A 10-Year Follow-Up Study on Long-Term Clinical Outcomes of Lumbar Microendoscopic Discectomy

Wang, M.; Zhou, Yue; Wang, J.; Zhang, Z.; Li, C.

doi:10.1055/s-0031-1297248

Cited by 35 publications

(33 citation statements)

References 19 publications

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“…2,3,9,[17][18][19]21,25,26,28,33,36,[41][42][43]45,49,[52][53][54][56][57][58]61 MED techniques employ a longitudinal paramedian incision through which a tubular retractor is placed and visualization is achieved through an endoscope. 2,6,10,13,19,24,25,29,36,46,51,53,57,60,62,64 Percutaneous discectomy entails placing a sheath directly into the disc space via a transforaminal approach, extraforaminal approach, or interlaminar approach and then using a suction/debrider or chemical injection to remove the disc. 1,11,12,23,30,37,44,50 To assess the risk of bias for each study, 3 reviewers (M.F.S., J.J.X., and E.Y.T.)…”

Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

127

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

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Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

127

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“…10,17,34,42,43 Microendoscopic discectomy (MED) uses a tubular transmuscular working channel (16-20 mm) to approach the spine coupled with an endoscope to enable visualization. 8,9,31,33,35,44,51,52,54,55 The same muscle-splitting device can also be used with the microscope to perform a minimally invasive microdiscectomy. [2][3][4][11][12][13][20][21][22]26,49 Also, full endoscopic techniques have been used for the treatment of LDH via an interlaminar or transforaminal (endoscopic transforaminal discectomy [ETD]) approach.…”

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confidence: 99%

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Hubbe¹,

Franco-Jimenez²,

Klingler³

et al. 2016

SPI

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OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

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“…Wang et al 4 reported the long-term clinical outcomes of lumbar microendoscopic diskectomy with a follow-up duration ranging from 98 to 127 months (mean: 114 months), and only five patients (3.5%) required additional surgery due to a recurrence of herniation. In the present study, the rate of reoperation due to a recurrence of herniation was 11.1% (5/45), with the duration of follow-up ranging from 120 to 143 months (mean: 126.0 months).…”

Section: Discussionmentioning

confidence: 99%

“…3 There have been some studies of long-term outcomes following microendoscopic diskectomy for patients with DH and of middle-term outcomes following microendoscopic decompression for patients with SS without and with degenerative spondylolisthesis (DS). [4][5][6] Wang et al 4 reported the long-term clinical outcomes of lumbar microendoscopic diskectomy based on the modified MacNab criteria. Minamide et al 5 evaluated the 5-year clinical outcomes after microendoscopic laminotomy for SS using the Japanese Orthopaedic Association scoring system, the 36-item Short-Form Health Survey (SF-36), and Roland-Morris Disability Questionnaire (RDQ).…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes Following Lumbar Microendoscopic Diskectomy and Microendoscopic Decompression: Minimum 10-year Follow-up Evaluation Performed Using a Patient-based Outcome Measure

Aihara

Endo

Suzuki

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Study Design Retrospective study of prospectively collected outcome data. Background No studies have evaluated the long-term outcomes following microendoscopic diskectomy for lumbar disk herniation (MEDH) and microendoscopic decompression for lumbar spinal stenosis (MEDS) using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Objective To assess the minimum 10-year outcomes following MEDH and MEDS. Patients and Methods Seventy-six patients were classified into three groups: disk herniation (DH) group (33 patients underwent MEDH); spinal stenosis (SS) group (23 patients underwent MEDS); and degenerative spondylolisthesis (DS) group (20 DS patients underwent MEDS). The follow-up rate was 50.3% (76/151). The results were statistically compared using Scheffé's F test for differences among the DH, SS, and DS groups. The paired t test was used to compare the preoperative and postoperative visual analog scale (VAS) scores. The degrees of improvement (DOIs) on JOABPEQ and the intensities of improvement (IOIs) on VAS at the first follow-up evaluation (FFE) (mean: 12 months after the operation) and at the most recent follow-up evaluation (MRFE) (mean: 126 months) of the DH group were statistically compared by the paired t test. DOIs and IOIs at MRFE of the SS group (mean: 126 months) and DS group (mean: 125 months) were statistically compared by the unpaired t test. A p value < 0.05 was considered statistically significant. Results Statistical comparisons of the DOIs in all five functional scores and IOIs in low back pain (LBP), leg pain, and leg numbness showed no significant differences among the DH, SS, and DS groups. The effectiveness rates of pain-related disorders, gait disturbance, and social life disturbance in JOABPEQ were almost equally high in all three groups. Significant decreases in LBP, leg pain, and numbness, as measured with VAS, were noted at MRFE in all three groups. No significant differences were observed between FFE and MRFE concerning the DOIs and IOIs of the DH group, and between the SS and DS groups concerning the DOIs and IOIs at MRFE. Conclusion Clinical 1-year outcomes of MEDH were thought to be maintained for > 10 years, and MEDS leads to the same clinical long-term outcomes with DS as without DS. Moreover, MEDH and MEDS were almost equally effective for > 10 years not only in improving LBP, leg pain, and numbness but also especially in improving pain-related disorders, gait disturbance, and social life disturbance by detailed quality-of-life assessment using JOABPEQ.

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A 10-Year Follow-Up Study on Long-Term Clinical Outcomes of Lumbar Microendoscopic Discectomy

Abstract: The 10-year follow-up study showed that the long-term clinical outcomes of MED are satisfactory and better than those of the traditional discectomy procedure. The MED procedure is both feasible and efficacious for the treatment of LDH.

Cited by 35 publications

References 19 publications

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Long-term Outcomes Following Lumbar Microendoscopic Diskectomy and Microendoscopic Decompression: Minimum 10-year Follow-up Evaluation Performed Using a Patient-based Outcome Measure

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