Our Summary

This research paper aimed to examine the safety and effectiveness of a surgical technique called minimally invasive tubular microdiscectomy for the treatment of repeated lumbar disc herniation (a condition where a disc in the lower back herniates or slips out of place). This technique, unlike others like microendoscopic and endoscopic transforaminal discectomy, has never been used for repeated cases of this condition before.

The researchers studied 30 patients who had this surgery for repeated lumbar disc herniation. They looked at pain scores before and after the surgery, the clinical outcome based on modified Macnab criteria (a standard used to assess the result of spinal surgeries), and any complications that occurred. They followed up with the patients for at least 1.5 years.

The average surgery time was around 90 minutes. The pain scores significantly decreased from an average of 5.9 before surgery to 1.7 after surgery. The overall success rate (judged by excellent or good outcomes according to Macnab criteria) was 90%. In terms of complications, accidental tears in the dura (a layer covering the brain and spinal cord) occurred in 5 patients (around 17%) but this didn’t lead to any negative neurological consequences or impact the clinical outcome. Instability occurred in 2 patients (about 7%).

The conclusion is that this surgical technique is as effective and safe as other minimally invasive techniques. The rate of accidental dura tears doesn’t lead to worse outcomes or higher health risks. The technique is a valid treatment option for repeated lumbar disc herniation.

FAQs

  1. What is minimally invasive tubular microdiscectomy and how is it different from other surgical techniques?
  2. What were the results of the study on using this technique for repeated lumbar disc herniation?
  3. What were the complication rates for this surgical technique, and how did these impact the overall outcomes?

Doctor’s Tip

A doctor might tell a patient considering microdiscectomy for repeated lumbar disc herniation that it is a minimally invasive and effective surgical technique with a high success rate and low risk of complications. They may also mention that while accidental tears in the dura and instability can occur in a small percentage of cases, these do not typically lead to negative neurological consequences or impact the overall outcome of the surgery. It is important for patients to discuss any concerns or questions with their healthcare provider before undergoing the procedure.

Suitable For

Patients who are typically recommended microdiscectomy are those who have:

  1. Lumbar disc herniation: This is the most common condition that microdiscectomy is used to treat. Patients with a herniated disc in the lower back that is causing pain, numbness, or weakness in the legs may be recommended for this surgery.

  2. Persistent symptoms: Patients who have tried conservative treatments such as physical therapy, medications, and injections but continue to experience persistent and disabling symptoms may be candidates for microdiscectomy.

  3. Recurrent disc herniation: Patients who have had a previous lumbar discectomy and are experiencing a recurrence of symptoms due to another herniation may be recommended for microdiscectomy.

  4. Radiculopathy: Patients with radicular symptoms such as sciatica (pain that radiates down the leg) or neurogenic claudication (pain or weakness in the legs with walking) may benefit from microdiscectomy.

  5. Good overall health: Patients who are in good overall health and are able to tolerate surgery and the recovery process may be recommended for microdiscectomy.

It is important for patients to discuss their symptoms, medical history, and treatment options with their healthcare provider to determine if microdiscectomy is the right treatment for them.

Timeline

Before the microdiscectomy:

  • Patient experiences symptoms of repeated lumbar disc herniation such as lower back pain, leg pain, numbness, or weakness.
  • Patient undergoes diagnostic tests such as MRI or CT scan to confirm the diagnosis.
  • Patient consults with a spine surgeon to discuss treatment options.
  • Patient decides to undergo minimally invasive tubular microdiscectomy surgery.

After the microdiscectomy:

  • Surgery time is around 90 minutes.
  • Patient experiences significant decrease in pain scores from an average of 5.9 before surgery to 1.7 after surgery.
  • Overall success rate according to Macnab criteria is 90%.
  • Complications such as accidental dura tears occur in 17% of patients but do not lead to negative neurological consequences.
  • Follow-up with patients for at least 1.5 years to monitor outcomes and complications.
  • Conclusion is that the surgical technique is effective and safe for repeated lumbar disc herniation.

What to Ask Your Doctor

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

  1. What are the potential risks and complications associated with microdiscectomy?
  2. How long is the recovery period after microdiscectomy surgery?
  3. What is the success rate of microdiscectomy for repeated lumbar disc herniation?
  4. Are there any alternative treatment options to consider before choosing microdiscectomy?
  5. Will I need physical therapy or rehabilitation after the surgery?
  6. How many microdiscectomy surgeries have you performed, and what is your success rate?
  7. What is the likelihood of needing additional surgeries in the future after microdiscectomy?
  8. Are there any long-term effects or complications to be aware of after microdiscectomy?
  9. What can I do to help ensure a successful outcome after microdiscectomy surgery?
  10. How soon after surgery can I expect to see improvement in my symptoms?

Reference

Authors: Hubbe U, Franco-Jimenez P, Klingler JH, Vasilikos I, Scholz C, Kogias E. Journal: J Neurosurg Spine. 2016 Jan;24(1):48-53. doi: 10.3171/2015.4.SPINE14883. Epub 2015 Sep 18. PMID: 26384131