Conventional Microdiscectomy Research Articles

Qualitative Evaluation of Paraspinal Musculature After Minimally Invasive Lumbar Decompression: A Prospective Study.

To quantify fatty infiltration and degree of paraspinal muscle degeneration in patients submitted to tubular microdiscectomy and conventional open microdiscectomy. A prospective cohort of patients was submitted to microdiscectomy for lumbar disc herniation after failure of conservative treatment. Selection of the technique was based on the surgeon's preference. Analysis of the multifidus muscle was performed using the Goutallier system and the percentage of fat in the muscle. Preoperative and 1-year postoperative T2-weighted magnetic resonance imaging was used, and statistical analysis was carried out using the Wilcoxon test and Spearman correlation test using a significance level of 5%. Thirty-two patients were included in the study. The percentage of fatty infiltration in the muscle increased on both sides of the spine 1 year after surgery, although only the ipsilateral side presented statistical significance in patients submitted to conventional microdiscectomy (43.3% preoperative and 57.8% postoperative). Muscular degeneration increased significantly ipsilateral to the disc herniation according to the Goutallier classification (grades 1-2) for both interventions. No statistically significant difference was found for fatty infiltration scores or for the degree of muscular degeneration of the multifidus in the comparative analysis of the methods. Muscular damage resulting from surgery of lumbar disc herniation significantly increases fatty infiltration and degeneration of the multifidus. Muscular degeneration was associated with worsening back pain. While no significant difference was found between the techniques, the tubular minimally invasive approach shows a tendency for less muscle damage. These findings highlight the importance of minimizing muscle injury during surgery to improve postoperative recovery and long-term outcomes.

Uniportal Dual Mode Dry-Saline Endoscopy for Lumbar Disc Herniation

Objective: Posterior dry medium endoscopic lumbar discectomy techniques have been successfully used to treat lumbar disc prolapse. A drawback of these techniques is repeated blood staining of the scope tip while working close to the surgical target. To address this drawback, we modified the design of the previous Arthrospine system and made it compatible for use in air and saline medium to treat lumbar, cervical, and thoracic disc prolapse. Herein, we describe the operative technique and results of lumbar discectomy in a dual (air/saline) medium using this system.Methods: Eighty patients underwent endoscopic discectomy using the Arthrospine Duo system for lumbar disc prolapse. The procedure was conducted through a muscle dilatation approach using 5-mm and 10-mm dilators. The Arthrospine Duo tube was passed over a 10-mm dilator, the working insert was adjusted over the tube in a press-fit manner, and endoscopic discectomy was performed using a 30° arthroscope and conventional microdiscectomy instruments in an air or saline medium.Results: As per the modified MacNab criteria, 80% (n=64) of patients had excellent, 12.5% (n=10) good, 6.25% (n=5) fair, and 1.25 patients (n=1) had poor results. The leg pain visual analogue scale improved from 7.87±0.68 to 1.3±0.67 at 2 years of follow-up. As complications, dural tears and transient paraesthesia occurred in 4 patients (5%) each, nerve root injury in 1 patient (1.25%), and superficial wound infection in 5 patients (6.25%).Conclusion: The uniportal Arthrospine Duo system can be used in air/saline medium and is an excellent minimally invasive option for lumbar discectomy.

Full-Endoscopic Foraminoplasty and Lumbar Discectomy for Single-Level Lumbar Disc Herniation.

The Transforaminal Endoscopic Surgical System (TESSYS) technique has gained popularity for the treatment of lumbar disc herniations. Foraminoplasty is the key procedure in TESSYS. However, it requires advanced skills and long-term learning, which hinder its widespread adoption among surgeons. Recently, the introduction of full-endoscopic solutions has made the process more manageable. The main difference from traditional single-portal endoscopic surgery is that full-endoscopic surgery is equipped with a larger working channel, allowing full visualization of foraminoplasty and decreasing reliance on intraoperative fluoroscopy. Recently, published studies have shown that full-endoscopic foraminoplasty and lumbar discectomy (FEFLD) could achieve comparable results to conventional microdiscectomy in terms of pain relief and functional outcomes, while enhancing postoperative recovery. This study describes the technique of FEFLD in detail, including every crucial step, such as patient positioning, puncture trajectory, endoscopic dissection of the superior articular process (SAP), endoscopic foraminoplasty, and more. We hope this will be helpful to beginners who wish to apply this approach.

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.

Tension-activated nanofiber patches delivering an anti-inflammatory drug improve repair in a goat intervertebral disc herniation model.

Conventional microdiscectomy treatment for intervertebral disc herniation alleviates pain but does not repair the annulus fibrosus, resulting in a high incidence of recurrent herniation and persistent dysfunction. The lack of repair and the acute inflammation that arise after injury can further compromise the disc and result in disc-wide degeneration in the long term. To address this clinical need, we developed tension-activated repair patches (TARPs) for annulus fibrosus repair and local delivery of the anti-inflammatory factor anakinra (a recombinant interleukin-1 receptor antagonist). TARPs transmit physiologic strain to mechanically activated microcapsules embedded within the patch, which release encapsulated bioactive molecules in direct response to spinal loading. Mechanically activated microcapsules carrying anakinra were loaded into TARPs, and the effects of TARP-mediated annular repair and anakinra delivery were evaluated in a goat model of annular injury in the cervical spine. TARPs integrated with native tissue and provided structural reinforcement at the injury site that prevented aberrant disc-wide remodeling resulting from detensioning of the annular fibrosus. The delivery of anakinra by TARP implantation increased matrix deposition and retention at the injury site and improved maintenance of disc extracellular matrix. Anakinra delivery additionally attenuated the inflammatory response associated with TARP implantation, decreasing osteolysis in adjacent vertebrae and preserving disc cellularity and matrix organization throughout the annulus fibrosus. These results demonstrate the therapeutic potential of TARPs for the treatment of intervertebral disc herniation.

Minimally Invasive Transforaminal Interbody Fusion Versus Microdiscectomy Without Fusion for Recurrent Lumbar Disk Herniation: A Prospective Comparative Study.

The objective of this study was to compare the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) versus standard revision diskectomy for recurrent lumbar disk herniation (RLDH). RLDH is the most common cause of redo surgery after a microdiscectomy. Commonly, in patients without evidence of spinal instability, many surgeons would simply redo microdiscectomy, while others proceed to a redo microdiscectomy with arthrodesis. According to the literature, there is no evidence of what the best management of an RLDH would be. This study involved 90 patients who underwent lumbar microdiscectomy in the past and were now experiencing a new lumbar disk herniation for the first time. The patients were divided into two groups, each with 45 patients: group A received standard revision microdiscectomy, whereas group B received revision microdiscectomy with MIS TLIF.The Japanese Orthopaedic Association score, operating time, blood loss, duration of hospital stay, costs, and complications were all prospectively recorded in a database and examined. Back and leg discomfort were measured using the visual analog scale. The mean total postoperative Japanese Orthopaedic Association score across the groups exhibited no statistically significant difference, nor did the preoperative clinical and epidemiological data. Although postoperative leg pain was comparable in both groups, postoperative lower back pain in group A was much worse than that in group B. Additional revision surgery was necessary for six individuals in group A. Group A had higher rates of dural rupture and postoperative neurological impairment. Group A experienced much less intraoperative blood loss, longer operation times, and postoperative hospital stays. In patients with RLDH, revision microdiscectomy is effective. In comparison with conventional microdiscectomy, MIS TLIF reduces intraoperative risk of dural rupture or neural injury, postoperative incidence of mechanical instability or recurrence, and postoperative lower back pain. Prospective, randomized, multicenter, comparative study.

Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation

This study aimed to evaluate the clinical outcomes of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) in the treatment of symptomatic lumbar disc herniation (LDH). From January 2020 and May 2021, 128 patients with single-level LDH at L4-5 or L5-S1 received FEFLD, UBE discectomy or MD. Patients were divided into three groups according to surgical method: the FEFLD group (n = 43), the UBE group (n = 42), and the MD group (n = 43). Operative time, fluoroscopy frequency, in-bed time, length of hospital stays, total expenses, complications, visual analogue scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among three groups. There were no significant differences in VAS or ODI scores at 12months after surgery among three groups. In comparison with the MD group, the FEFLD and UBE group yield better VAS scores for back pain on the first day following surgery (P < 0.05). The FEFLD group was superior to the UBE group or MD group with less time in bed and shorter hospital stay (P < 0.05). The operation time and total expenses in the UBE group were significantly longer and higher than those in the FEFLD group or MD group (P < 0.05). FEFLD and UBE discectomy yield comparable results to conventional MD concerning pain relief and functional outcomes. In addition, FEFLD and UBE discectomy enable less back pain in the immediate postoperative period. FEFLD offers advantages in rapid recovery. Conventional MD is still an efficient and cost-effective surgical procedure.

Personalized neurosurgical tactics in the treatment of intervertebral hernias of the lumbar spine

Objective. Analysis of literature data of modern neurosurgical techniques in the treatment of lumbar disc herniation; clarification of the features of surgical tactics and results during microsurgical, endoscopic methods and laser thermoplastic of the intervertebral disk. Methods. A retrospective analysis of the results of conventional microdiscectomy (228 cases), laser disc decompression (22 observations) and percutaneos endoscopic discectomy (4 observations) for lumbar disc herniation from 2016 to 2018. The results of surgical treatment was assessed according to the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), modified MacNab criteria, and morphometric data of MRI and CT scans during the preoperative and postoperative periods, as well as 6 and 12 months after surgery. Results. The result of the study was a comparison of the literature data with those obtained in our clinic in the treatment of patients using all the indicated methods. On our material, we received confirmation of the feasibility and perspectivity of using minimally invasive methods in the treatment of lumbar disc herniation with low probability of recurrence and repeated treatment for pain. Also agree with the statement that the techniques have limited application, especially with instability in the VMS and multilevel lesion. Conclusion. Endoscopic discectomy, as well as laser disc decompression, are minimally invasive methods of treatment lumbar disc herniation, and have become an alternative to open lumbar microdiscectomy, as they allow minimizing surgical trauma, the effects of surgery, and quickly regress pain syndrome, contributing to early post-operative activation of the patient. A personalized approach in the treatment of lumbar disc herniation is based on the competent selection of patients and the clarification of a number of factors in determining.

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.

Percutaneous Transforaminal Endoscopic Lumbar Discectomy in Obese Patients

Abstract Background: Obese patients are at higher risk of compli-cations after spinal surgery such as slower wound healing and increased infection rates. Percutaneous Endoscopic Lumbar Discectomy (PELD) has advantages over conventional micro-discectomy because it decreases perioperative complications and increases favorable clinical outcomes. Aim of Study: The aim of this study is to evaluate the clinical outcomes of PELD in obese patients as compared to patients who have a normal body mass index. Patients and Methods: Obesity is defined as a Body Mass Index (BMI) of more than 30kg/m2. Our study included 32 obese patients and 35 normal BMI patients treated by PELD for radiating pain caused by a single-level lumbar disc herni-ation. Clinical and functional outcomes using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) and follow-up was done at 2 weeks, 1, 2, 6 and 12 months post-operatively. All surgeries were done by the same surgeon. Results: Overall clinical and functional outcomes were improved during post-operative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In the obese group, two patients had late re-herniation, of these, 1 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient underwent another PELD surgery. In control group, there was one early reherniations which occurred within a months after PELD, which patient underwent conventional microdiscectomy. Conclusion: PELD is an effective, safe, and minimally invasive technique for obese patients. The PELD decreases the post-operative morbidity and allows for faster mobility and rehabilitation. The results were comparable to patients with normal body mass index.

Body image and cosmesis after percutaneous transforaminal endoscopic discectomy versus conventional open microdiscectomy for sciatica caused by lumbar disk herniation: results of a randomized controlled trial

Body image and cosmesis after percutaneous transforaminal endoscopic discectomy versus conventional open microdiscectomy for sciatica caused by lumbar disk herniation: results of a randomized controlled trial

Tubular Microdiscectomy versus Conventional Surgery for Sciatica. A Comparative Prospective Enzyme Study

Abstract Objective Muscle injury is inevitable during surgical exposure of the spine, and it is quantified by the release of creatine phosphokinase. The aim of the present study is to make a comparison between tubular microdiscectomy and conventional microdiscectomy by using the pre- and postoperative serum concentrations of creatine phosphokinase as an indicator of muscle injury. Materials and Methods A total of 28 patients who underwent surgery for lumbar disc herniation were allocated into 2 groups: 12 patients (group A) operated by transflaval microdiscectomy, and 16 patients (group B) operated by tubular microdiscectomy. The serum concentration of total creatine phosphokinase was measured before surgery (creatine phosphokinase 1) and 1 day after surgery (creatine phosphokinase 2). Results There were 12 women and 16 men; the mean age of the patients and the mean duration of the surgery were respectively 49.5 years and 56 minutes for group A, and 47.3 years and 60 minutes for group B. The p-values of creatine phosphokinase 1, creatine phosphokinase 2 and the creatine–phosphokinase ratio were respectively 0,34; 0,31; and 0,57 (p &lt; 0.05). Conclusion The present study demonstrated that there was no significant difference between tubular microdiscectomy and conventional microdiscectomy according to the analysis of the levels of creatine phosphokinase.

Tubular Discectomy Versus Conventional Microdiscectomy for the Treatment of Lumbar Disc Herniation: A Comparative Study

Tubular Discectomy Versus Conventional Microdiscectomy for the Treatment of Lumbar Disc Herniation: A Comparative Study

Percutaneous Endoscopic Lumbar Discectomy Versus Microdiscectomy for the Treatment of Lumbar Disc Herniation: Pain, Disability, and Complication Rate-A Randomized Clinical Trial.

The objective was to compare the traditional microdiscectomy with percutaneous endoscopic lumbar discectomy for the treatment of disc herniations regarding pain, disability, and complications. Randomized clinical trial with 47 patients with disc herniations treated with 2 different surgical techniques: traditional microdiscectomy or percutaneous endoscopic lumbar discectomy. Forty-seven patients were divided into 2 groups and monitored for 12 months. Irradiated and low back pain were evaluated with the visual analog scale. Surgery complications were recorded. After surgery, the sciatica and disability improved significantly but without significant differences between the groups. Improvements in back pain were significant until the third month. There were no statistical differences between groups regarding recurrence, infection, and the need for reoperation. Endoscopic discectomy results are similar to those of conventional microdiscectomy regarding pain and disability improvement. Postoperative lumbar pain is less intense with endoscopic discectomy than conventional microdiscectomy only during the first 3 months. Endoscopic discectomy is a safe and efficient alternative to microdiscectomy. Trial protocol registration number: RBR-5symrd (http://www.ensaiosclinicos.gov.br).

Complications and limitations of endoscopic spine surgery and percutaneous instrumentation

Endoscopic spine surgery has started replacing conventional microdiscectomy in various centers across the globe. With development in the field of optics and instrumentation, the field of percutaneous endoscopic spine surgery has evolved immensely. With increasing experience, endoscopic spine surgeons have expanded the indications not only to lumbar paramedian disc herniations but also to central disc herniations, high-grade migrated disc herniations, sequestered herniations, thoracic and cervical disc herniations, and more recently, lumbar canal stenosis. With broadening indications, unexpected adverse events are bound to increase. Hence, it is essential for the endoscopic spine surgeons to be aware of the potential hazards and unexpected complications of the procedure so that appropriate care is taken to avoid adverse events as much as possible. In this article, we summarize all the complications of transforaminal endoscopic discectomy reported in the literature. We have classified the complications into intraoperative, immediate postoperative, and late postoperative complications. The senior author has also suggested the tips to avoid these complications and carry out the procedure as safely as possible. As percutaneous instrumentation, particularly, percutaneous pedicular screws, is also becoming common with the development of minimally invasive spine surgery, we have also summarized its complications and limitations. An insight into these complications will help the endoscopic surgeons to take special precautions when performing the procedure.

Brake reaction time before and after surgery for patients with sequestrectomy versus conventional microdiscectomy

The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy on breaking response time (BRT) for lumbar disc herniation (LDH). BRT is the key factor for return to drive recommendations after surgery.A prospective clinical study was conducted. Patients aged 25–65 years who underwent surgery for lumbar disc herniation and held a valid motorcar driving license were recruited in a single institution. The patients were assessed before surgery, immediately after the surgery and at the follow up examination 30 days post-surgery. BRT was measured using a driving simulator, a visual analogue scale (VAS) was used for pain assessment. BRT values were compared with BRT values of a healthy control group.In patients treated with microdiscectomy BRT reduced from 749 (±223) msec before surgery to 649 (±223) msec immediately after the surgery. In the sequestrectomy group BRT reduced from 852 (±561) msec before surgery to 693 (±173) msec immediately after the surgery. BRT at follow up was 610 (±145) msec for patients treated with microdiscectomy and 630 (±98) msec for patients operated with sequestrectomy. BRT for healthy controls was 487 (±116) msec. Pain improved significantly for both patient samples.Sequestrectomy and microdiscectomy were associated with similar effects on pain and BRT after surgery. There was no statistically significant difference between BRT of both patient samples at 30 days follow up examination. Both surgical techniques showed a positive effect on BRT. No statistically significant difference between sequestrectomy and microdiscectomy on BRT could be found.

Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial

IntroductionFor sciatica caused by lumbar disc herniation (LDH), the standard surgical technique is conventional microdiscectomy. In recent years, minimally invasive techniques (eg, percutaneous transforaminal endoscopic discectomy (PTED), paraspinal minitubular microdiscectomy...

Unilateral discectomy: outcomes, postoperative pain, complications.

In low back pain management surgery is currently commonly used with a new technique called minimally invasive discectomy, while open discectomy is still preferable in many cases. In this regard, the efficacy of tubular discectomy (TD) were compared with conventional standard lumbar disc procedure (conventional microdiscectomy). This study was performed as a clinical trial conducted on patients who were under TD and conventional microdiscectomy using unilateral retractor at Bou Ali, Mehrad, Laleh Hospitals during the years 2001 to 2017. The pain score was determined based on the use of Visual Analogue Scale (VAS). The Roland Morris Disability Questionnaires (RMQ) and mean Oswestry disability index (ODI) were also calculated. Our findings revealed that the two groups were similar in terms of demographic characteristics (age, sex, body mass index, etc.) (p> 0.05). The findings indicated the superiority of TD over the classic approach. The mean scores of ODI in conventional microdiscectomy and TD groups were reported as 12.53 ± 7.09 and 9.51 ± 7.83, respectively. ODI revealed that patients with TD surgery had less disability in lifting objects, sitting, standing, and traveling. In the conventional microdiscectomy group, 12 (20%) patients were affected by complications of surgery, but no complication was reported in any patient with TD (p = 0.000). The mean index of Roland Morris disability in the conventional microdiscectomy and TD groups were estimated to be 6.033 ± 2.98 and 3.73 ± 3.25 (p = 0.000). However, both groups did not differ in terms of visual scores for pain and relapse (p > 0.05). Our study demonstrates that disease relapse within 6 months after the surgery, the RMQ and the ODI values were significantly better in TD than the other group.

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.

Comparative Clinical Effectiveness of Tubular Microdiscectomy and Conventional Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Network Meta-Analysis.

This study is a systematic literature review and meta-analysis. To evaluate the efficacy of tubular microdiscectomy (TMD) compared with conventional microdiscectomy (CMD) for lumbar disc herniation (LDH). TMD has developed rapidly due to reduced tissue trauma by minimization of the required access to spine and disc herniation; however, CMD remains the standard of care for this patient group. To date, it remains debatable whether TMD is superior to CMD for LDH. We performed a comprehensive database search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trails for prospective randomized controlled trials (RCTs), through using Medical Subject Headings (MeSH) terms "microdiscectomy," "tubular microdiscectomy," "minimally invasive surgery," and "spinal disease." The retrieved results were last updated on March 15, 2018. Two independent investigators selected qualified studies, extracted indispensable data, assessed risk of bias of original papers. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to grade quality of evidence. If I >50, the heterogeneity is considerable. Four RCT studies (total n = 605), involving 610 individuals with a follow-up period of no less than 12 months, were selected for further review. We assessed these studies as low overall risk of bias. There was low-quality evidence that TMD was superior to CMD considering postoperative Oswestry Disability Index scores (SMD, -3.43, 95% CI, -4.64 to -2.21, P < 0.00001). Compared with CMD, the TMD group exhibited significantly worse Short Form-36 physical function scores (SMD, -4.83, 95% CI, -8.94 to -0.72, P = 0.02). There were no significant differences in the visual analogue scale (P = 0.30), operative time (P = 0.68), dural tear (P = 0.52), and reoperation (P = 0.98). The benefits 1 year after TMD were similar to that of CMD. There was no significant difference in the incidence of reoperation and dural tear. 1.