Our Summary

This research paper is about a study that compared three types of surgeries for lumbar disc herniations, a condition that affects the discs in the lower back. These surgeries are endoscopic discectomy (ED), open microdiscectomy (OM), and tubular microdiscectomy (TM). ED is a less invasive procedure that is thought to result in less pain and quicker recovery times.

The researchers analyzed 26 studies of these surgeries, including outcomes for 2,577 patients. They found that patients who underwent OM had more blood loss and stayed longer in the hospital compared to those who had ED or TM. They also took longer to return to work and had higher scores for postoperative leg and back pain, as well as disability, compared to those who had ED. Patients who had OM also had higher levels of certain markers for inflammation and muscle damage after surgery.

However, the researchers note that while ED appears to have some advantages over OM, the differences were small and may not be clinically significant. Plus, many of the included studies were retrospective and may have a high risk of bias. To make definitive conclusions about the best surgical treatment for lumbar disc herniations, they call for more high-quality prospective studies.

FAQs

  1. What are the three types of surgeries compared in the study for lumbar disc herniations?
  2. How does the recovery of patients who underwent open microdiscectomy (OM) compare to those who had endoscopic discectomy (ED) or tubular microdiscectomy (TM)?
  3. Why do the researchers suggest that more high-quality prospective studies are needed to make definitive conclusions about the best surgical treatment for lumbar disc herniations?

Doctor’s Tip

One helpful tip a doctor might tell a patient about microdiscectomy is to follow their postoperative care instructions carefully. This may include recommendations for activity restrictions, physical therapy, pain management, and wound care. By following these instructions, patients can help ensure a successful recovery and minimize the risk of complications.

Suitable For

Patients who are typically recommended for microdiscectomy surgery are those who have not responded to conservative treatments such as physical therapy, medication, and injections. They may be experiencing symptoms such as severe leg pain, numbness, weakness, and difficulty walking due to a lumbar disc herniation. Patients who have a clear MRI or CT scan showing a disc herniation that is pressing on a nerve are good candidates for microdiscectomy. Additionally, patients who are in good overall health and do not have any contraindications for surgery may be recommended for this procedure.

Timeline

Before microdiscectomy:

  1. Patient experiences lower back pain, leg pain, and possibly numbness or weakness in the affected area.
  2. Patient undergoes imaging tests such as MRI or CT scan to diagnose the lumbar disc herniation.
  3. Patient may undergo conservative treatments such as physical therapy, medications, and injections to manage the symptoms.

After microdiscectomy:

  1. Patient undergoes the microdiscectomy surgery, which involves removing the herniated portion of the disc to relieve pressure on the nerves.
  2. Patient may experience some pain and discomfort after surgery, which is managed with pain medications.
  3. Patient begins physical therapy to regain strength and flexibility in the lower back.
  4. Patient gradually resumes daily activities and work, with guidance from the healthcare team.
  5. Patient experiences improvement in symptoms such as reduced pain, numbness, and weakness in the affected area.

What to Ask Your Doctor

Some questions a patient should ask their doctor about microdiscectomy surgery include:

  1. What are the potential risks and complications associated with microdiscectomy surgery?
  2. How long is the recovery time for a microdiscectomy procedure?
  3. What are the expected outcomes and success rates for microdiscectomy surgery?
  4. How does microdiscectomy compare to other surgical options for treating lumbar disc herniations?
  5. Will I need physical therapy or rehabilitation after microdiscectomy surgery?
  6. How soon after surgery can I expect to return to normal activities, such as work or exercise?
  7. What is the long-term prognosis for patients who undergo microdiscectomy surgery?
  8. Are there any lifestyle changes or precautions I should take after undergoing microdiscectomy surgery?
  9. How often will I need follow-up appointments or imaging studies after microdiscectomy surgery?
  10. Are there any alternative treatments or non-surgical options that I should consider before deciding on microdiscectomy surgery?

Reference

Authors: Barber SM, Nakhla J, Konakondla S, Fridley JS, Oyelese AA, Gokaslan ZL, Telfeian AE. Journal: J Neurosurg Spine. 2019 Sep 6;31(6):802-815. doi: 10.3171/2019.6.SPINE19532. Print 2019 Dec 1. PMID: 31491760