title: Tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk herniation: 2-year results of a double-blind randomized controlled trial.
abstract: BACKGROUND
  Transmuscular tubular diskectomy has been introduced to increase the rate of recovery, although evidence is lacking.
  
  
  OBJECTIVE
  To evaluate the 2-year results of tubular diskectomy compared with conventional microdiskectomy.
  
  
  METHODS
  Three hundred twenty-eight patients with persistent leg pain caused by lumbar disk herniation were randomly assigned to undergo tubular diskectomy (167 patients) or conventional microdiskectomy (161 patients). Main outcome measures were scores from Roland-Morris Disability Questionnaire for Sciatica, Visual Analog Scale for leg pain and low-back pain, and Likert self-rating scale of global perceived recovery.
  
  
  RESULTS
  On the basis of intention-to-treat analysis, there was no significant difference between tubular diskectomy and conventional microdiskectomy in Roland-Morris Disability Questionnaire for Sciatica scores during 2 years after surgery (between-group mean difference [Δ] = 0.6; 95% confidence interval [CI], -0.3-1.6). Patients treated with tubular diskectomy reported more leg pain (Δ = 3.3 mm; 95% CI, 0.2-6.2) and more low-back pain (Δ = 3.0 mm; 95% CI, -0.2-6.3) than those patients treated with conventional microdiskectomy. At 2 years, 71% of patients assigned to tubular diskectomy documented a good recovery vs 77% of patients assigned to conventional microdiskectomy (odds ratio, 0.76; 95% CI, 0.45-1.28; P = .35). Repeated surgery rates within 2 years after tubular diskectomy and conventional microdiskectomy were 15% and 10%, respectively (P = .22).
  
  
  CONCLUSIONS
  Tubular diskectomy and conventional microdiskectomy resulted in similar functional and clinical outcomes. Patients treated with tubular diskectomy reported more leg pain and low-back pain, although the differences were small and not clinically relevant.
authors.affiliation: Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands. m.arts@mchaaglanden.nl
authors.forename: Mark P
authors.initials: MP
authors.lastname: Arts
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: M Elske
authors.initials: ME
authors.lastname: van den Akker
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Ronald H M A
authors.initials: RH
authors.lastname: Bartels
authors.forename: W F
authors.initials: WF
authors.lastname: Tan
authors.forename: Wilco C
authors.initials: WC
authors.lastname: Peul
mesh_terms: D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods*; D004311:Double-Blind Method; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000601:surgery; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D016896:Treatment Outcome