The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury.
OBJECTIVE
The objective of this study was to evaluate the invasiveness of microendoscopic discectomy (MED) in comparison with microscopic discectomy (MD) by measuring serum levels of creatine phosphokinase (CPK)-MM and lactate dehydrogenase (LDH)-5, and by comparing visual analog scale (VAS) scores of postoperative pain.


METHODS
This study included a group of 15 patients who underwent surgery using MED and 15 patients who underwent surgery using MD, both for single-level unilateral herniated nucleus pulposus. The CPK-MM and LDH-5 levels were measured at admission and after 1, 3, and 5 days postoperatively. Pain assessment was recorded using scores raging from 0 to 10 on a subjective VAS at admission and at 1, 3, and 5 days postoperatively.


RESULTS
The mean CPK-MM levels were lower for the MED group than for the MD group at both 3 (576.1 +/- 286.3 IU/L compared with 968.1 +/- 377.8 IU/L) and 5 days (348.1 +/- 231.0 IU/L compared with 721.7 +/- 463.2) postoperatively (p < 0.05). The mean VAS scores for postoperative back pain were lower in the MED group than in the MD group, both at 1 (3.3 +/- 2.3 compared with 5.8 +/- 1.5) and 5 days (1.9 +/- 1.1 compared with 3.6 +/- 1.1) postoperatively (p < 0.01).


CONCLUSIONS
The MED procedure is less invasive than MD, and causes less muscle damage and less back pain.
Shin
Dong Ah
DA
Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Kim
Keung Nyun
KN
Shin
Hyun Cheol
HC
Yoon
Do Heum
DH
D000328:Adult; D001416:Back Pain / Q000517:prevention & control; D052283:Creatine Kinase, MM Form / Q000097:blood; D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007431:Intraoperative Complications / Q000517:prevention & control*; D007527:Isoenzymes / Q000097:blood; D007770:L-Lactate Dehydrogenase / Q000097:blood; D000080864:Lactate Dehydrogenase 5; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000201:enzymology / Q000293:injuries*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D012447:Sacrum / Q000601:surgery
D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase; D000080864:Lactate Dehydrogenase 5; D052283:Creatine Kinase, MM Form