Microendoscopic discectomy (MED) for lumbar disc prolapse

Nakagawa, Hiroyuki; Kamimura, Mikio; Uchiyama, Shigeharu; Takahara, Kenji; Itsubo, Toshiro; Miyasaka, Tadaatsu

doi:10.1016/s0967-5868(02)00337-5

Cited by 93 publications

(69 citation statements)

References 23 publications

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“…The operation duration reported in the literature for a standard microdiscectomy ranging from 54 to 70 min was compatible to our findings for the MC procedures at both centres and even the MAPN procedure at the transfer centre [10,12,25,36,39]. For an endoscopic procedure using a tubular system Nakagawa reported a duration of 79 min [26]. For the same tubular procedure using direct vision operation durations between 60 [3], 97 [30], 105.7 [25] and 136 min [16] were reported.…”

Section: Discussionsupporting

confidence: 89%

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial

Franke

Greiner-Perth²,

Boehm

et al. 2009

Eur Spine J

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A Prospective randomised controlled study was done to determine statistical difference between the standard microsurgical discotomy (MC) and a minimally invasive microscopic procedure for disc prolapse surgery by comparing operation duration and clinical outcome. Additionally, the transferability of the results was determined by a bicentric design. The microscopic assisted percutaneous nucleotomy (MAPN) has been advocated as a minimally invasive tubular technique. Proponents have claimed that minimally invasive procedures reduce postoperative pain and accelerate the recovery. In addition, there exist only a limited number of well-designed comparison studies comparing standard microdiscotomy to a tubular minimally invasive technique that support this claim. Furthermore, there are no well-designed studies looking at the transferability of those results and possible learning curve phenomena. We studied 100 patients, who were planned for disc prolapse surgery at two centres [50 patients at the developing centre (index) and 50 patients at the less experienced (transfer) centre]. The randomisation was done separately for each centre, employing a blockrandomisation procedure with respect to age and preoperative Oswestry score. Operation duration was chosen as a primary outcome parameter as there was a distinguished shortening observed in a preliminary study at the index centre enabling a sound case number estimation. The following data were compared between the two groups and the centres with a 12-month follow-up: surgical times (operation duration and approach duration), the clinical results, leg and back pain by visual analogue scale, the Oswestry disability index, length of hospital stay, return to work time, and complications. The operation duration was statistically identical for MC (57.8 ± 20.2 min) at the index centre and for MAPN (50.3 ± 18.3 min) and MC (54.7 ± 18.1 min) at the transfer centre. The operation duration was only significantly shorter for the MAPN technique at the index centre with 33.3 min (SD 12.1 min). There was a huge clinical improvement for all patients regardless of centre or method revealed by a repeated measures ANOVA for all follow-up visits Separate post hoc ANOVAs for each centre revealed that there was a significant time-method (MAPN vs. MC) interaction at the index centre (F = 3.75, P = 0.006), whereas this crucial interaction was not present at the transfer centre (F = 0.5, P = 0.7). These results suggest a slightly faster clinical recovery for the MAPN patients only at the index centre. This was due to a greater reduction in VAS score for back pain at discharge, 8-week and 6-month follow up (P \ 0.002). The Oswestry-disability scores reached a significant improvement compared to the initial values extending over the complete follow-up at both centres for J. Franke and R. Greiner-Perth contributed equally to this work. both methods without revealing any differences for the two methods in either centre. There was no difference regarding complications. The results demonstrate...

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Section: Discussionsupporting

confidence: 89%

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial

Franke

Greiner-Perth²,

Boehm

et al. 2009

Eur Spine J

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“…The surgeons who accepted to be part of the study worked in close cooperation within the spinal department of a single Institution, and had a longer than 5 years experience with the use of MED and a longer than 10 years experience with the use of MD and OD at the start of study. This aimed at limiting the bias effect of a long surgical learning curve, especially correlated with MED [2,14,17,20,21]. In group 1, the Metr'X system (Medtronic Sofamor Danek, Memphis, USA) with a 16-or 18-mm tubular retractor was used.…”

Section: Surgical Techniquementioning

confidence: 99%

“…In groups 2 and 3, a Caspar retractor was used to obtain direct vision of the operative field, with the obvious difference that in group 2 a surgical microscope was used, while in group 3 magnifying loops were used as needed [3,5,9,[15][16][17]. The surgical technique did not differ from what has already been published on MED, MD and OD for the treatment of LDH [2,3,5,7,9,[14][15][16][17]19]. Laminotomy, medial facetectomy when needed and nerve root retraction followed by discectomy were all performed identically in the three groups [2,3,6,11,17,18,20,21,23].…”

Section: Surgical Techniquementioning

confidence: 99%

“…In 1997, Foley and Smith [17] described micro endoscopic discectomy (MED) as a new percutaneous technique and in 2002 reported on their first established results. 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: 96%

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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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“…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.…”

mentioning

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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Microendoscopic discectomy (MED) for lumbar disc prolapse

Cited by 93 publications

References 23 publications

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial

Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial

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

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

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