title: Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon.
abstract: METHODS
  A prospective study was conducted on the surgical procedures for lumbar disc herniation.
  
  
  OBJECTIVE
  The objective of this study is to investigate the surgical outcomes of different methods when performed by the same surgeon, using a prospective study.
  
  
  BACKGROUND
  Macro discectomy is widely known as a common surgical procedure for lumbar disc herniation, while microdiscectomy in place of Caspar technique (the Caspar method) and microendoscopic discectomy by a posterior approach are reported as less invasive surgical methods for this condition. However, there have not been a significant number of prospective studies conducted to compare different surgical procedures for lumbar disc herniation.
  
  
  METHODS
  The target of our study was a group of 62 patients (male: 43, female: 19) who underwent surgery by macro discectomy (A group) and 57 patients (male: 33, female: 24) who underwent surgery by microdiscectomy in place of Caspar technique (B group). The mean ages at surgery were 34 (14 to 62) years and 41 (18 to 65) years respectively, and the mean duration of follow-up was 2 years and 8 months (12 months to 4 years). For all patients, the surgery was performed by 1 of the authors. The items investigated were the operation time, amount of bleeding, duration of hospitalization, amount of analgesic agent used after surgery, pre- and postoperative scores based on judgment criteria for treatment of lumbar spine disorders established by the Japanese Orthopaedic Association score, visual analog scales (VAS, 0 to 10) for lumbago before surgery and at discharge, VAS for sciatica before surgery and at discharge, perioperative complications, and cases requiring further surgery.
  
  
  RESULTS
  There were no significant differences between the 2 surgical procedures in the frequency of use of an analgesic agent after surgery, the pre- and postoperative Japanese Orthopaedic Association scores or postoperative VAS for sciatica. Statistically significant differences were observed in the operation time, amount of bleeding, duration of hospitalization, and postoperative VAS for lumbar pain, but the differences were not large, and may not have been clinically significant.
  
  
  CONCLUSIONS
  For herniotomy for lumbar disc herniation, both macro discectomy and microdiscectomy are appropriate, as long as surgeons have mastery of the procedures.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya University School of Medicine, Nagoya, 466-8550, Japan. yokatayama@hotmail.com
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Katayama
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Hisatake
authors.initials: H
authors.lastname: Yoshihara
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sakai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Shojiro
authors.initials: S
authors.lastname: Nakashima
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010820:Physicians; D011446:Prospective Studies; D016896:Treatment Outcome