Our Summary
This research paper talks about a study comparing two types of surgeries used to treat herniated discs in the lower back. These surgeries are called full-endoscopic lumbar discectomy (FELD) and open discectomy or microdiscectomy.
The study analyzed a number of previous studies from four online databases to see which surgery had more risks and complications. The main focus was on the overall rate of complications, but they also looked at how often the problem came back and if any additional surgeries were needed.
According to the analysis, FELD had fewer overall complications compared to open discectomy or microdiscectomy. However, there was no significant difference in specific complications and the rate of the problem coming back.
Additionally, the study found that FELD had a lower risk of injury to the dura (a protective covering of the brain and spinal cord), but a higher risk of transient dysesthesia (a temporary abnormal sensation), residual fragment (leaving a piece of the disc behind), and the need for additional surgeries.
The researchers conclude that FELD has a lower risk of overall complications, but caution that the evidence quality is moderate to low and the risks of bias from the original studies should be considered.
FAQs
- What are the two types of surgeries used to treat herniated discs in the lower back discussed in the study?
- According to the research, which surgery had fewer overall complications - Full-endoscopic lumbar discectomy (FELD) or open discectomy/microdiscectomy?
- What specific risks were found to be associated with FELD according to the study?
Doctor’s Tip
One helpful tip a doctor might tell a patient about discectomy is to carefully weigh the risks and benefits of each type of surgery before making a decision. It’s important to discuss with your doctor about your individual situation, preferences, and any potential concerns you may have. It’s also important to follow your doctor’s post-operative instructions and attend all follow-up appointments to ensure proper healing and recovery.
Suitable For
Patients who are typically recommended for discectomy are those who have persistent and severe leg pain, weakness, and numbness caused by a herniated disc in the lower back. These symptoms can be due to pressure on the nerves in the spinal canal, which can result in pain radiating down the leg, difficulty walking, and loss of sensation or muscle strength.
Patients who have tried conservative treatments such as physical therapy, medication, and injections without significant improvement may be good candidates for discectomy. Additionally, patients who have signs of nerve damage such as foot drop, loss of bladder or bowel control, or progressive weakness in the legs may also benefit from surgery to decompress the nerves.
Overall, the decision to recommend discectomy surgery is made on a case-by-case basis, taking into consideration the severity of symptoms, response to conservative treatments, and the overall health and medical history of the patient. It is important for patients to discuss their options with their healthcare provider to determine the best course of treatment for their specific condition.
Timeline
Before the discectomy surgery, the patient typically experiences symptoms of a herniated disc, such as back pain, leg pain, numbness, or weakness. They may undergo imaging tests like an MRI to confirm the diagnosis. The patient and their healthcare provider will discuss the best treatment options, which may include conservative treatments like physical therapy or epidural steroid injections.
After the decision is made to proceed with surgery, the patient will undergo pre-operative evaluations and preparations. This may include blood tests, imaging studies, and consultations with the surgical team. The patient will also receive instructions on how to prepare for the surgery, such as fasting before the procedure.
During the discectomy surgery, the surgeon will remove the herniated portion of the disc that is pressing on the nerve roots. The surgery can be performed using either the full-endoscopic lumbar discectomy (FELD) technique or the open discectomy or microdiscectomy technique.
After the surgery, the patient will be monitored in the recovery room before being transferred to a hospital room or discharged home. They will receive instructions on post-operative care, including wound care, pain management, and activity restrictions. Physical therapy may also be recommended to help with recovery and rehabilitation.
In the weeks and months following the discectomy surgery, the patient should gradually experience relief from their symptoms as the nerve roots are no longer compressed. They may still have some residual pain or discomfort, which can be managed with medications or physical therapy. Follow-up appointments with the surgeon will be scheduled to monitor the healing process and address any concerns or complications that may arise.
What to Ask Your Doctor
Some questions a patient should ask their doctor about discectomy include:
- What are the risks and complications associated with both full-endoscopic lumbar discectomy (FELD) and open discectomy or microdiscectomy?
- How often does the problem come back after each type of surgery?
- What is the likelihood of needing additional surgeries after FELD or open discectomy?
- What specific complications should I be aware of for each type of surgery?
- How does the risk of injury to the dura compare between FELD and open discectomy?
- What are the risks and benefits of transient dysesthesia and residual fragment after FELD?
- How will you determine which surgery is the best option for me?
- What is the recovery process like for each type of surgery?
- Are there any factors that may increase my risk of complications with either FELD or open discectomy?
- Are there any alternative treatments or procedures that I should consider before deciding on surgery?
Reference
Authors: Yang CC, Chen CM, Lin MH, Huang WC, Lee MH, Kim JS, Chen KT. Journal: World Neurosurg. 2022 Dec;168:333-348. doi: 10.1016/j.wneu.2022.06.023. PMID: 36527213