Medium-Term Results of Minimally Invasive Surgery Vs. Open Surgery for the Treatment of Lumbar Degenerative Discopathy

Abstract

Background: Currently, lumbar pathology has the option of being surgically treated in an open way (OPEN) or a minimally invasive way (MIS), a treatment that is presented as an alternative that promises the same results but with less soft tissue injury and a speedy recovery. The objective of this study is to analyse the perioperative and postoperative results of patients undergoing open posterolateral or circumferential arthrodesis in comparison with minimally invasive surgery in lumbar degenerative pathology. Material and methods:A retrospective comparative study was carried out on 83 patients operated on using the OPEN technique and 36 patients using the MIS technique. Both diagnosed with lumbar degenerative disc disease, without previous interventions, with no central canal stenosis and symptoms of low back pain and radiculopathy. To assess the results, we carried out a preoperative and postoperative clinical follow-up at 3, 6 and 12 months. Among other items, the lumbar and radicular VAS, the patient's functional and occupational status, as well as the appearance of complications during follow-up and the need for reoperation were compared.Results: Lumbar and radicular VAS improved in both groups during follow-up. However, this improvement was noticeably better in the open surgery group during the first year. Regarding functional recovery, it was shown that at 3 months more than 62.2% of the open group had totally or partially recovered their activity compared to 51.4% of the MIS group and at 6 months more than 95.2% of the open group had partially or fully recovered vs. 69.7% of the MIS group. A statistically significant difference was found in both cases (p<0.05). Only after a year do the results become equal. Regarding the appearance of complications, a rate of 41.7% of complications of some kind was found during the first year in the MIS group, especially in the first 3 months after surgery, compared to 18.1% in those operated openly. This being a statistically significant difference. The reoperation rate was 11% vs 2.4%, respectively, throughout the follow-up.Conclusions: Open and percutaneous surgery are two very different techniques that aim to achieve the same results. However, in light of our study we have been able to see that functional recovery and pain improvement, although after one year it is equal in both groups, it is plausibly better in those operated on openly. In summary, we can conclude that minimally invasive surgery is currently unable to improve the results of open surgery in patients suffering from degenerative disc disease, which could open a debate on its current indications.