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

Katayama, Yoshito; Matsuyama, Yukihiro; Yoshihara, Hisatake; Sakai, Yoshihito; Nakamura, Hiroshi; Nakashima, Shojiro; Ito, Zenya; Ishiguro, Naoki

doi:10.1097/01.bsd.0000211201.93125.1c

Cited by 120 publications

(110 citation statements)

References 20 publications

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“…39 In addition, it was reported that minimally invasive surgery had the advantages of diminishing postoperative pain 40 and the rate of postoperative recurrence. 41 The postoperative complications are decreased after minimally invasive surgery. 42 Therefore, the hospitalization time could be reduced because of the good surgery result.…”

Section: Discussionmentioning

confidence: 99%

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

Shao

Wang

et al. 2014

Spinal Cord

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Study design: The pooled data were analyzed using RevMan 5.2 software. Objectives: The aim was to compare the efficacy of minimally invasive and conventional surgery for lumbar disc herniation (LDH) in Chinese Han population. Setting: China. Methods: An electronic search up to November 2013 was performed to retrieve all relevant articles. The overall standardized mean difference (SMD) for continuous outcomes and odds ratio (OR) for dichotomous variables as well as their 95% confidence intervals (CIs) were calculated to compare the efficacy of minimally invasive and conventional surgery. Results: A total of 23 studies involving 1913 patients treated by minimally invasive surgery and 2295 patients treated by conversational surgery were included in this meta-analysis. The overall estimate indicated that minimally invasive surgery could significantly decrease the hospitalization time (SMD ¼ À2.03, 95% CI, À2.49 to 1.56, Po0.0001), blood loss (SMD ¼ À2.65, 95% CI À3.33 to 1.97, Po0.0001), incision length (SMD ¼ À3.57, 95% CI, À4.39 to 2.75, Po0.0001), recurrence rate (odds ratio (OR) ¼ 0.22, 95 CI: 0.08-0.60, P ¼ 0.003) and complications (OR ¼ 0.47, 95% CI: 0.25-0.92, P ¼ 0.03) and increase the postoperative excellent rate (OR ¼ 1.82, 95% CI, 1.44-2.31, Po0.0001) compared with conventional surgery. In addition, the pooled data showed that there was no statistically significant difference in the operative time (SMD ¼ À0.58, 95% CI, À1.32 to 0.15, P ¼ 0.12) between LDH patients treated by minimally invasive and conventional surgery. Conclusion: In conclusion, minimally invasive surgery was a more safe and effective treatment for treating LDH in Chinese Han population when compared with conventional surgery.

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Section: Discussionmentioning

confidence: 99%

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

Shao

Wang

et al. 2014

Spinal Cord

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“…Despite a steep learning curve, bi-dimensional view and higher costs, several authors have reported on the reliability of this new technique in retrospective series [2,14], but a randomised clinical trial comparing MED with OD did not find significant differences in the main outcome indexes [20]. Meanwhile, MD and OD analysed in a prospective comparative study showed similar clinical outcomes [11], while MED and MD compared in another prospective comparative study behaved similarly [22].…”

Section: Introductionmentioning

confidence: 93%

“…Inclusion criteria to enter the study were a diagnosis of symptomatic, single level posterior lumbar disc herniation (LDH) made by spine specialists (orthopaedic and neurosurgeons) in patients aged 18-65 years with pain and/or neurological signs in concordant distribution lasting at least over 6 weeks of appropriate conservative treatment consisting of systemic drugs for pain relief and/or epidural steroid administration [3,6,11,18,20,21,23]. Exclusion criteria were less than 6 weeks of pain duration, cauda equina symptoms, foraminal or extra-foraminal herniations, cervical or lumbar spine stenosis of any aetiology, malignancy, previous spine surgery, spinal deformity including spondylolisthesis of any aetiology, concurrent infection and rheumatic disease [3,6,11,18,20,21,23].…”

Section: Admission Criteria and Recruitment Of Patientsmentioning

confidence: 99%

Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy

et al. 2010

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Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and complications obtainable with the three techniques. 240 patients aged 18-65 years affected by posterior lumbar disc herniation and symptoms lasting over 6 weeks of conservative management were randomised to micro-endoscopic (group 1), micro (group 2) or open (group 3) discectomy. Exclusion criteria were less than 6 weeks of pain duration, cauda equina compromise, foraminal or extra-foraminal herniations, spinal stenosis, malignancy, previous spinal surgery, spinal deformity, concurrent infection and rheumatic disease. Surgery and follow-up were made at a single Institution. A biomedical researcher independently collected and reviewed the data. ODI, back and leg VAS and SF-36 were the outcome measures used preoperatively, postoperatively and at 6-, 12-and 24-month follow-up. 212/240 (91%) patients completed the 24-month follow-up period. VAS back and leg, ODI and SF36 scores showed clinically and statistically significant improvements within groups without significant difference among groups throughout follow-up. Dural tears, root injuries and recurrent herniations were significantly more common in group 1. Wound infections were similar in group 2 and 3, but did not affect patients in group 1. Overall costs were significantly higher in group 1 and lower in group 3. In conclusion, outcome measures are equivalent 2 years following lumbar discectomy with micro-endoscopy, microscopy or open technique, but severe complications are more likely and costs higher with micro-endoscopy.

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“…Katayama Y et al in randomized control study with macro and micro discectomy compared post operative analgesic requirement, functional outcome and VAS score found difference in operation time (40 minute vs 45 minutes), blood loss (29 gm vs 25 gm) hospital stay (8.3 days vs 8.5 days)but none of them were clinically relevant. 28 Shorter hospital stays, less blood loss and operation time are not related with better clinical outcome and not a predictor of reoccurrence sciatica or re-herniation.…”

mentioning

confidence: 99%

Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation

Shrestha

Dhoju

et al. 2017

Kathmandu Univ. Med. J.

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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

Abstract: For herniotomy for lumbar disc herniation, both macro discectomy and microdiscectomy are appropriate, as long as surgeons have mastery of the procedures.

Cited by 120 publications

References 20 publications

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy

Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation

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