Our Summary

This research paper is about a study that aimed to compare the efficiency and safety of three surgical procedures: full-endoscopic discectomy (FED), micro-endoscopic discectomy (MED), and open discectomy (OD). These are all treatments for a condition known as symptomatic lumbar disc herniation, which is a problem with a disc in the lower back that can cause severe pain.

Data from 23 studies, involving more than 27,000 cases, were analyzed. The results showed that there was no significant difference in the amount of leg pain patients felt after surgery, whether they had undergone FED, MED, or OD. The same was true when considering patients’ reported disability levels after surgery.

However, the study found that the FED procedure took significantly less time than the OD. It also found that the MED procedure, as well as the endoscopic approaches overall (which includes FED and MED), resulted in significantly less blood loss during surgery than the OD. The FED procedure alone also showed a trend towards less blood loss than the OD, but the difference wasn’t statistically significant.

When it came to complications, recurrence, or reoperation rates, or specific issues like dural tears, root injury, wound infections, and spondylodiscitis, there was no difference between the three procedures.

In conclusion, the study suggested that FED and MED could be safe and efficient alternatives to the traditional OD procedure. However, the authors stressed that further research is needed to confirm these results.

FAQs

  1. What are the three surgical procedures compared in this study for treating symptomatic lumbar disc herniation?
  2. What were the main findings of the study comparing full-endoscopic discectomy (FED), micro-endoscopic discectomy (MED), and open discectomy (OD)?
  3. Did the study find any difference in complication rates between the three surgical procedures?

Doctor’s Tip

A helpful tip a doctor might give a patient about discectomy is to discuss with them the different surgical procedures available, such as full-endoscopic discectomy (FED), micro-endoscopic discectomy (MED), and open discectomy (OD), and to consider the potential benefits and risks of each option. It’s important for patients to have a thorough understanding of their treatment options and to work with their healthcare provider to make an informed decision that is best for their individual situation. Additionally, following post-operative instructions and attending follow-up appointments are crucial for a successful recovery after discectomy surgery.

Suitable For

Patients with symptomatic lumbar disc herniation who are considering surgical treatment may be recommended discectomy, particularly full-endoscopic discectomy (FED) or micro-endoscopic discectomy (MED), based on the findings of this study. These procedures may be especially beneficial for patients who are looking for less invasive options with shorter operating times and reduced blood loss compared to open discectomy (OD). Additionally, patients who are concerned about potential complications or recurrence rates may find FED or MED to be favorable alternatives. It is important for patients to discuss their individual circumstances with their healthcare provider to determine the most appropriate treatment option for their specific needs.

Timeline

Before the discectomy procedure, a patient typically experiences severe pain in the lower back and leg due to symptomatic lumbar disc herniation. They may have tried conservative treatments such as physical therapy, medications, and injections without success.

After the discectomy procedure, the patient may experience immediate relief from their leg pain. Over the next few weeks to months, they will have to follow their surgeon’s post-operative instructions, which may include restrictions on certain activities, physical therapy, and pain management. The patient will gradually return to normal activities and may experience improvements in their overall quality of life.

In the long term, patients who undergo discectomy can expect to have a reduced risk of recurrent disc herniation and may experience improvements in their back pain and overall function. Regular follow-up appointments with their surgeon will be necessary to monitor their progress and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about discectomy include:

  1. What are the potential risks and complications associated with each type of discectomy procedure (FED, MED, OD)?
  2. How long is the recovery process for each procedure, and what is the expected outcome in terms of pain relief and mobility?
  3. Are there any specific criteria that make a patient more suitable for one type of discectomy over another?
  4. How experienced is the surgeon in performing the chosen discectomy procedure, and what is their success rate?
  5. Will physical therapy or other treatments be necessary after the surgery, and if so, what is the recommended plan for rehabilitation?
  6. What is the likelihood of needing additional surgery or experiencing a recurrence of symptoms in the future?
  7. How will the choice of discectomy procedure impact factors such as length of hospital stay, post-operative pain management, and overall recovery time?
  8. Are there any specific lifestyle changes or precautions that the patient should take before or after the surgery to optimize the results?
  9. What are the expected costs associated with each type of discectomy procedure, and will insurance cover the expenses?
  10. Are there any ongoing research studies or new developments in the field of discectomy that the patient should be aware of before making a decision?

Reference

Authors: Phan K, Xu J, Schultz K, Alvi MA, Lu VM, Kerezoudis P, Maloney PR, Murphy ME, Mobbs RJ, Bydon M. Journal: Clin Neurol Neurosurg. 2017 Mar;154:1-12. doi: 10.1016/j.clineuro.2017.01.003. Epub 2017 Jan 8. PMID: 28086154