Objective assessment of reduced invasiveness in MED

Abstract

Microendoscopic discectomy (MED) has been accepted as a minimally invasive procedure for lumbar discectomy because of the small skin incision and short hospital stay required for this surgery. However, there are few objective laboratory data to confirm the reduced systemic responses in the early phase after this procedure. In order to substantiate the reduced invasiveness of MED compared to microdiscectomy (MD) or procedures involved in one-level unilateral laminotomy, the invasiveness of each surgical procedure was evaluated by measuring serum levels of biochemical parameters reflective of a postoperative inflammatory reaction and damage to the paravertebral muscles. Thirty-three patients who underwent lumbar discectomy or one-level unilateral laminotomy (MED in 15 cases, MD in 11 cases and one-level unilateral laminotomy in 7 cases with lumbar spinal canal stenosis) were included in this study. The serum levels of C-reactive protein (CRP) and creatine phosphokinase (CPK) were measured at 24 h after operation. Interleukin-6 (IL-6) and Interleukin-10 (IL-10) were measured at 2, 4, 8 and )24 h following the surgery to monitor the inflammatory response to the respective surgery. The post-operative serum CRP levels from both the MD and MED groups were significantly lower than those from the open laminotomy group. However, there was no significant difference in these serum levels between the MED and MD groups. The levels of IL-6 and IL-10 in the MED group during0 the first post-operative day were also significantly lower than those in the laminotomy group. When the MED and MD groups were compared, the IL-6 levels in the MED group were lower than in MD group at 2, 4 and 8 h after surgery, but the differences were not statistically significant. However, the level was significantly lower in the MED group at 24 h after surgery. In terms of IL-10, no significant difference was noted between the MED and MD groups over the study period. The changes in serum levels of postoperative inflammatory: markers (CRP, IL-6 and IL-10) in the early phase indicated reduced inflammatory reactions in MED as well as in MD when compared with classical open unilateral laminotomy. These data draw a direct link between the lower level of the inflammatory response and reduced invasiveness of MED. However, an indicator for muscle damage (CPK) appeared not to be affected by the type of surgical procedure used to correct disc herniation.Keywords Microendoscopic discectomy AE Microdiscectomy AE Lumbar disc herniation AE Minimally invasive surgery Eur Spine J (2006) 15: 577-582

Posterior endoscopic discectomy: Results in 300 patients

“…Discectomy (MED) by endospine system has claimed even lesser tissue invasion than microdiscectomy with even smaller skin incision, lesser use of analgesics, and early return to work. Least tissue invasion is established by many reports comparing the postoperative MRI signal of paraspinal muscles,27 intraoperative electromyographic findings establishing less invasion to nerve roots,28 and by measuring serum levels of biochemical parameters reflective of a postoperative inflammatory reaction and damage to the paravertebral muscles 29. Our personal opinion is similar, though this was not the parameter studied in our series.…”

Endoscopic lumbar discectomy: Experience of first 100 cases

“…Least tissue invasion is established by many reports comparing the postoperative MRI signal of paraspinal muscles,27 intraoperative EMG findings establishing less invasion to nerve roots,28 and by measuring serum levels of biochemical parameters reflective of a postoperative inflammatory reaction and damage to the paravertebral muscles 29. Our personal opinion is similar as all patients had only a 18-mm skin incision and postoperative MRI done in initial cases showed very less signal changes in the paraspinal muscles though these were not the parameters studied in our series.…”

Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion

“…Mini-invasive approaches, besides a minor cutaneous incision, can produce lesser lumbar muscular damage than the classic approach, as it has been suggested [29], with laboratory enzymatic [41] and blood-analysis studies [24,37] and with MRI controls [24,25,41]. Is this reduced tissular damage leading these patients to a better and faster recovery of their daily life activities?…”