Open fenestration discectomy versus microscopic fenestration discectomy for lumbar disc herniation: a randomized controlled trial

Sherwan A Hamawandi,Ameer Kadhim Al-Humairi,Injam Ibrahim Sulaiman

doi:10.1186/s12891-020-03396-x

Sherwan A Hamawandi, Ameer Kadhim Al-Humairi + Show 1 more

Open Access

https://doi.org/10.1186/s12891-020-03396-x

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Abstract

BackgroundFenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.Methods60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3 months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years.ResultsIn both groups, all patients have minimal disability by Oswestry Disability Index after surgery.There were significant differences between means of post-operative Visual Analogue Scale for back pain between these two groups after 1 week (3.7 in group A versus 2.2 in group B) (t = 13.28, P = < 0.001*) and after 3 months (1.73 in group A versus 0.43 in group B) (t = 10.54, P = < 0.001*).There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group).There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P < 0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P < 0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P < 0.001).ConclusionUse of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.Trial registrationNCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485

Highlights

Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery
Patients are divided randomly into two groups: Group A: 30 patients were treated with open fenestration discectomy, Group B: 30 patients were treated with fenestration microdiscectomy
When we compare Visual Analog Scale (VAS) for back pain in each group between preoperative and 4 periods of assessments, we found there were significant differences between means of VAS for back pain pre-operative and post-operative assessments in four time periods (Tables 1 and 2) and this explained by that fenestration discectomy, whether open or microscopic, can remove disc herniated fragments so the cause of local irritation was removed

Summary

Introduction

Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation. Our study compared the results of open fenestration discectomy and microscopic fenestration discectomy for symptomatic lumbar disc herniation L4-L5 with follow up of 4 years in consideration of improvement in function and relief of back pain and leg pain, post-operative hospital stay, return to daily activities, complications, cost of surgery, recurrence rate of disc herniation, reoperation rate and type of surgery for recurrent disc herniation There are several studies compared between open and microscopic methods as surgical treatment of lumbar disc herniation with variable results, no clear clinical and statistical evidences showed which is superior and there is no randomized control trial study which can give clear evidence whether which method can results in less recurrent disc herniation and less reoperation rate as well as the cost of surgery and the type of surgery that may be needed for recurrent disc herniation [8,9,10,11,12,13,14,15,16,17].

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