Endoscopic lumbar discectomy vs microdiscectomy: Early results, complications and learning curve an Australian perspective

Abstract

BackgroundEndoscopic spine surgery has been recently introduced in Australia. A comparison of endoscopic lumbar discectomy, open or microscopic approach with learning curve is presented. Patients and methodsA retrospective observational cohort study design of Uniportal endoscopic lumbar discectomy of a single surgeon series was conducted. All patients above 18 years of age with symptomatic disc herniation and who have failed non-surgical management were selected. This data is the initial 30 consecutive uniportal endoscopic lumbar discectomy patients (group E). These were compared to the immediately prior 30 lumbar microdiscectomy (Group M) cases of the same surgeon. Demography, operative data, complications and postoperative results were collected. Learning curve duration for endoscopic cases was also examined. ResultsThere were 39 males and 21 females with mean age of 53.6 yrs. In group E there were 23 Transforaminal cases and 7 interlaminar cases. Mean operative time was 125.5 min. The first 10 cases took 181 mins, next 111mins and last 10, 84 mins showing a vast improvement with learning curve. A significant difference in operative time between transforaminal endoscopic and interlaminar endoscopic discectomy (P < 0.001) was found. On comparison of endoscopic and microscopic cases a significant difference was found in blood loss (p < 0.001) and there was an expected non-significant difference in operation time. Complication rates at 6 weeks were comparable (dural tears – 1 E, 2 M) and recurrent discs (E = 1,M = 2). An additional recurrence occurred at 20 weeks postop in the endoscopic group that required a revision discectomy surgery. ConclusionWe present an Australian perspective of endoscopic vs microscopic lumbar discectomy. Early results reveal comparable outcomes of endoscopic lumbar discectomy compared to microscopic surgery with respect to operative time, blood loss and complications. In endoscopic cases, interlaminar approach had longer operative time and complications compared to transforaminal approach. With the learning curve the operative times improved. Further studies are required to evaluate long term outcomes and complications.