermann M, Bydon M, Gokaslan A, McGovern K, Bydon A. Spontaneous regression of sequestrated lumbar disc herniations: Literature review. Clin Neurol Neurosurg. 2014; 120: 136-141.

Kim ES, Oladunjoye AO, Li JA, Kim KD. Spontaneous regression of herniated lumbar discs. J Clin Neurosci. 2014; 21: 909-913.

Pang J, Tan F, Chen W, Li C, Dou S, Guo J et al. Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation. World Journal of Clinical Cases, 2020; 8 (14): 2942-2949.

Teli M, Lovi A, Brayda-Bruno M, Zagra A, Corriero A, Giudici F et al. Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. European Spine Journal, 2010; 19 (3): 443-450.

Martín-Láez R, Martínez-Agüeros J, Suárez-Fernández D, Montiaga-Núñez F, Vázquez-Barquero A. Complications of endoscopic microdiscectomy using the EASYGO! system: is there any difference with conventional discectomy during the learning-curve period?. Acta Neurochirurgica, 2012; 154 (6): 1023-1032.

Garg B, Nagraja U, Jayaswal A. Microendoscopic versus Open Discectomy for Lumbar Disc Herniation: A Prospective Randomised Study. Journal of Orthopaedic Surgery, 2011; 19 (1): 30-34.

Hussein M, Abdeldayem A, Mattar M. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. European Spine Journal, 2014; 23 (9): 1992-1999.

Huang T, Hsu R, Li Y, Cheng C. Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. Journal of Orthopaedic Research, 2005; 23 (2): 406-411.

Acharya KN, Nathan TS, Kumar JR, Menon KV. Primary and revision lumbar discectomy: a three-year review from one center. Indian J Orthop. 2008; 42: 178-181.

Gibson JN, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? – A review. Surgeon, 2012; 10: 290-296.

Frucella G, Maldonado D. [Percutaneous Lumbar Endoscopic Discectomy: Presentation of 60 Cases Intervened in Argentina with Awake Patients]. Surg Neurol Int. 2019; 10: S37-S45.

Li K, Gao K, Zhang T, Lv CL. Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study. Eur Spine J. 2019.

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Published

2022-09-30

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Original Articles