title: Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy.
abstract: Existing studies on micro-endoscopic lumbar discectomy report similar outcomes to those of open and microdiscectomy and conflicting results on complications. We designed a randomised controlled trial to investigate the hypothesis of different outcomes and complications obtainable with the three techniques. 240 patients aged 18-65 years affected by posterior lumbar disc herniation and symptoms lasting over 6 weeks of conservative management were randomised to micro-endoscopic (group 1), micro (group 2) or open (group 3) discectomy. Exclusion criteria were less than 6 weeks of pain duration, cauda equina compromise, foraminal or extra-foraminal herniations, spinal stenosis, malignancy, previous spinal surgery, spinal deformity, concurrent infection and rheumatic disease. Surgery and follow-up were made at a single Institution. A biomedical researcher independently collected and reviewed the data. ODI, back and leg VAS and SF-36 were the outcome measures used preoperatively, postoperatively and at 6-, 12- and 24-month follow-up. 212/240 (91%) patients completed the 24-month follow-up period. VAS back and leg, ODI and SF36 scores showed clinically and statistically significant improvements within groups without significant difference among groups throughout follow-up. Dural tears, root injuries and recurrent herniations were significantly more common in group 1. Wound infections were similar in group 2 and 3, but did not affect patients in group 1. Overall costs were significantly higher in group 1 and lower in group 3. In conclusion, outcome measures are equivalent 2 years following lumbar discectomy with micro-endoscopy, microscopy or open technique, but severe complications are more likely and costs higher with micro-endoscopy.
authors.affiliation: Department of Spinal Surgery, Galeazzi Orthopaedic Institute, Via Galeazzi 4, 20161 Milan, Italy. marcoteli@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Teli
authors.forename: Alessio
authors.initials: A
authors.lastname: Lovi
authors.forename: Marco
authors.initials: M
authors.lastname: Brayda-Bruno
authors.forename: Antonino
authors.initials: A
authors.lastname: Zagra
authors.forename: Andrea
authors.initials: A
authors.lastname: Corriero
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Giudici
authors.forename: Leone
authors.initials: L
authors.lastname: Minoia
mesh_terms: D000328:Adult; D017586:Diskectomy / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D004388:Dura Mater / Q000293:injuries*; D004724:Endoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018579:Patient Selection; D012008:Recurrence; D011795:Surveys and Questionnaires; D016896:Treatment Outcome