Our Summary

This research paper is a review of 18 studies comparing two minimally invasive surgical procedures for treating herniated lumbar discs: percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED). The results showed no significant difference between the two procedures in terms of operation duration, disability index, leg pain, overall pain, success rate, complication rate, and recurrence rate. However, PELD had some advantages, including smaller incision size, less blood loss, shorter hospital stay, and lower back pain at the last follow-up. On the other hand, MED had fewer fluoroscopy (imaging technique) times and a lower re-operation rate. The researchers concluded that both methods can achieve excellent results, but more practice is needed to improve PELD. They also suggested considering the economic factor according to different regions before choosing a treatment strategy. More detailed studies with larger samples are needed to confirm these results.

FAQs

  1. What were the main findings of the research comparing percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED)?
  2. What are the advantages and disadvantages of PELD and MED as found in the study?
  3. What further research is suggested by the authors to confirm the results of the study?

Doctor’s Tip

A doctor might tell a patient about discectomy that it is important to follow post-operative instructions carefully, including physical therapy exercises, to support recovery and prevent recurrence of herniated discs. It is also important to maintain a healthy weight, practice good posture, and avoid activities that may strain the back to prevent further injury. It is important to communicate any persistent pain or new symptoms to your healthcare provider for proper management.

Suitable For

Patients who are typically recommended for discectomy are those who have not experienced relief from conservative treatments such as physical therapy, medication, and injections for at least 6 weeks. They may have symptoms such as severe leg pain, weakness, numbness, or tingling due to a herniated lumbar disc pressing on a nerve. Patients with a confirmed diagnosis of a herniated lumbar disc on imaging studies such as MRI are also considered candidates for discectomy. Additionally, patients who have tried other treatments and still have persistent symptoms that significantly affect their daily activities and quality of life may be recommended for surgery.

Timeline

Before Discectomy:

  1. Patient experiences lower back pain, leg pain, and other symptoms of a herniated lumbar disc.
  2. Patient undergoes diagnostic tests such as MRI or CT scans to confirm the diagnosis.
  3. Patient may undergo conservative treatments such as physical therapy, medications, and injections to manage the symptoms.

After Discectomy:

  1. Patient undergoes pre-operative preparation including medical evaluation and discussion of the procedure with the surgeon.
  2. Patient undergoes the minimally invasive discectomy procedure, either PELD or MED.
  3. Patient may experience some pain and discomfort after the surgery, which is managed with medications.
  4. Patient undergoes post-operative rehabilitation including physical therapy to regain strength and flexibility.
  5. Patient gradually resumes normal activities and experiences improvement in symptoms such as lower back pain and leg pain.
  6. Patient follows up with the surgeon for monitoring and evaluation of the surgical outcome.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a discectomy procedure?
  2. How long is the recovery period after a discectomy surgery?
  3. Will I need physical therapy or other post-operative care after the procedure?
  4. What are the success rates of discectomy surgery for treating herniated lumbar discs?
  5. How do the outcomes of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) compare in terms of pain relief and functional improvement?
  6. Is there a higher risk of recurrence with one procedure over the other?
  7. How do the costs of PELD and MED compare, and will insurance cover the procedure?
  8. Are there any specific factors that make me a better candidate for one procedure over the other?
  9. What is the long-term prognosis for someone who undergoes a discectomy surgery?
  10. How experienced are you in performing PELD and MED procedures, and what is your success rate with these surgeries?

Reference

Authors: Shi R, Wang F, Hong X, Wang YT, Bao JP, Liu L, Wang XH, Xie ZY, Wu XT. Journal: Int Orthop. 2019 Apr;43(4):923-937. doi: 10.1007/s00264-018-4253-8. Epub 2018 Dec 13. PMID: 30547214