Minimally invasive surgical management of symptomatic lumbar disc herniation: can the endoscope replace the microscope?

Abstract

BackgroundDegenerative lumbar spine pathologies such as spinal stenosis and disc herniation constitute the most common causes of back pain and radiculopathy. After the introduction of the operative microscope in the 1970s, microscopic discectomy has become the gold standard of treatment for herniated lumbar disc by many surgeons. A tubular endoscopic approach was first described in 1997 by Foley and Smith as a new minimally invasive technique alternative to open surgical techniques. The objective of this study is to evaluate the outcome and efficacy of microscopic discectomy and endoscopic discectomy for the management of herniated lumbar disc as regard the clinical results, operation time, intraoperative blood loss, and postoperative complications.ResultsThis is a retrospective study of 40 patients, with symptomatic lumbar disc herniation managed by the authors either by microscopic discectomy (MD) (n = 20) or by endoscopic discectomy (ED) (n = 20). Patients were followed up and postoperative data was recorded at 1, 6, 12 months after surgery. Clinical scoring systems included the Visual Analog Scale (VAS) for the preoperative and the postoperative low back ache (VAS-B) as well as preoperative and postoperative sciatic pain (VAS-S), in addition to the evaluation of the modified Japanese Orthopedic Association scale (mJOA) over the same time intervals. Significant postoperative improvement in clinical and functional outcome of the two groups was noted, including a statistically significant improvement in postoperative VAS-B and VAS-S as well as the mJOA scores in comparison to the preoperative data (p = 0.001). There was a statistically significant shorter operative time, less blood loss and less rate of operative complications recorded in the microscopic discectomy group as compared with endoscopic discectomy group in our study.ConclusionsOur study concluded that microscopic lumbar discectomy is as safe and effective as endoscopic lumbar discectomy for the management of symptomatic lumbar disc herniation with a low complication rate, less operative blood loss and operative time. Larger series and further studies would be yet considered with longer follow-up periods.