Few Differences in Complication Rates Found Among Various Lumbar Microdiscectomy Techniques
Findings likely reflect real-world practice
Commentary by Roger Härtl, MD
A meta-analysis of complication rates from lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy show few differences between the various techniques. The findings likely reflect real-world practice, the study authors reported in Neurosurgical Focus.
The researchers examined differences in complication rates among lumbar open, MED, and percutaneous microdiscectomy procedures among prospective studies that included 10 or more patients each and were published after 1990. Of the 2,634 studies screened in the systematic review, 42 prospective cohort or randomized controlled trials were identified and included in the analysis.
Complication rates by type of surgical technique for microdiscectomy are shown in the Table. Meta-analysis showed that percutaneous microdiscectomy was associated with a significantly higher rate of intraoperative nerve root injury following percutaneous procedures compared with MED. No other significant differences in complication outcomes were found between the different microdiscectomy techniques.
“The review concluded that there were no significant differences between open, MED, and percutaneous discectomies with regard to rates of complications, hematoma, neurologic deficits, infections, or recurrent disc herniations,” commented Roger Härtl, MD, Professor of Neurological Surgery and Director of Spinal Surgery at the Weill Cornell Brain and Spine Center in New York. “However, there were statistically higher intraoperative nerve root injury rates following percutaneous procedures relative to MED, even though the rates were low (1.1% and 0.9%, respectively).”
“The clinical implications are that there is a steeper learning curve with percutaneous procedures and patients and surgeons should be aware that nerve root injury rates may be higher with percutaneous procedures,” Dr. Härtl said. “Conversely, the review did not consider hospital length of stay or improvement of symptoms. Though the overall complication rates may be similar to open procedures, with MED and endoscopic techniques, patients often report less postoperative pain, shorter hospital stays, faster recovery times, better cosmesis with smaller scars, and higher satisfaction scores immediately postop. These findings were not reported in the review, but nonetheless, are important factors for patients and surgeons alike, in considering which procedures they would like to utilize.”
Strengths and Limitations of the Study
“The strengths of this study are that a large number of studies were reviewed and the studies included in this review were all prospective cohorts, or randomized controlled trials, both of which reduce reviewer bias,” Dr. Härtl said. “The limitations include that the authors didn’t look at improvement in function, length of hospital stay, return to work, and patient satisfaction scores. Patients will frequently have improved outcomes with minimally invasive as compared to open procedures.”