title: Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up.
abstract: BACKGROUND
  There is a long-held concept among spine surgeons that endoscopic lumbar discectomy procedures are reserved for small-contained disc herniation; 8-year follow-up has not been reported. The purpose of this study is to assess microendoscopic discectomy (MED) in patients with large uncontained lumbar disc herniation (the antero-posterior diameter of the extruded fragment is 6-12 mm or more on axial cuts of MRI) and report long-term outcome.
  
  
  METHODS
  One hundred eighty-five patients with MED or standard open discectomy underwent follow-up for 8 years. Primary (clinical) outcomes data included Numerical Rating Scale (NRS) for back and leg symptoms and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary (objective) outcomes data included operative time, blood loss, postoperative analgesics, length of hospital stay, time to return to work, reoperation and complication rate, patient satisfaction index (PSI), and modified (MacNab) criteria.
  
  
  RESULTS
  At the end of the follow-up, the leg pain relief was statistically significant for both groups. NRS back pain, ODI, PSI and MacNab criteria showed significant deterioration for control group. Secondary outcomes data of MED group were significantly better than the control group.
  
  
  CONCLUSIONS
  Large, uncontained, lumbar disc herniations can be sufficiently removed using MED which is an effective alternative to open discectomy procedures with remarkable long-term outcome. Although the neurological outcome of the two procedures is the same, the morbidity of MED is significantly less than open discectomy. Maximum benefit can be gained if we adhere to strict selection criteria. The optimum indication is single- or multi-level radiculopathy secondary to a single-level, large, uncontained, lumbar disc herniation.
authors.affiliation: Tennessee University, Memphis, USA, m_hussien9@yahoo.com.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hussein
authors.forename: Ashraf
authors.initials: A
authors.lastname: Abdeldayem
authors.forename: Mahmoud M M
authors.initials: MM
authors.lastname: Mattar
mesh_terms: D000293:Adolescent; D000328:Adult; D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult
references.citation: J Bone Joint Surg Am. 1971 Jul;53(5):891-903
references.pmid: 4326746
references.citation: Spine (Phila Pa 1976). 2009 Jan 1;34(1):24-9
references.pmid: 19127158
references.citation: Spine (Phila Pa 1976). 1995 Apr 15;20(8):887-900
references.pmid: 7644953
references.citation: Spine (Phila Pa 1976). 1994 Dec 1;19(23):2667-70 discussion 2671
references.pmid: 7899961
references.citation: Spine (Phila Pa 1976). 2003 May 15;28(10):1080-7; discussion 1087-8
references.pmid: 12768153
references.citation: Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952
references.pmid: 11074683
references.citation: Spine (Phila Pa 1976). 2011 Nov 15;36(24):2061-8
references.pmid: 22048651
references.citation: Spine (Phila Pa 1976). 1991 Sep;16(9):1044-8
references.pmid: 1835160
references.citation: Spine (Phila Pa 1976). 1995 Feb 15;20(4):421-30
references.pmid: 7747225
references.citation: Eur Spine J. 2000 Feb;9 Suppl 1:S24-9
references.pmid: 10766054
references.citation: Spine (Phila Pa 1976). 1999 Feb 15;24(4):364-71; discussion 371-2
references.pmid: 10065521
references.citation: J Bone Joint Surg Am. 1989 Jun;71(5):719-21
references.pmid: 2525132
references.citation: Biometrics. 1977 Mar;33(1):159-74
references.pmid: 843571
references.citation: Neurosurgery. 2005 Oct;57(4 Suppl):357-60; discussion 357-60
references.pmid: 16234685
references.citation: J Spinal Disord. 1998 Apr;11(2):146-50
references.pmid: 9588472
references.citation: Spine (Phila Pa 1976). 1990 Nov;15(11):1142-7
references.pmid: 2267608
references.citation: Spine (Phila Pa 1976). 1996 Mar 15;21(6):741-9
references.pmid: 8882698
references.citation: J Neurosurg. 1987 Jul;67(1):49-53
references.pmid: 3598671
references.citation: Spine (Phila Pa 1976). 2001 Jul 15;26(14):1599-605
references.pmid: 11462094
references.citation: N Engl J Med. 2001 Feb 1;344(5):363-70
references.pmid: 11172169
references.citation: Surg Neurol. 2005 Dec;64(6):483-8, discussion 488-9
references.pmid: 16293454
references.citation: J Bone Joint Surg Br. 1988 Nov;70(5):723-7
references.pmid: 2973465
references.citation: Neurosurg Focus. 2002 Aug 15;13(2):E5
references.pmid: 15916402
references.citation: J Spinal Disord. 1999 Aug;12(4):287-92
references.pmid: 10451043
references.citation: Acta Orthop Scand. 1977;48(6):630-4
references.pmid: 607751
references.citation: Acta Neurochir (Wien). 1993;125(1-4):120-6
references.pmid: 8122535
references.citation: Eur Spine J. 2002 Feb;11(1):20-6
references.pmid: 11931060
references.citation: Clin Orthop Relat Res. 1988 Feb;227:143-51
references.pmid: 2962798
references.citation: Psychol Bull. 1979 Mar;86(2):420-8
references.pmid: 18839484
references.citation: Spine (Phila Pa 1976). 2006 Nov 1;31(23):2689-94
references.pmid: 17077737
references.citation: Acta Orthop Scand Suppl. 1970;129:1-76
references.pmid: 5269867
references.citation: Neurosurgery. 2001 Feb;48(2):334-7; discussion 338
references.pmid: 11220376
references.citation: Spine (Phila Pa 1976). 2008 Apr 20;33(9):931-9
references.pmid: 18427312
references.citation: J Bone Joint Surg Br. 1988 Aug;70(4):659-62
references.pmid: 3403620
references.citation: Spine (Phila Pa 1976). 1983 Mar;8(2):131-40
references.pmid: 6857385
references.citation: Spine (Phila Pa 1976). 1988 Dec;13(12):1418-22
references.pmid: 3212575