Our Summary

This research paper looks into two different methods of treating a herniated lumbar disc, a common cause of lower back pain, in patients who also have a condition called spondylolisthesis, which is a slippage of one bone in the spine over another. The two methods are called open lumbar microdiscectomy (OLM) and percutaneous endoscopic lumbar discectomy (PLELD).

The research involved 84 patients between 20 to 60 years old who underwent either OLM or PLELD at a hospital between 2007 and 2014. They were followed up for at least three years after their surgery.

The results showed that the PLELD method had fewer patients needing to undergo the same surgery again compared to the OLM method. Also, the disc height (the space between the spinal bones) decreased more after OLM than after PLELD. The OLM method also had worse rates of damage to the endplate, which is the part of the vertebra that contacts the disc, and changes in the signal intensity of the subchondral bone, which is the layer of bone just below the cartilage in a joint.

However, both methods had similar final clinical outcomes, meaning that patients’ symptoms and quality of life were similar after either surgery.

The study concludes that for patients with spondylolisthesis and a herniated lumbar disc, PLELD might be a better treatment option to reduce the chance of needing the same surgery again and to slow down disc degeneration. However, the study acknowledges that it had a small sample size and that there might be bias in patient selection, so more research is needed.

FAQs

  1. What were the two methods of treating a herniated lumbar disc studied in this research?
  2. What were the results of the study comparing open lumbar microdiscectomy (OLM) and percutaneous endoscopic lumbar discectomy (PLELD)?
  3. What does the study suggest about the best treatment option for patients with spondylolisthesis and a herniated lumbar disc?

Doctor’s Tip

A helpful tip a doctor might tell a patient about microdiscectomy is to discuss the different surgical methods available, such as open lumbar microdiscectomy (OLM) and percutaneous endoscopic lumbar discectomy (PLELD), and consider the potential benefits and risks of each method. It is important to have a thorough discussion with your healthcare provider to determine the best treatment option for your specific condition. Additionally, it is important to follow your doctor’s post-operative instructions, including physical therapy and activity restrictions, to ensure optimal recovery and long-term success of the surgery.

Suitable For

Patients who are typically recommended microdiscectomy are those who have a herniated lumbar disc that is causing lower back pain, leg pain, and numbness or weakness in the legs. In the case of this specific study, patients with spondylolisthesis, a condition where one vertebra slips forward over another, were also included. Patients who have not responded to conservative treatments such as physical therapy, medication, and injections may be candidates for microdiscectomy surgery.

It is important for patients to undergo a thorough evaluation by a spine specialist to determine if microdiscectomy is the appropriate treatment option for their specific condition. Additionally, patients should be in overall good health and able to tolerate surgery and the recovery process.

Overall, microdiscectomy is a common surgical procedure recommended for patients with herniated lumbar discs who have not seen improvement with conservative treatments. It can provide relief from symptoms and improve the quality of life for patients suffering from chronic back pain.

Timeline

Before the microdiscectomy procedure, a patient typically experiences lower back pain, leg pain, numbness, and weakness. They may have undergone imaging tests such as MRI or CT scans to diagnose the herniated lumbar disc. The patient likely tried conservative treatments such as physical therapy, pain medication, and steroid injections before deciding to undergo surgery.

After the microdiscectomy procedure, the patient may experience some pain and discomfort at the surgical site, which can be managed with medication. They will need to follow post-operative instructions such as avoiding heavy lifting, bending, or twisting for a certain period of time. Physical therapy may be recommended to help with recovery and strengthen the back muscles. Over time, the patient should experience a decrease in symptoms such as pain, numbness, and weakness, leading to an improvement in their quality of life.

What to Ask Your Doctor

Questions a patient should ask their doctor about microdiscectomy:

  1. What are the potential risks and complications associated with both open lumbar microdiscectomy (OLM) and percutaneous endoscopic lumbar discectomy (PLELD)?
  2. How long is the recovery time for each procedure, and what is the expected post-operative pain level?
  3. Are there any specific factors that would make me a better candidate for one method over the other?
  4. How likely is it that I will need to undergo the same surgery again in the future with each method?
  5. How will each method affect the disc height and potential damage to the endplate and subchondral bone?
  6. What are the expected long-term outcomes in terms of symptom relief and quality of life with each method?
  7. Are there any alternative treatments or surgical options that I should consider?
  8. How experienced are you in performing both OLM and PLELD procedures?
  9. Will I need to undergo any additional imaging or tests before deciding on a treatment plan?
  10. Are there any specific post-operative care instructions or rehabilitation exercises I should follow after the surgery?

Reference

Authors: Yun DJ, Park SJ, Lee SH. Journal: Pain Physician. 2020 Jul;23(4):393-404. PMID: 32709174