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

Abstract

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.

Influência da extensão da artrodese lombossacra nos resultados clínicos e funcionais

“…Estima-se que 53% dos brasileiros economicamente ativos irão apresentar lombalgia incapacitante ao longo de sua vida e 33% terão dor ciática associada 3 . Apesar do tratamento conservador ter uma alta taxa de bons resultados 4 e ser predominante nos casos de dor ciática secundária a hérnias discais ou estenose do canal vertebral, a cirurgia pode estar indicada quando não houver regressão do quadro álgico por pelo menos seis semanas, se persistência e/ou progressão do déficit neurológico e nos casos de crises repetitivas e incapacitantes de lombociatalgia 4,5 . O tratamento cirúrgico das afecções degenerativas lombossacras, quando acompanhadas de instabilidade mecânica, deve contemplar a melhora da dor e/ ou da disfunção neurológica (descompressão) e a estabilização mecânica (artrodese) 6,7 .…”

A prospective analysis of efficacy of fenestration discectomy in patients with symptomatic lumbar disc prolapse

“…The optimal patient is one with predominant unilateral leg pain, extending below the knee that has been present for atleast 6 weeks despite conservative measures. The operated patients had less postoperative pain due to the minimal soft tissue exposure, minimal handling of paraspinal muscles on one side only, less or no damage to lamina, no damage to facet joints [12,13,14] . All the patients required less dose of postoperative analgesics.…”

A Retrospective Study of Microscope-Assisted Discectomy versus Open Fenestration Discectomy for Lumbar Disc Herniation

“…Now it become one of the main surgical procedures for lumbar disc herniation and has been considered as the gold standard in Europe and the USA due to the small trauma and the satisfactory results. But retrospective comparative studies between the conventional and microscope-assisted discectomy are not so such [4][5][6]. Therefore, we compared these two operation methods by randomly selecting 467 cases with lumbar disc herniation into two groups from February 2003 to March 2011.…”