Which is better in laborers? A comparison between Open and Micro Endoscopic Discectomy

Abstract

Introduction: None of the studies compared the results of open lumbar discectomy (OLD) and microendoscopic discectomy (MED) surgeries in laborers. The aim of this study was to compare the clinical and functional impact of OLD versus MED surgery in laborers to find out which is better. Materials and Methods: This retrospective study was performed in 91 laborers (54 males and 37 females) who underwent OLD (n = 41) versus MED (n = 50) for the single- or double-level lumbar disc herniation (LDH). All patients were operated at a single institute after a failure of conservative trial for 6 weeks. Patients with associated severe disc degeneration, stenosis, instabilities, or other pathologies were excluded from the study. The clinical results were evaluated with Oswestry Disability Index (ODI), visual analog score (VAS), and duration of return back to work. Results: The average age of the study group was 39.8 ± 12.1 years. Average follow-up was 50.2 ± 13.9 months. The entire study group comprised manual labor work such as farming or loading work with an average income of US $53.6 ± 14.6 (approximately INR 4000) per month. The patients belonged to low socioeconomic status as per modified Kuppuswamy scale. The post-operative VAS scores were significantly reduced in both MED (7.6–2.0) and open discectomies (7.2–2.1). Improvement ODI scores also showed similar trends for MED (57.3–20.6) and for open discectomies (55.1–20.1). Average duration to return to work was significantly less in the MED group in comparison to the OLD group (18.0 vs. 25.5 days). There were total 4 (4.4%) complications perioperatively. There were one superficial wound infection in the OLD and one dural tear in the MED group. Both were managed conservatively. There was one patient from each group having recurrent disc herniation that was managed conservatively. There were one patient from the MED and two patients from the OLD group who could not return to their previous work or had to modify their work du