Our Summary

This research paper compares two types of surgical treatments for lumbar disc herniation (a condition where a disc in the lower back gets damaged and presses on the nerves) in Korean patients. The two methods are open lumbar microdiscectomy, which is a traditional and widely accepted method, and percutaneous endoscopic lumbar discectomy, a newer method.

The researchers reviewed seven studies involving 1254 patients from 1973 (when the newer method was first introduced) to March 2018. They found that patients who had the newer method reported less pain and disability, had shorter operation times, and stayed in the hospital for less time. However, there was no significant difference in terms of overall satisfaction with the surgery, rate of complications, rate of recurrence, and reoperation rate.

One limitation of this research is that all the studies reviewed were not randomized controlled trials (RCTs), which are the gold standard in research because they help eliminate bias. Also, the studies varied in terms of the type of surgery (whether it was the first surgery or a repeat surgery), treatment options before the surgery, follow-up period, etc. Plus, the number of patients was relatively small.

In conclusion, while the newer method showed better results in some aspects, the traditional method still had good outcomes. Therefore, the researchers recommend conducting a large-scale randomized controlled trial in the future to compare these two methods more accurately.

FAQs

  1. What are the two types of surgical treatments for lumbar disc herniation discussed in the research paper?
  2. What were the findings of the research in terms of patient outcomes and satisfaction between the two surgical methods?
  3. What limitations did the researchers identify in their study comparing open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy?

Doctor’s Tip

A doctor might tell a patient considering a discectomy that while the newer method of percutaneous endoscopic lumbar discectomy may offer some benefits such as less pain and shorter recovery time, the traditional method of open lumbar microdiscectomy still has good outcomes. It is important to discuss the options with your healthcare provider and consider factors such as your specific condition, preferences, and potential risks before making a decision. Additionally, it may be beneficial to wait for more research, such as a large-scale randomized controlled trial, to provide more definitive information on the best approach for your individual case.

Suitable For

Patients who are typically recommended for discectomy are those who have tried conservative treatments for their lumbar disc herniation (such as physical therapy, medication, injections) but have not experienced significant improvement in their symptoms. These patients may have severe pain, weakness, numbness, or tingling in their lower back, buttocks, legs, or feet due to the compression of the nerves by the damaged disc. Additionally, patients who have significant functional limitations and reduced quality of life due to their symptoms may also be candidates for discectomy.

Timeline

Before discectomy:

  • Patient experiences lower back pain, leg pain, numbness, or weakness
  • Patient undergoes diagnostic tests such as MRI or CT scan to confirm lumbar disc herniation
  • Patient may try conservative treatments such as physical therapy, medications, or injections to manage symptoms
  • If conservative treatments fail to provide relief, patient may be recommended for surgery

After discectomy:

  • Patient undergoes pre-operative evaluations and preparations
  • Patient undergoes discectomy surgery, either open lumbar microdiscectomy or percutaneous endoscopic lumbar discectomy
  • Patient experiences post-operative pain and discomfort, which is managed with medications
  • Patient undergoes physical therapy and rehabilitation to regain strength and mobility
  • Patient follows up with their surgeon for monitoring and evaluation of recovery progress
  • Patient may experience improvement in symptoms such as pain, numbness, and weakness in the lower back and legs

Overall, the goal of discectomy is to relieve symptoms, improve quality of life, and restore function in patients with lumbar disc herniation.

What to Ask Your Doctor

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

  1. What are the differences between open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy?
  2. Which method do you recommend for my specific condition and why?
  3. What are the potential risks and complications associated with each type of surgery?
  4. How long is the recovery time for each method?
  5. What is the success rate of each method in terms of pain relief and improving function?
  6. Will I need physical therapy or rehabilitation after the surgery?
  7. Are there any long-term effects or considerations I should be aware of after undergoing the procedure?
  8. How many of these procedures have you performed, and what is your success rate?
  9. Are there any alternative treatments or non-surgical options I should consider?
  10. What can I expect in terms of pain management and follow-up care after the surgery?

Reference

Authors: Kim M, Lee S, Kim HS, Park S, Shim SY, Lim DJ. Journal: Biomed Res Int. 2018 Aug 7;2018:9073460. doi: 10.1155/2018/9073460. eCollection 2018. PMID: 30175149