A controlled study of microsurgical versus standard lumbar discectomy

Henriksen, Leif; Schmidt, K.; Eskesen, Vagn; Jantzen, Ellen C.

doi:10.1080/02688699650040160

Cited by 86 publications

(42 citation statements)

References 17 publications

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“…Thus, the current systematic review was based on ten original articles that met the inclusion criteria: Tullberg et al [31], Kelly et al [16], Mayer et al [18], Henriksen et al [11], Hermantin et al [12], Schick et al [24], Tureyen et al [32], Huang et al [13], Katayama et al [15], and Righesso Neto et al [23] (Table 2).…”

Section: Methodsmentioning

confidence: 99%

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations

Gotfryd¹,

Avanzi²

2008

International Orthopaedics (SICO

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The focus of this study was to examine the safety and effectiveness of three different discectomy techniques using a posterior approach for the treatment of herniated lumbar discs. There are only a small number of prospective randomised studies comparing posterior lumbar discectomy techniques, and no recent systematic review has been published on this matter. Using the Cochrane Collaboration guidelines, all randomised or "quasi-randomised" clinical trials, comparing classic, microsurgical, and endoscopic lumbar discectomies using a posterior approach were systematically reviewed. No statistically significant differences were found between these techniques regarding improvement in pain, sensory deficits, motor strength, reflexes, and patient satisfaction. Current data suggest that the microsurgical and endoscopic techniques are superior to the classic technique for the treatment of single level lumbar disc herniations with respect to volume of blood loss, systemic repercussions, and duration of hospital stay. All three surgical techniques were found to be effective for the treatment of single level lumbar disc herniations in patients without degenerative vertebral deformities. No conclusions could be drawn from the clinical randomised studies reviewed regarding the safety of the three techniques studied due to insufficient data on postoperative complications.Résumé L'objectif de cette étude est d'évaluer trois techniques différentes de discectomie après abord postéri-eur du rachis lors du traitement des hernies discales lombaires. Il existe un petit nombre d'études prospectives randomisées comparant les techniques de discectomies par voie postérieure lombaire. Aucune revue systématique n'a été publiée. En utilisant la base de Cochrane, nous avons étudié de façon systématique un certain nombre d'études comparant les discectomies par voie micro chirurgicale classique ou par endoscopie. Aucune différence significative n'a été trouvée entre toutes ces techniques tant sur le plan de l'amélioration de la douleur que des déficits sensoriels, des problèmes moteurs ou des réflexes et de la satisfaction des patients. Les données de la littérature suggèrent que la micro chirurgie et les techniques d'endoscopie sont supérieures aux techniques classiques dans le traitement d'une hernie à un seul niveau, notamment en ce qui concerne les pertes sanguines, les complications systémiques et la durée de séjour. Ces trois techniques sont des techniques qui peuvent être utilisées pour les hernies discales à un seul niveau chez les patients qui ne présentent pas de déformations dégénératives de la colonne vertébrale. Aucune conclusion ne peut être donnée concernant la revue des études cliniques randomisées, notamment en ce qui concerne l'absence de complications sur les trois techniques utilisées. Ceci est secondaire à l'insuffisance des données de la littérature sur les complications post-opératoires.

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Section: Methodsmentioning

confidence: 99%

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations

Gotfryd¹,

Avanzi²

2008

International Orthopaedics (SICO

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“…Four of them included economical evaluations [28][29][30][31] and 20 used proxy measures [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. Eight were randomized controlled trials (RCTs) and 16 were non-randomized comparison studies.…”

Section: Description Of Resultsmentioning

confidence: 99%

“…When compared to CNL [32,36,37,42] and MD [33][34][35]39,44,46,49] no clear picture emerges for or against CD, but it is noteworthy that the studies with the highest quality assessment [32,39,42,49] all report no difference between techniques. It thus remains unclear which, if any method is superior.…”

Section: Studies Reporting Proxy Measures For Costsmentioning

confidence: 99%

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The cost-effectiveness of conventional discectomy compared to other surgical techniques for lumbar disk herniation. A systematic review

Thorsen

Ødegaard-Olsen²,

Leboeuf‐Yde³

et al. 2018

Rheumatol Orthop Med

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“…16,19 Likewise, Level I evidence demonstrates equivalence between instrumented and noninstrumented lumbar fusion with respect to clinical improvement, complications, hospital metrics, and fusion rates. 12 These data highlight how, in the setting of equivalent outcomes, technological advances and shifting patient preferences can guide changes in treatment modalities.…”

Section: Discussionmentioning

confidence: 99%

Tubular microdiscectomy: techniques, complication avoidance, and review of the literature

Clark

Safaee

Khan

et al. 2017

Neurosurgical Focus

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OBJECTIVEMicroendoscopic discectomy is a minimally invasive surgery technique that was initially described in 1997. It allows surgeons to work with 2 hands through a small-diameter, operating table–mounted tubular retractor, and to apply standard microsurgical techniques in which a small skin incision and minimal muscle dissection are used. Whether the surgeon chooses to use an endoscope or a microscope for visualization, the technique uses the same type of retractor and is thus called tubular microdiscectomy. The goal in this study was to review the current literature, examine the level of evidence supporting tubular microdiscectomy, and describe surgical techniques for complication avoidance.METHODSThe authors performed a systematic PubMed review using the terms “microdiscectomy trial,” “tubular and open microdiscectomy,” “microendoscopic open discectomy,” and “minimally invasive open microdiscectomy OR microdiskectomy.” Of 317 references, 10 manuscripts were included for analysis based on study design, relevance, and appropriate comparison of open to tubular discectomy.RESULTSSimilar and very favorable clinical outcomes can be expected from tubular and standard microdiscectomy. Studies have demonstrated equivalent operating times for both procedures, with lower blood loss and shorter hospital stays associated with tubular microdiscectomy. Furthermore, postoperative analgesic usage has been shown to be significantly lower after tubular microdiscectomy. Overall rates of complications are no different for tubular and standard microdiscectomy.CONCLUSIONSProspective randomized trials have been used to evaluate outcomes of common minimally invasive lumbar spine procedures. For lumbar discectomy, Level I evidence supports equivalently good outcomes for tubular microdiscectomy compared with standard microdiscectomy. Likewise, Level I data indicate similar safety profiles and may indicate lower blood loss for tubular microdiscectomy. Future studies should examine the comparative value of these procedures.

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A controlled study of microsurgical versus standard lumbar discectomy

Cited by 86 publications

References 17 publications

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations

The cost-effectiveness of conventional discectomy compared to other surgical techniques for lumbar disk herniation. A systematic review

Tubular microdiscectomy: techniques, complication avoidance, and review of the literature

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