login
  Password reminder
Spinal News
Contact the editor Visit Spinal News Twitter feed Visit Spinal News Facebook page
 

Minimally invasive discectomy is as effective as open discectomy for improvement of leg pain


Thursday, 19 Apr 2012 11:05
Ali Bydon
Ali Bydon


A meta-analysis published in The Journal of Neurosurgery: Spine shows that, contrary to a recently published randomised controlled trial, minimally invasive discectomy for the relief of leg pain in patients with lumbar radiculopathy provides equivalent long-term outcomes to open discectomy.


Hormuzdiyar Dasenbrock, Department of Neurosurgery, Brigham and Women’s/Children’s Hospital of Boston/Harvard Medical School, Boston, USA, and co-authors reported that minimally invasive discectomy has been proposed as an alternative to open discectomy because, potentially, it may cause less muscle damage, decreased pain, and improved recovery time after surgery.

However, they added that while several small randomised controlled trials have shown the technique to have equivalent outcomes regarding leg pain to open discectomy, the largest trial to date found that open discectomy was associated with significantly greater improvements in leg pain. Dasenbrock et al wrote: “Thus, the authors concluded that patients undergoing minimally invasive discectomy have less favourable outcomes.”


Dasenbrock et al added that as the results of the randomised controlled trials on the technique differed, a meta-analysis of the evidence was “merited”.


After searching for relevant studies using the Medline and Embase databases, Dasenbrock et al identified six randomised control trials for review (837 patients in total; 388 randomised to minimally invasive discectomy and 449 randomised to open discectomy). They did not find a significant difference in the relief of leg pain between the two techniques at either short-term or long-term follow-up. They wrote: “The pooled mean Visual Analogue Scale (VAS) leg pain score was preoperatively was 6.9 and 7.2 in the minimally invasive discectomy and open discectomy groups, respectively. Postoperatively, in both groups, there was a substantial decrease in the VAS score with long-term follow-up—to 1.6 points in the minimally invasive discectomy and the open discectomy cohorts.” Additionally although recurrent disc herniation was more common in patients randomised to minimally invasive discectomy, the pooled risk of recurrent disc herniation was not significantly different in this group compared with the discectomy group.


Incidental durotomies were significantly more frequent in patients randomised to the minimally invasive technique than patients randomised to the open technique (5.67 vs. 2.9%, respectively, relatively risk 2.05, 95% confidence interval 1.05–3.98). Dasenbrock et al suggested that this difference may be because of the limited visualisation and poor depth perception that are known potential limitations of minimally invasive open discectomy. They added: “But, it may also be due to the learning curve associated tubular retraction.” However, despite this finding, there was no significant difference in the number of total complications between the two techniques.


Dasenbrock et al concluded: “The current evidence suggests that both open and minimally invasive discectomy lead to a substantial and equivalent degree of short- and long-term improvement in leg pain, the primary symptom of many patients with lumbar radiculopathy.”


Ali Bydon, associate professor of neurosurgery and clinical director of spinal surgery at Johns Hopkins University, told Spinal News International that although both procedures, open or minimally invasive, are equally efficacious, he favours open discectomy because of the higher incidence of spinal fluid leakage and dural injury with minimally invasive discectomy. He added: "We found that open discectomy remains the most viable and least risky surgical option for patients with lumbar disk herniation."




Add New Comment

Related Items


Most popular


Epidural glucocorticoid injections provide little or no benefit for spinal stenosis
Friday, 11 Jul 2014
A new study indicates that epidural injections of glucocorticoids and lidocaine provide little or no benefit compared with epidural injections of lidocaine alone for patients with lumbar spinal ... Epidural glucocorticoid injections provide little or no benefit for spinal stenosis

Trial shows significant pain relief for spine cancer patients following targeted radiofrequency ablation treatment
Wednesday, 23 Jul 2014
The study followed patients at five leading academic centres and found a significant decrease (p <0.01) in pain scores after targeted radiofrequency ablation (t-RFA) with the Star (DFINE) tumour ... Trial shows significant pain relief for spine cancer patients following targeted radiofrequency ablation treatment

CE mark for FLXfit 3D expandable interbody cage
Tuesday, 01 Jul 2014
Expanding Orthopedics has announced that the FLXfit, its novel expandable and articulated TLIF cage with lordotic correction, has received CE mark approval and is now cleared for commercialisation in ... CE mark for FLXfit 3D expandable interbody cage

Features


Managing back pain in children
Friday, 29 Aug 2014
Omar Gabbar reviews the prevalence and management of back pain in children and adolescents, including the importance of excluding serious pathologies. Managing back pain in children

The ASIA impairment scale for spinal injuries may show worsening despite neurological improvement
Thursday, 31 Jul 2014
Ibrahim Gündoğdu and colleagues report in Spinal Cord that the American Spinal Injury Association (ASIA) impairment scale is limited because it could show worsening despite a patient with a spinal ... The ASIA impairment scale for spinal injuries may show worsening despite neurological improvement

Profiles


Lori Karol
Wednesday, 13 Aug 2014
Lori Karol, Texas Scottish Rite Hospital, Dallas, USA, talks to Spinal News International about the ... Lori Karol

Luiz Pimenta
Thursday, 12 Jun 2014
Luiz Pimenta, immediate past president of the International Society for the Advancement of Spinal S... Luiz Pimenta

Cardiac Rhythm News Vascular News Cardiovascular News Interventional News Spinal News NeuroNews
BIBA Medical BIBA MedTech Insights CX Symposium ilegx
 
Password Reminder

BIBA Medical, 526 Fulham Road, Fulham, London, SW6 5NR.
TEL: +44 (0)20 7736 8788 FAX: +44 (0)20 7736 8283 EMAIL: 
info@bibamedical.com
© BIBA Medical Ltd is a company registered in England and Wales with company number 2944429.
VAT registration number 730 6811 50.
Site Map | Terms and Conditions