Our Summary

This research paper is a comparison of different techniques used to treat herniated discs in the lower back. The techniques include traditional open or micro discectomy (OD/MD), microendoscopic discectomy (MED), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy. The researchers looked at the rates of complications for each of these methods using two classification systems.

They found that the overall complication rates for these techniques ranged from 5.8% to 25.8%. Out of all the techniques, PELD had the lowest risk of overall complications and the lowest risk of complications that required conservative treatment. This was based on moderate to high-quality evidence.

However, when they looked at data from cohort studies, they found some evidence (though of low quality) that MED had a higher risk of certain types of complications, and PELD had a higher risk of reherniations and reoperations. PLDD, on the other hand, had a lower risk of overall complications, post-operative complications, certain types of complications, reherniations, and reoperations.

In simpler terms, the study suggests that PELD might be the safest option for treating herniated discs in the lower back, but more research is needed to confirm these findings.

FAQs

  1. What are the different techniques used to treat herniated discs in the lower back as discussed in the research?
  2. Which technique has the lowest risk of overall complications according to the research?
  3. What does the research suggest about the risks of reherniations and reoperations with the various discectomy techniques?

Doctor’s Tip

A helpful tip a doctor might tell a patient about discectomy is to carefully consider all treatment options and discuss the potential risks and benefits with their healthcare provider before making a decision. It’s also important to follow post-operative instructions carefully, including proper rest, activity modification, and physical therapy, to ensure a successful recovery.

Suitable For

Patients who are typically recommended for discectomy are those who have not responded to conservative treatments such as physical therapy, medications, and injections, and continue to experience severe pain, weakness, or numbness in the back or legs due to a herniated disc. These patients may have tried non-surgical options for several weeks or months without improvement, and their symptoms are significantly affecting their quality of life and daily activities. Additionally, patients who have neurological deficits such as muscle weakness or changes in bowel or bladder function may also be candidates for discectomy to prevent further nerve damage. Ultimately, the decision to undergo discectomy should be made in consultation with a spine specialist who can evaluate the patient’s individual case and recommend the most appropriate treatment option.

Timeline

Timeline of patient experience before and after discectomy:

Before discectomy:

  1. Patient experiences symptoms of a herniated disc, such as back pain, leg pain, numbness, or weakness.
  2. Patient undergoes diagnostic tests, such as MRI or CT scans, to confirm the diagnosis of a herniated disc.
  3. Patient may undergo conservative treatments, such as physical therapy, medications, or epidural injections, to manage symptoms.
  4. If conservative treatments are unsuccessful, patient and surgeon decide to proceed with discectomy surgery.

After discectomy:

  1. Patient undergoes discectomy surgery to remove the herniated portion of the disc and relieve pressure on the nerves.
  2. Patient may experience some pain and discomfort immediately following surgery.
  3. Patient is typically discharged from the hospital within a few days and instructed on post-operative care.
  4. Patient may need to take pain medications and attend physical therapy to aid in recovery.
  5. Patient gradually resumes normal activities and experiences relief from symptoms over time.
  6. Patient follows up with surgeon for post-operative appointments to monitor healing and address any concerns.

What to Ask Your Doctor

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

  1. What are the different techniques available for treating my herniated disc, and which one do you recommend for me?
  2. What are the potential complications associated with the discectomy procedure?
  3. How likely am I to experience complications that require further treatment?
  4. Are there any specific risks or complications associated with the technique you are recommending?
  5. What is the success rate of the recommended technique in terms of relieving my symptoms?
  6. How long is the recovery process expected to take, and what can I do to promote healing?
  7. Are there any alternative treatments or therapies that I should consider before undergoing discectomy?
  8. How often do patients experience reherniations or the need for reoperations after undergoing discectomy with the recommended technique?
  9. What are the long-term outcomes and potential risks associated with the recommended technique compared to other available options?
  10. Are there any specific factors about my condition or medical history that could affect the success or safety of the recommended discectomy technique?

Reference

Authors: Chen X, Chamoli U, Vargas Castillo J, Ramakrishna VAS, Diwan AD. Journal: Eur Spine J. 2020 Jul;29(7):1752-1770. doi: 10.1007/s00586-020-06389-5. Epub 2020 Apr 9. PMID: 32274586