Our Summary

This research paper looks at the cost-effectiveness of four different surgical techniques used to treat lumbar disc herniation (LDH), a condition that affects the discs in the lower back. These techniques include microdiscectomy (MD), transforaminal endoscopic lumbar discectomy (TELD), interlaminar endoscopic lumbar discectomy (IELD), and unilateral biportal endoscopic discectomy (UBED).

The study involved 565 patients aged between 20 and 60 years old who had undergone one of these surgeries and were reviewed a year later. The costs of these surgeries were calculated, including both direct costs (such as the cost of the surgery itself) and indirect costs (like work loss due to recovery time).

The study found that the endoscopic discectomy (ED) techniques (TELD, IELD, and UBED) were more cost-effective than microdiscectomy (MD). On average, ED saved an additional $8,064 per quality-adjusted life year (a measure of the quality and quantity of life added by a medical treatment) compared to MD.

In simple terms, the study suggests that endoscopic discectomy techniques are not only cheaper but also provides better quality of life for patients compared to the traditional microdiscectomy technique.

FAQs

  1. What are the four surgical techniques studied for treating lumbar disc herniation (LDH)?
  2. Which surgical technique was found to be the most cost-effective for treating lumbar disc herniation?
  3. How were the costs of the different surgical techniques measured in this study?

Doctor’s Tip

A helpful tip a doctor might give a patient about discectomy is to consider discussing the option of endoscopic discectomy techniques with their healthcare provider. These techniques have been shown to be more cost-effective and can offer better outcomes in terms of quality of life compared to traditional microdiscectomy. It is important for patients to weigh the benefits and risks of each option before making a decision about their treatment.

Suitable For

Patients who are typically recommended for discectomy are those who have been diagnosed with lumbar disc herniation (LDH) and have not responded to conservative treatments such as physical therapy, medication, or steroid injections. These patients often experience severe back or leg pain, numbness, weakness, or tingling that interferes with their daily activities and quality of life. Discectomy may be recommended for patients who have a significant disc herniation causing compression of the spinal nerves, leading to symptoms that are not improving with non-surgical interventions. Additionally, patients who have recurrent episodes of LDH or who have significant functional limitations due to their symptoms may also be candidates for discectomy.

Timeline

Before Discectomy:

  1. Patient experiences symptoms of lumbar disc herniation, such as lower back pain, leg pain, and weakness.
  2. Patient undergoes diagnostic tests, such as MRI or CT scans, to confirm the diagnosis of lumbar disc herniation.
  3. Patient undergoes conservative treatments, such as physical therapy, medications, and injections, to manage symptoms.
  4. If conservative treatments fail to provide relief, patient and their healthcare provider discuss the option of surgery.

After Discectomy:

  1. Patient undergoes pre-operative assessments and preparation for surgery.
  2. Patient undergoes discectomy surgery, where the herniated portion of the disc is removed to relieve pressure on the spinal nerves.
  3. Patient is monitored in the recovery room and then transferred to a hospital room for post-operative care.
  4. Patient undergoes physical therapy and rehabilitation to regain strength and mobility.
  5. Patient is discharged from the hospital and continues with at-home recovery and follow-up appointments with their healthcare provider.
  6. Patient experiences relief from symptoms and improved quality of life following successful discectomy surgery.

What to Ask Your Doctor

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

  1. What are the different surgical techniques available for treating my lumbar disc herniation, and which one do you recommend for me?
  2. What are the potential risks and complications associated with the specific surgical technique you are recommending?
  3. What is the expected recovery time and rehabilitation process after the surgery?
  4. How long will I need to be off work or restricted in my activities following the surgery?
  5. What are the success rates of the different surgical techniques in terms of relieving pain and improving function?
  6. Are there any alternative treatments or non-surgical options that I should consider before proceeding with surgery?
  7. What is the cost of the surgery, including any potential additional costs such as physical therapy or follow-up appointments?
  8. How does the cost-effectiveness of the different surgical techniques compare, and how will this impact my decision-making process?
  9. Can you provide me with any additional information or resources to help me better understand my condition and treatment options?
  10. Are there any specific pre-operative or post-operative instructions I should follow to optimize my recovery and outcomes?

Reference

Authors: Choi KC, Shim HK, Kim JS, Cha KH, Lee DC, Kim ER, Kim MJ, Park CK. Journal: Spine J. 2019 Jul;19(7):1162-1169. doi: 10.1016/j.spinee.2019.02.003. Epub 2019 Feb 10. PMID: 30742976