Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

Abstract

Objective :The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. Methods : Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). Results : The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. Conclusion : Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain. KEY WORDS :Lumbar spine˙ Muscle sparing technique˙ Microdiscectomy˙ Minimally invasive surgery.

Does Percutaneous Lumbosacral Pedicle Screw Instrumentation Prevent Long-Term Adjacent Segment Disease after Lumbar Fusion?

“…Although some authors claim that the natural history of spine degeneration dictates the majority of revision cases secondary to ASD, others have deduced that the specific procedure, instrumentation, and certain risk factors are attributable to an increased rate of ASD [1,4,12,13]. It has been suggested that reduced destruction of the posterior stabilizers of the lumbar spine characterized by minimally invasive instrumentation and fusion could reduce the rate of ASD and thus the need for costly revision surgeries [14][15][16][17][18]. Conversely, others suggest that use of the percutaneous method increases the incidence of superior articular facet violation, theoretically impacting ASD incidence [19].…”

What is the Rate of Lumbar Adjacent Segment Disease after Percutaneous versus Open Fusion?

“…Previous studies have demonstrated that MIS surgery may be associated with less muscle dissection and denervation than open procedures. Furthermore, previous studies have established that mIS surgery is at least as effective as open surgical decompression. However, previous studies have not compared the effects of specific instrumentation techniques on adjacent spinal segments.…”

“…Despite the fact that minimally invasive (MIS) fusion techniques clearly cause less paraspinous muscle damage association than open fusion, to the authors' knowledge, there have been no studies to demonstrate whether MIS surgery is reduces the incidence of ASD. We hypothesized that MIS results in a lower incidence of ASD than open surgery because the former causes less damage to paraspinous muscles.…”

Radiologic Efficacy and Patient Satisfaction after Minimally Invasive Unilateral Laminotomy and Bilateral Decompression in Patients with Lumbar Spinal Stenosis: A Retrospective Analysis

“…The biomechanical advantages of bilateral decompression via the unilateral approach were discussed in previous studies. 17,18 Our findings demonstrate that MISS procedures can achieve sufficient neural decompression with minimal damage, as well as significant improvements in radiologic parameters and patient satisfaction.…”