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Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes

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Abstract

Purpose

To date, various minimally invasive surgeries for lumbar disc herniation (LDH) have been performed in many countries, including microendoscopic discectomy (MED) and percutaneous endoscopic discectomy (PED). We herein report the surgical indications, current concepts, and techniques of minimally invasive discectomy for LDH, including MED and PED. The postoperative outcomes and risks of complications compared with conventional discectomy are also discussed.

Methods

By reviewing past literatures, the current concepts, surgical techniques, and clinical outcomes were described.

Results

Minimally invasive discectomy is generally performed using a transmuscular approach with an endoscopic technique and can reduce muscle and soft tissue damage. The minimal invasiveness can also reduce the severity of postoperative pain and improve patient satisfaction compared with conventional open discectomy. Based on the data of previous systematic reviews and meta-analyses, minimally invasive lumbar discectomy, such as MED and PED, appears to be safe and effective alternatives to open discectomy for patients with symptomatic LDH. These minimally invasive surgeries can provide beneficial effects to shorten the hospital stay and time to return to work. However, minimally invasive discectomy has a demanding learning curve. Only a well-trained surgeon and support team should perform these less invasive procedures.

Conclusions

Clinical evidence supporting the superiority of MED and PED is still limited. Well-designed prospective multicentered randomized controlled trials with large samples are therefore needed in order to draw a convincing conclusion.

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References

  1. Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty P 2nd, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL Jr, Toton JF, North American Spine S (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 14(1):180–191. https://doi.org/10.1016/j.spinee.2013.08.003

    Article  PubMed  Google Scholar 

  2. Postacchini F (1999) Management of herniation of the lumbar disc. J Bone Joint Surg Br 81(4):567–576

    Article  CAS  PubMed  Google Scholar 

  3. Campbell P, Wynne-Jones G, Muller S, Dunn KM (2013) The influence of employment social support for risk and prognosis in nonspecific back pain: a systematic review and critical synthesis. Int Arch Occup Environ Health 86(2):119–137. https://doi.org/10.1007/s00420-012-0804-2

    Article  PubMed  Google Scholar 

  4. Gautschi OP, Hildebrandt G, Cadosch D (2008) Acute low back pain—assessment and management. Praxis (Bern 1994) 97(2):58–68. https://doi.org/10.1024/1661-8157.97.2.58

    Article  CAS  Google Scholar 

  5. Maroon JC (2002) Current concepts in minimally invasive discectomy. Neurosurgery 51(5 Suppl):S137–S145

    PubMed  Google Scholar 

  6. Blamoutier A (2013) Surgical discectomy for lumbar disc herniation: surgical techniques. Orthop Traumatol Surg Res 99(1 Suppl):S187–S196. https://doi.org/10.1016/j.otsr.2012.11.005

    Article  CAS  PubMed  Google Scholar 

  7. Ruetten S, Komp M, Merk H, Godolias G (2007) Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6(6):521–530. https://doi.org/10.3171/spi.2007.6.6.2

    Article  PubMed  Google Scholar 

  8. Choi G, Pophale CS, Patel B, Uniyal P (2017) Endoscopic spine surgery. J Korean Neurosurg Soc 60(5):485–497. https://doi.org/10.3340/jkns.2017.0203.004

    Article  PubMed Central  PubMed  Google Scholar 

  9. Dezawa A, Sairyo K (2011) New minimally invasive discectomy technique through the interlaminar space using a percutaneous endoscope. Asian J Endosc Surg 4(2):94–98. https://doi.org/10.1111/j.1758-5910.2011.00072.x

    Article  CAS  PubMed  Google Scholar 

  10. Sairyo K, Chikawa T, Nagamachi A (2018) State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: discectomy, foraminoplasty, and ventral facetectomy. J Orthop Sci 23(2):229–236. https://doi.org/10.1016/j.jos.2017.10.015

    Article  PubMed  Google Scholar 

  11. Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–215

    Article  Google Scholar 

  12. Bokov A, Isrelov A, Skorodumov A, Aleynik A, Simonov A, Mlyavykh S (2011) An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician 14(6):545–557

    PubMed  Google Scholar 

  13. Fritsch EW, Heisel J, Rupp S (1996) The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976) 21(5):626–633

    Article  CAS  Google Scholar 

  14. Hussein M, Abdeldayem A, Mattar MM (2014) Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. Eur Spine J 23(9):1992–1999. https://doi.org/10.1007/s00586-014-3296-9

    Article  PubMed  Google Scholar 

  15. Salenius P, Laurent LE (1977) Results of operative treatment of lumbar disc herniation. A survey of 886 patients. Acta Orthop Scand 48(6):630–634

    Article  CAS  PubMed  Google Scholar 

  16. Foley KT (1997) Microendoscopic discectomy. Tech Neurosurg 3:301–307

    Google Scholar 

  17. Schick U, Dohnert J, Richter A, Konig A, Vitzthum HE (2002) Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 11(1):20–26

    Article  CAS  PubMed  Google Scholar 

  18. Muramatsu K, Hachiya Y, Morita C (2001) Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love’s method. Spine (Phila Pa 1976) 26(14):1599–1605

    Article  CAS  Google Scholar 

  19. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33(9):931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7

    Article  Google Scholar 

  20. Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T (2003) Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 10(2):231–235

    Article  PubMed  Google Scholar 

  21. Sairyo K, Egawa H, Matsuura T, Takahashi M, Higashino K, Sakai T, Suzue N, Hamada D, Goto T, Takata Y, Nishisho T, Goda Y, Sato R, Tsutsui T, Tonogai I, Kondo K, Tezuka F, Mineta K, Sugiura K, Takeuchi M, Dezawa A (2014) State of the art: transforaminal approach for percutaneous endoscopic lumbar discectomy under local anesthesia. J Med Investig 61(3–4):217–225

    Article  Google Scholar 

  22. Li X, Han Y, Di Z, Cui J, Pan J, Yang M, Sun G, Tan J, Li L (2016) Percutaneous endoscopic lumbar discectomy for lumbar disc herniation. J Clin Neurosci 33:19–27. https://doi.org/10.1016/j.jocn.2016.01.043

    Article  PubMed  Google Scholar 

  23. Iprenburg M (2007) Transforaminal endoscopic surgery-technique and provisional results in primary disc herniation. Eur Musculoskelet Rev:73–76

  24. Jacobs WC, van Tulder M, Arts M, Rubinstein SM, van Middelkoop M, Ostelo R, Verhagen A, Koes B, Peul WC (2011) Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. Eur Spine J 20(4):513–522. https://doi.org/10.1007/s00586-010-1603-7

    Article  PubMed  Google Scholar 

  25. Love JG, Walsh NN (1940) Intraspinal protrusion of intervertebral disks. Arch Surg 10:454–484

    Article  Google Scholar 

  26. Mathews HH, Long BH (2002) Minimally invasive techniques for the treatment of intervertebral disk herniation. J Am Acad Orthop Surg 10(2):80–85

    Article  PubMed  Google Scholar 

  27. Yamada H, Yoshida M, Hashizume H, Minamide A, Nakagawa Y, Kawai M, Iwasaki H, Tsutsui S (2012) Efficacy of novel minimally invasive surgery using spinal microendoscope for treating extraforaminal stenosis at the lumbosacral junction. J Spinal Disord Tech 25(5):268–276. https://doi.org/10.1097/BSD.0b013e3182206dd3

    Article  PubMed  Google Scholar 

  28. Epstein NE (2002) Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord 40(10):491–500. https://doi.org/10.1038/sj.sc.3101319

    Article  CAS  PubMed  Google Scholar 

  29. Tezuka F, Sakai T, Abe M, Yamashita K, Takata Y, Higashino K, Chikawa T, Nagamachi A, Sairyo K (2017) Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach. Spine J 17(12):1875–1880. https://doi.org/10.1016/j.spinee.2017.06.012

    Article  PubMed  Google Scholar 

  30. Zheng C, Wu F, Cai L (2016) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children. Int Orthop 40(6):1099–1102. https://doi.org/10.1007/s00264-016-3155-x

    Article  PubMed  Google Scholar 

  31. Hijikata S (1989) Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop Relat Res 238:9–23

    Article  Google Scholar 

  32. Kambin P, Zhou L (1996) History and current status of percutaneous arthroscopic disc surgery. Spine (Phila Pa 1976) 21(24 Suppl):57S–61S

    Article  CAS  Google Scholar 

  33. Wang K, Hong X, Zhou BY, Bao JP, Xie XH, Wang F, Wu XT (2015) Evaluation of transforaminal endoscopic lumbar discectomy in the treatment of lumbar disc herniation. Int Orthop 39(8):1599–1604. https://doi.org/10.1007/s00264-015-2747-1

    Article  PubMed  Google Scholar 

  34. Atlas SJ, Keller RB, Chang Y, Deyo RA, Singer DE (2001) Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine Study. Spine (Phila Pa 1976) 26(10):1179–1187

    Article  CAS  Google Scholar 

  35. Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J (2008) Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 33(25):2789–2800. https://doi.org/10.1097/BRS.0b013e31818ed8f4

    Article  Google Scholar 

  36. He J, Xiao S, Wu Z, Yuan Z (2016) Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. Eur Spine J 25(5):1373–1381. https://doi.org/10.1007/s00586-016-4523-3

    Article  PubMed  Google Scholar 

  37. Smith N, Masters J, Jensen C, Khan A, Sprowson A (2013) Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J 22(11):2458–2465. https://doi.org/10.1007/s00586-013-2848-8

    Article  PubMed Central  PubMed  Google Scholar 

  38. Akinduro OO, Kerezoudis P, Alvi MA, Yoon JW, Eluchie J, Murad MH, Wang Z, Chen SG, Bydon M (2017) Open versus minimally invasive surgery for extraforaminal lumbar disk herniation: a systematic review and meta-analysis. World Neurosurg 108(924–938):e923. https://doi.org/10.1016/j.wneu.2017.08.025

    Article  Google Scholar 

  39. Qin R, Liu B, Hao J, Zhou P, Yao Y, Zhang F, Chen X (2018) Percutaneous endoscopic lumbar discectomy versus posterior open lumbar microdiscectomy for the treatment of symptomatic lumbar disc herniation: a systemic review and meta-analysis. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.08.236

  40. Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A (2016) Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: a meta-analysis. Int J Surg 31:86–92. https://doi.org/10.1016/j.ijsu.2016.05.061

    Article  PubMed  Google Scholar 

  41. Chang X, Chen B, Li HY, Han XB, Zhou Y, Li CQ (2014) The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomised controlled trials. Int Orthop 38(6):1225–1234. https://doi.org/10.1007/s00264-014-2331-0

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Haruo Kanno, Toshimi Aizawa, Ko Hahimoto & Eiji Itoi

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  1. Haruo Kanno
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  2. Toshimi Aizawa
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Correspondence to Haruo Kanno.

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Kanno, H., Aizawa, T., Hahimoto, K. et al. Minimally invasive discectomy for lumbar disc herniation: current concepts, surgical techniques, and outcomes. International Orthopaedics (SICOT) 43, 917–922 (2019). https://doi.org/10.1007/s00264-018-4256-5

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