Serum creatine phosphokinase levels as an indicator of muscle injury following lumbar disc surgery: Comparison of fully endoscopic discectomy and microdiscectomy.
OBJECTIVE
The aim of this study is to make a comparison between fully endoscopic lumbar discectomy (FELD) and conventional microdiscectomy (MD) by using pre- and postoperative serum creatine phosphokinase (CPK) levels in correlation with postoperative low-back pain.


METHODS
Fortyfive consecutive patients who underwent surgery for lumbar disc herniation were allocated into three groups with 15 patients on each: (1) FELD with interlaminar approach (IL), (2) FELD with transforaminal approach (TF), (3) Conventional MD. Serum CPK levels pre- and 1, 6, 12 and 24h postoperatively, patients' body mass index (BMI), operation duration and hospital stays were recorded. The low-back pain pre- and postoperatively was assessed with the use of the 100mm visual analog scale (VAS) and the "Oswestry Disability Index" (ODI).


RESULTS
There were 16 female (35.5%) and 29 male (64.5%) patients with a mean age of 44.1 years. CPK levels at 6th, 12th and 24th hours postoperatively were found significantly lower in TF and IL groups compared to MD group (p<0.004). Mean operation duration was significantly shorter in MD group (p: 0.014). There was a significant decrease in both the VAS and ODI scores after the surgery in all patient groups (p<0.001). Postoperative VAS scores were found significantly higher in MD group (p: 0.04).


CONCLUSIONS
Minimal invasive nature of FELD procedures compared to the MD was substantiated by serum CPK levels in this study. To draw definitive conclusions regarding pain relief, larger patient samples should be evaluated, although postoperative VAS scores were found in favor of FELD.
Department of Neurosurgery, Liv Hospital, Istanbul, Turkey. Electronic address: moakcakaya@gmail.com.
Mehmet Osman
MO
Akçakaya
Department of Neurosurgery, Private Asia Hospital, Istanbul, Turkey.
Ali Güven
AG
Yörükoğlu
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Aydın
A
Aydoseli
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Yavuz
Y
Aras
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Pulat Akın
PA
Sabancı
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Muhittin Emre
ME
Altunrende
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Müge
M
Dolgun
Department of Neurosurgery, Liv Hospital, Istanbul, Turkey.
Burcu
B
Göker
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Fahir
F
Şencan
Department of Anethesiology and Reanimation, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Achmet
A
Ali
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Altay
A
Sencer
D000328:Adult; D001416:Back Pain / Q000209:etiology*; D003402:Creatine Kinase / Q000097:blood*; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care
D003402:Creatine Kinase
Creatine phosphokinase; Fully endoscopic; Interlaminar; Microdiscectomy; Minimally invasive; Muscle injury; Transforaminal