Conventional Discectomy Research Articles

Conventional versus tubular microdiscectomy for lumbar disc herniation: A prospective randomized study

Abstract Background: Microdiscectomy is a commonly performed surgical technique used to treat lumbar disc prolapse. A minimally invasive alternative called tubular discectomy is hypothesized to cause less tissue damage and result in a faster recovery compared to conventional discectomy. Previous studies have found similar pain resolution outcomes between two techniques, but they were underpowered and lacked data on differences in recovery time. Our study aims to compare functional outcomes, and assess differences in recovery time and perioperative complications between the two procedures. Materials and Methods: This prospective randomized study included 63 patients, divided into two groups. The preoperative evaluation was done by clinical examination and documenting Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. Intra- and postoperative complications were also noted. Postoperative follow-up assessment was done at regular intervals up to 2 years. Results: Both groups showed a significant decrease in ODI, VAS leg and back scores following surgery, which continued to decline throughout the follow-up period. However, there was no significant difference in outcomes between the two treatment groups at each postoperative follow-up. There were also no significant differences in blood loss or intra- and postoperative complications. Patients who underwent tubular microdiscectomy had a significantly shorter hospital stay compared to conventional microdiscectomy. Conclusion: Both conventional and tubular microdiscectomy are effective means of treating disc herniation. While patients who underwent tubular microdiscectomy had a shorter hospital stay, the modest clinical benefits do not necessarily warrant the transition to a minimally invasive approach given the learning curve associated with the technique.

Functional Outcome of Open Conventional Discectomy of Patients with Prolapse Lumbar Intervertebral Disc – A Prospective Observational Study

Introduction: Low back pain is one of the most common complaints in clinical practice with life time prevalence ranging from 65-80%. The annual prevalence of low back pain ranges from 15% to 45% but is largely dependent on population. Major cause of low back pain leading to severe morbidity throughout the world affecting mainly the young population is lumbar disc prolapse. Prolapsed intervertebral disc is an important cause of spondylogenic backache. Conservative treatment is often preferred for LDH, but patients who fail to respond to this are treated with surgery. Surgical treatment aims to remove the herniated nucleus pulposus to the largest extent possible to relieve nerve compression while minimizing spinal instability. Aim of the Study: The aim of this study was to assess the functional Outcome of open conventional discectomy among patients with prolapse lumbar intervertebral disc or lumbar herniated disk. Methods: This was a prospective observational study and was conducted in the Department of Orthopaedics Surgery, Square Hospitals Ltd, Dhaka, Bangladesh during the period from January 2008 to December 2020. We included 300 patients with prolapse lumbar intervertebral disc undergoing open conventional discectomy in our study. Result: In our study we found majority (36%) of our patients was aged 41-50 years and most of our study patients were male (70%) compared to female (30%). We found the mean age was 44.73 ± 8.9 years. Among all patients 78% had lower lumber problem & 22% had upper lumber problem. Most of our patients (44.5%) had L4-L5 level, followed by 31.5% had L5-S1 level. We found the mean vas score for leg pain and back pain in preoperative period significantly reduced at postoperative 2nd week, 3rd month, 6th month and 1st year. The mean ODI score was 56.24 ± 4.18 in preoperative period. At postoperative 1st year follow up the mean score significantly reduced to 3.26 ± 2.64 in our study. Majority (37%) of our patients had good outcome, followed ....

Full Endoscopic Interlaminar Approach for Paracentral L5-S1 Disc Herniation

The full endoscopic interlaminar approach (FEILA) is a minimally invasive technique for lumbar discectomy. It has multiple advantages over other conventional discectomy methods, including less traumatization of the soft tissues, fewer complication rates (dural injury, bleeding), rapid rehabilitation, quick return to daily life activities, and preferable cosmetic results. FEILA is a surgery with a relatively steep learning adaptation. Endoscopic surgery is a closed tubular approach, and all surgical maneuvers are performed within a uniportal single working channel. Also, the technique has not yet been standardized and well-documented. Therefore, the early learning stages of this technique may not be easy for most surgeons. Despite these, FEILA is easy, and the operation length is comparable to and even shorter than other techniques of lumbar discectomy. FEILA for lumbar discectomy could be considered a safe and effective alternative procedure for paracentral L5-S1 disc herniation. Here, we describe the technique of FEILA, including every cutoff step required to reach technical proficiency for surgeons who want to start applying this approach.

Endoscopic Microdiscectomy Versus Conventional Discectomy for Lumber Disc Diseases; A Randomized Controlled Trial at Tertiary Care Hospital

Objective: The aim of this study is to determine the efficacy of endoscopic microdisectomy versus conventional discectomy for lumber disc disease. Study Design: Randomized Control trial Place and Duration: Dow International Medical College and Hospital OJHA Campus, Karachi during the period from December, 2021 to May, 2022. Methods: Total 70 patients of both genders were presented in this study. Patients detailed demographics age, sex and BMI were recorded after taking written consent. Patients were aged between 18-70 years, Patients were divided in to two groups I and II. Group I had 35 patients and underwent for endoscopic microdisectomy and group II received conventional discectomy among 35 patients. The research included patients with low back pain radiating to the legs and prolapsed intervertebral discs at the L5–S1 and L4–L5 levels on MRI. Post-operatively effectiveness was observed between both groups, by using Oswestry disability index (ODI) in follow up of 10 months. Complete data was analyzed by SPSS. Results: Total 34 (48.6%) patients were females and 36 (51.4%) were males. Mean age of the patients were 48.32± 6.44 years with mean BMI 26.14± 3.23 kg/m2. Significantly no difference was observed between age and BMI. Patients who had prolapsed disc at L4-5 levels were 26 (37.14%) and 44 (62.86%) patients had prolapsed disc at L5-S1. Mean post-operative ODI in group I was 21.14± 54 and in group II was 24.16± 3.31. Mean post-operative vas in group I was 3.5 and in group II was 5.7. In group I hospital stay, blood loss and complications were observed less as compared to group II. Conclusion: We concluded in this that both endoscopic microdisectomy and conventional discectomy was effective and safe procedures. But conventional discectomy was found less effective as compared to endoscopic microdisectomy in terms of rapid mobilization and postoperative pain. Keywords: Oswestry Disability Index (ODI), Lumbar Disc Prolapse, Endoscopic Discectomy, Visual Analog Score (VAS)

Analysis of Long-Term Results of Lumbar Discectomy With and Without an Interspinous Device.

Discectomy is the surgical treatment of choice for disc herniation. However, discectomy can lead to disc degeneration and vertebral instability over time. Interspinous devices (ISDs), added to conventional surgery, constitute a low-invasive alternative that attempts to prevent these complications. The aim of this study is to compare the long-term clinical and functional outcomes of patients undergoing conventional discectomy with those who had an ISD added during surgery. This analytical-descriptive, retrospective, and transversal studyinvestigated outcomes of 114 patients who underwent surgery for a lumbar disc herniation between 2008 and 2011. The results were evaluated with a minimum follow-up of 8 years (mean, 10 years) by means of different questionnaires: visual analog scale (VAS), Oswestry Disability Index (ODI), consumption of analgesic medication, work status, degree of satisfaction, and complications and reinterventions during the follow-up period. At the end of the follow-up, an overall improvement of VAS of 5 points (71%) and ODI of 36 points (77%) was observed, with a degree of satisfaction of 76% with disc surgery. The analysis between both groups showed a better behavior in VAS and ODI in the implant group, with a pre- and postsurgery difference of 73% and 79% compared to 66% and 77% in the control group, respectively, though this finding was not statistically significant. The current analgesic consumption and the degree of satisfaction were also better in the group with an implant. Compared with the non-implant group, the number of reinterventions at the end of the follow-up was lower (7% vs 15.5%) and the time until the second intervention was higher (81.5 vs 41 months) in the group with an implant, but the differences were not statistically significant. Lumbar discectomy proved to be a safe technique for the treatment of disc herniation, and results are maintained over time. The additional gesture of adding an ISD to conventional discectomy improves clinical outcomes overall, but not in a statistically significant way. The lower number of reinterventions and the longer period without surgery being required may mean a certain protective effect of the ISD on the intervertebral disc being operated on.

Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis.

This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation. Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods. One RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, P < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, P = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, P = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, P = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, P = 0.861) between groups. Endoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings. The online version contains supplementary material available at 10.1007/s43465-022-00636-1.

Comparing the efficacy and safety of minimally invasive biportal endoscopic spine surgery versus conventional microscopic discectomy in single-level lumbar herniated intervertebral disc (ENDO-BH Trial): a multicenter, prospective, randomized controlled equivalence trial study protocol

BackgroundBiportal endoscopic surgery has recently been performed in lumbar discectomy, with advantages over conventional surgery, such as less skin scarring and muscle damage. However, the clinical results have not been established. Although previous studies reported no difference between the biportal endoscopic and microscopic discectomy clinical results, the evidence was weak. Therefore, this study aims to evaluate the efficacy and safety of the biportal endoscopic discectomy versus the microscopic discectomy.MethodsThis prospective multicenter randomized controlled equivalence trial is designed to compare the efficacy and safety outcomes of patients who underwent lumbar discectomy using biportal endoscopy or microscopy. We will include 100 participants (50 per group) with a lumbar herniated disc. The primary outcome will be the Oswestry Disability Index (ODI) score 12 months after surgery based on a modified intention-to-treat strategy. The secondary outcomes will include the visual analog scale score for low back and lower extremity radiating pain, the ODI score, the Euro-Qol-5-Dimensions score, surgery satisfaction, walking time, postoperative return to daily life period, postoperative surgical scar, and surgery-related variables, such as postoperative drainage, operation time, admission duration, postoperative creatine kinase, and implementation status of conversion to open surgery. Radiographic outcomes will also be analyzed using magnetic resonance imaging (MRI) or computed tomography (CT) and simple radiographs. Safety will be assessed by evaluating all adverse and severe adverse events and surgery-related effects. The participants will be assessed by a blinded assessor before surgery (baseline) and 2 weeks and 3, 6, and 12 months after surgery.DiscussionThis trial will be the first prospective, multicenter, randomized controlled trial to analyze the efficacy and safety of biportal endoscopic discectomy in lumbar herniated disc.This trial is designed for evaluating the equivalence of the results between biportal endoscopic and microscopic discectomy including adequate sample size, blinded analyses, and prospective registration to reduce bias. This trial will provide enough data on the effectiveness and safety of biportal endoscopic surgery and will be an important study that allows clear conclusions.Trial registrationClinical Research Information Service (cris.nih.go.kr.) (KCT0006191). Registered on 27 March 2021

Tubular Microdiscectomy for Recurrent Disc Prolapse Following Two Rounds of Open Laminectomy and Discectomy: A Case Report and Literature Review

Background Data: Recurrence of LDH has been reported in 5%–11% of patients after conventional discectomy, and most of these patients are usually treated with repeated discectomy through the same initial approach. Tubular microdiscectomy is an increasingly popular surgery for lumbar disc prolapse and has replaced conventional open surgery in the last decade. However, it requires more experience and has a steep learning curve, especially in revision cases.

Lumbar Disc Herniation in Heavy Manual Workers: Conventional Microdiscectomy versus (MIS) TLIF with Unilateral Fixation

Introduction: Conventional discectomy is a common surgical method for treating lumbar disc prolapse. The situation may differ in heavy manual workers who may have more pronounced degenerative spine disease, broad-based disc herniations, and are expected to be exposed postoperatively to the same preoperative manual stress. This study was aimed at comparing the clinical outcomes in patients operated for conventional discectomy versus those operated for TLIF with unilateral spinal fixation.&#x0D; Methodology: Sixty patients underwent surgeries for lumbar disc herniation. They were divided into two groups; the microscopic conventional discectomy group and the fusion (TLIF and unilateral TPF) group. They were operated between 2017 and 2019. Participants were evaluated pre- and postoperatively at 3, 6, 9, and 12 months’ intervals. Pain was scored by Visual Analogue Scale (VAS) for both lower limb and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale and a new outcome score.&#x0D; Result: The two groups of patients were fairly homogeneous and comparable. Workload exposure to repetitive vibration was the biggest risk for disc prolapse and surgery (28.3%). Fusion group showed better clinical outcomes parameter including better VAS for back pain, better Prolo economic and functional rating scale, and better new clinical outcome score. In comparison, the discectomy group showed significantly higher recurrence rate and reoperation during the follow-up period. During the 12 months’ follow-up visit, when the patients were asked if, under the same circumstances, they would undergo the procedure again, 71.6% of the patients (43 patients) answered affirmatively and this reflects their satisfaction with the results of their surgeries. This satisfaction was reported in 27 patients (90%) in the fusion group and 16 patients (53.4%) in the discectomy group.&#x0D; Conclusion: Heavy manual workers treated with unilateral transforaminal interbody fusion reported less pain and lower disability scores all over the follow-up period. This technique is preferable to conventional discectomy because it reduces back and leg pain while avoiding the possibility of recurrence by heavy duties and maintains stability of the lumbar spine. We proposed a new clinical outcome score to monitor the clinical outcomes of spine surgery in heavy manual workers. It relates the outcomes to the hours of work, sick leaves, and patient satisfaction with surgery. In our group of patients, it showed significant improvement in the fusion group in comparison to the discectomy group.

Minimally Invasive Lumbar Discectomy Versus Conventional Discectomy for Symptomatic Lumbar Disc Herniation

Background: Lumbar disc herniation is a localized displacement of disc material beyond the normal margins of the intervertebral disc space and is the most common cause of sciatica. Lumbar microdiscectomy (MD) and open discectomy (OD) are commonly performed surgical procedures for patients with lumbar disc herniation. Objective: The aim of the current work was to compare the benefits and harms of minimally invasive discectomy (MID) versus MD/OD for management of lumbar intervertebral discopathy. Patients and Methods: This cross-sectional study was conducted at Menoufia university hospitals & Al-Haram Specialized Hospital including 36 Patients (with single or double level disc prolapse (L4-L5 or L5-S1) who underwent discectomy using microscopic/or conventional discectomy. Results: In group (1): 75% of the patients had good pain improvement (60 – 90%) and the rest had moderate improvement (40 – 60 %). In group (1) only 30% experienced intermittent pain while the rest have no pain. While in group (2) about 50% had an intermittent pain. There is no significant difference. In group (1) the mean days of hospital stay was (6.10 + 1.6) while in Group (2) the mean days of hospital stay was (1.60 + 0.12). The group (2) has significant short hospital stay length than group (1). Conclusion: It could be concluded that endoscopic approach was associated with similar postoperative pain improvement and frequency and lower operating time, blood loss and hospital stay in comparison to open approaches. We believe that both techniques are safe, and both can be used to lumber disk surgery, but microscopic technique is preferred for its better outcomes.

Evaluation of Lumbar Fusion in Recurrent Disc Prolapse

Abstract Background Recurrent disc herniation is the most common cause of reoperation after the primary disc surgery, The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disk herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion or percutaneous endoscopic interlaminar discectomy. Aim of the work to evaluate and compare the therapeutic effect between different modalities of treatment of the recurrent lumbar disc protrusion (RLDP) through 3 groups: (1) First group treated by conventional discectomy. (2) Second group treated by discectomy and lumbar fusion either by PLF, PLIF or TLIF. (3) Third group treated by percutaneous endoscopic interlaminar discectomy. Patients and methods It is a prospective cohort study performed between January 2012 and April 2017 on 150 patients complained of recurrent lumbar disc herniation. They were surgically treated at the Department of Neurosurgery, Ain Shams University Hospitals. All patients are evaluated clinically by VAS, JOA and Oswestry disability index (ODI) through follow up period of 2 years (one month, 6 months, 1 yr, 2 yrs). They were divided into 3 groups (I&amp;II and III) each group was a fifty patients Results the mean overall recovery rate is 89%, comparison between the three groups showed significant improvement of the endoscopic group and fixation group than simple discectomy group in term of VAS LBP, leg pain , JOA and ODI. Intraoperative blood loss, length of operation and hospital stay were significant less in endoscopic group than fixation and simple discectomy group CONCLUSION Recurrent lumbar disc prolapse management is a controversial issue, there are different surgical modalities (either by open discectomy, discectomy and fixation or Percutaneous interlaminar lumbar discectomy PEILD) although those surgical modalities are successful the PEILD is the optional choice that offers less tissue trauma, rapid recovery, less cost effect and early return to work

Single Level Lumbar Disk Herniation: Conventional Discectomy versus Interbody Fusion with Bilateral Pedicular Fixation

OBJECTIVE: The objective of the study was to compare between the conventional discectomy and the interbody fusion with bilateral pedicular screw fixation in the management of single level lumbar disk herniation.&#x0D; METHODS: This is a prospective study done on 50 patients (25 in each group) at Cairo University Hospitals in the period between October 2018 and June 2019 fulfilling the inclusion criteria. Diagnosis was made clinically with history (low back pain and sciatica),examination (motor power assessment, straight leg raising test), and radiological findings (MRI, CT and X-ray lumbar spine). The pain status (VAS) was pre and postoperatively evaluated and followed up every 3 months for 1 year.&#x0D; RESULTS: The study included 50 patients (25 in each group) (mean age 40.4 years old) with slight female predominance. The most common clinical findings presented at diagnosis were low back pain followed by lower limb pain in the form of claudication and sciatica. L5-S1 disk prolapse was the most common level affected in both groups followed by L4-5 level. Regarding the clinical outcome, there was statistical significance in the VAS of low back pain at 9 months and 1-year follow-up favoring the fusion group with mean VAS 0.40 and 1.32 (p &lt; 0.05).&#x0D; CONCLUSION: Clinical outcome was excellent in both groups. However, the reduction in low back pain after surgery was greater in the fusion group (p &lt; 0.05). The rate of recurrent disk herniation at the surgical level in the nonfusion group was higher, but intraoperative blood loss, operation time, length of hospital stay, and total cost of procedure were all less in the patients undergoing discectomy alone. Although there is still controversy regarding the pros and cons of fusion in association with disk excision without instability, fusion results were highly favorable.

Endoscopic versus conventional discectomy in lumbar disc prolapse

Endoscopic versus conventional discectomy in lumbar disc prolapse

Efficacy of a Novel Annular Closure Device after Lumbar Discectomy in Korean Patients : A 24-Month Follow-Up of a Randomized Controlled Trial.

ObjectiveLumbar discectomy is an effective treatment for lumbar disc herniation (LDH); however, up to 2–18% of patients with LDH have experienced recurrent disc herniation. The purpose of this study was to evaluate the efficacy of a novel annular closure device (ACD) for preventing LDH recurrence and re-operation compared with that of conventional lumbar discectomy (CLD). MethodsIn this prospective randomized controlled trial, we compared CLD with discectomy utilizing the Barricaid® (Intrinsic Therapeutics, Inc., Woburn, MA, USA) ACD. Primary radiologic outcomes included disc height, percentage of preoperative disc height maintained, and re-herniation rates. Additional clinical outcomes included visual analog scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and 12-item short-form health survey (SF-12) quality of life scores. Outcomes were measured at preoperation and at 1 week, 1, 3, 6, 12, and 24 months postoperation. ResultsSixty patients (30 CLD, 30 ACD) were enrolled in this study. At 24-month follow-up, the disc height in the ACD group was significantly greater than that in the CLD group (11.4±1.5 vs. 10.2±1.2 mm, p=0.006). Re-herniation occurred in one patient in the ACD group versus six patients in the CLD group (χ2=4.04, p=0.044). Back and leg VAS scores, ODI scores, and SF-12 scores improved significantly in both groups compared with preoperative scores in the first 7 days following surgery and remained at significantly improved levels at a 24-month follow-up. However, no statistical difference was found between the two groups. ConclusionLumbar discectomy with the Barricaid® (Intrinsic Therapeutics, Inc.) ACD is more effective at maintaining disc height and preventing re-herniation compared with conventional discectomy. Our results suggest that adoption of ACD in lumbar discectomy can help improve the treatment outcome.

Comparison of conventional microdiscectomy and sequestrectomy in ligamentum flavum preserved lumbar disc herniation surgery

Objective: Comparison of conventional microdiscectomy with sequestrectomy in lumbar disc herniation (LDH) surgery with ligamentum flavum (LF) preservation technique. Method: Study design was approved by local ethics committee. We retrospectively reviewed LDH 320 patients operated for disc pathologies in L3 - S1 levels in our clinic between June 2015 - June 2017. Two groups were formed in the study: sequestrectomy and conventional microdiscectomy. Demographic, operational and outcome data were compared between the groups. Results: Sequestrectomy group included 71 patients and conventional microdiscectomy group included 60 patients. There was no statistically significant difference between the groups in terms of age, sex, comorbidities, smoking, body mass index, disc pathology level, operative complications, amount of bleeding, length of stay, disc recurrence and low back pain, radicular pain, quality of life, surgical success and satisfaction results. Satisfactory improvement rates were found in the conventional discectomy (85%) and sequestrectomy group (91.5%) in mid-term follow-up. Operation time (mean 61.1 vs 94.6 min), and early postoperative opioid requirement (14.1% vs 27.1%) were significantly lower in the sequestrectomy group. Conclusions: In LDH surgery with LF preservative technique, satisfactory results were obtained with both methods with comparable. Recurrence rates and outcome. However, sequestrectomy is appropriate in cases without a wide annular defect due to the short operation time, low opioid requirement.

Postoperative direct health care costs of lumbar discectomy are reduced with the use of a novel annular closure device in high-risk patients

Lumbar discectomy is largely successful surgical procedure; however, reherniation rates in patients with large annular defects are as high as 27%. The expense associated with a revision surgery places significant burden on the healthcare system. To compare the direct health care costs through 5 years follow-up of conventional discectomy (Control) with those of discectomy supplemented by an adjunctive annular closure device (ACD) in high-risk patients with large annular defects. This was a cost-effectiveness study. All-cause index level reoperations were reviewed from a multicenter, randomized controlled superiority trial that allocated 554 high-risk discectomy patients with large annular defects to either control or ACD. Medicare and private insurer (Humana) direct costs were derived from a commercially available payer database to estimate costs in the US healthcare system, including those associated with facility, surgeon, imaging, follow-up visits, physical therapy, and injections. A 50:50 split between Medicare and commercial insurers was assumed for the base case analysis. The analysis was also performed on a 80:20 commercial:Medicare payer basis. For the base case scenario, a 2-year time horizon and outpatient cost setting was established for the index procedure. Repeat discectomy was assumed to be performed on a 60:40 outpatient-to-inpatient basis. Complications requiring surgery, revisions, and/or fusion were assumed to be managed in the inpatient setting. Total costs of reoperation and per-patient costs of reoperation were compared between groups for both forms of insurers. One author received consulting fees of <$50,000 for the completion of this study, and the other eight authors did not have any financial associations with the current work. Funding for this study was provided by Intrinsic Therapeutics, but all analyses, interpretation, and writing were performed independently by the authors. At two years follow-up, use of the ACD reduced the rate of symptomatic reherniations in a large defect population to 13% compared with 25% in the control group (p<.001). This reduction in symptomatic reherniations in the ACD group translated to a savings of $2,802 per patient in direct health care costs compared with Control at 2 years and $5,315 per patient by 5 years based on 50% private and 50% public (Medicare) payer split. Under the scenario of 80:20 private:public insurance reimbursement, the estimated direct cost savings were $3,215 and $6,099 per patient at 2- and 5-years postoperatively, respectively, with the use of the ACD. Symptomatic reherniation and reoperation rates were nearly double among control patients compared with ACD-treated patients, which translated to markedly greater per-patient healthcare costs in the control group, where the ACD was not used.

Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes.

To date, various minimally invasive surgeries for lumbar disc herniation (LDH) have been performed in many countries, including microendoscopic discectomy (MED) and percutaneous endoscopic discectomy (PED). We herein report the surgical indications, current concepts, and techniques of minimally invasive discectomy for LDH, including MED and PED. The postoperative outcomes and risks of complications compared with conventional discectomy are also discussed. By reviewing past literatures, the current concepts, surgical techniques, and clinical outcomes were described. Minimally invasive discectomy is generally performed using a transmuscular approach with an endoscopic technique and can reduce muscle and soft tissue damage. The minimal invasiveness can also reduce the severity of postoperative pain and improve patient satisfaction compared with conventional open discectomy. Based on the data of previous systematic reviews and meta-analyses, minimally invasive lumbar discectomy, such as MED and PED, appears to be safe and effective alternatives to open discectomy for patients with symptomatic LDH. These minimally invasive surgeries can provide beneficial effects to shorten the hospital stay and time to return to work. However, minimally invasive discectomy has a demanding learning curve. Only a well-trained surgeon and support team should perform these less invasive procedures. Clinical evidence supporting the superiority of MED and PED is still limited. Well-designed prospective multicentered randomized controlled trials with large samples are therefore needed in order to draw a convincing conclusion.

Percutaneous Endoscopic Lumbar Discectomy versus Conventional Open Discectomy: A Prospective Randomized Comparative Trial

Introduction: The majority of series considered the conventional open discectomy as the gold standard for the treatment of lumbar disc prolapse. Despite of the popularity of the lumbar endoscopic discectomy nowadays, many neurosurgeons still prefer conventional open discectomy. Purpose: Our study has been designed to compare between percutaneous endoscopic lumbar discectomy and conventional open discectomy; regarding surgical results, complications, clinical and functional outcomes. Patients and Methods: This study is a clinical prospective randomized controlled trial conducted upon 30 patients suffering from prolapsed lumbar disc, from December 2016 to May 2018. Those patients were divided randomly into 2 groups, 15 patients each. One group treated by percutaneous endoscopic interlaminar lumbar discectomy (PELD) and the other group treated by conventional open discectomy (COD). Operative time, wound size, Intraoperative blood loss, Intraoperative complications, postoperative hospital stay, Postoperative complication and the results of visual analogue score (VAS) and modified MacNab’s criteria were assessed. Results: This study included 30 patients (18 males and 12 females). The mean age was about 35 years. Although, there was postoperative improvement of the VAS and MacNab’s criteria in the two groups, there was no statistically significant difference between the preoperative and postoperative VAS of low back pain and radicular pain for the two groups in the follow up period. Conclusion: Both techniques give good results for patients; each technique has some advantages over the other.

Far Lateral Disc Prolapse: Surgical Options in Limited Resources Centers

Far lateral disc prolapse accounts for 6.5% to 12% of all lumbar disc prolapses. Surgical options include open laminectomy with discectomy, microscopic and endoscopic excision of the prolapsed disc. Some of these options may not be available in limited resources centers. We will highlight the effectiveness of various surgical options. Twenty patients with foraminal and extraforaminal lumbar disc prolapse were operated upon from January, 2015 to June, 2016 in the neurosurgical departments of Cairo and Fayoum Universities in Egypt by different modalities (open laminectomy with discectomy, microscopic and endoscopic discectomy). Seventeen patients had foraminal disc prolapse and only three patients had extraforaminal disc prolapse. Twelve patients were operated by conventional laminectomy approach. Microscope was used in four patients and four patients were operated endoscopically. Excellent radicular pain improvement was achieved in 15 cases (75%) including all of the laminectomy groups. Conventional laminectomy and discectomy in far lateral disc prolapse remains an excellent option especially in limited resources centers. Although building up experience with other surgical modalities is mandatory.

Comparing results of Endoscopic microdiscectomy and conventional discectomy for lumbar disc disease: A short term study

Comparing results of Endoscopic microdiscectomy and conventional discectomy for lumbar disc disease: A short term study