Skip to main content
SpringerLink
Log in

Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Studies comparing the relative merits of microdiscectomy and standard discectomy report conflicting results, depending on the outcome measure of interest. Most trials are small, and few have employed validated, multidimensional patient-orientated outcome measures, considered essential in outcomes research. In the present study, data were collected prospectively from six surgeons participating in a surgical registry. Inclusion criteria were: lumbar/lumbosacral degenerative disease; discectomy/sequestrectomy without additional fusion/stabilisation; German or English-speaking. Before and 3 and 12 months after surgery, patients completed the Core Outcome Measures Index comprising questions on leg/buttock pain, back pain, back-related function, symptom-specific well-being, general quality-of-life, and social and work disability. At follow-up, they rated overall satisfaction, global outcome, and perceived complications. Compliance with the registry documentation was excellent: 87% for surgeons (surgery forms), 91% for patients (for 12 months follow-up). 261 patients satisfied the inclusion criteria (225 microdiscectomy, 36 standard discectomy). The standard discectomy group had significantly greater blood-loss than the microdiscectomy (P < 0.05). There were no group differences in the proportion of surgical complications or duration of hospital stay (P > 0.05). The groups did not differ in relation to any of the patient-orientated outcomes or individual outcome domains (P > 0.05). Though not equivalent to an RCT, the study included every single eligible patient in our Spine Center and allowed surgeons to use their regular procedure; it hence had extremely high external validity (relevance/generalisability). There was no clinically relevant difference in outcome after lumbar disc excision dependent on the use of the microscope. The decision to use the microscope should rest with the surgeon.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Andrew DW, Lavyne MH (1990) Retrospective analysis of microsurgical and standard lumbar discectomy. Spine 15:329–335. doi:10.1097/00007632-199004000-00015

    Article  Google Scholar 

  2. Barrios C, Ahmed M, Arrotegui J, Bjornsson A, Gillstrom P (1990) Microsurgery versus standard removal of the herniated lumbar disc. A 3-year comparison in 150 cases. Acta Orthop Scand 61:399–403

    Article  PubMed  CAS  Google Scholar 

  3. Black N (1996) Why we need observational studies to evaluate the effectiveness of health care. BMJ 312:1215–1218

    PubMed  CAS  Google Scholar 

  4. Caspar W (1977) A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4:74–80

    Google Scholar 

  5. Caspar W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y (1991) The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery 28:78–86. doi:10.1097/00006123-199101000-00013 discussion 86-77

    Article  PubMed  CAS  Google Scholar 

  6. Deyo RA (2007) Back surgery–who needs it? N Engl J Med 356:2239–2243. doi:10.1056/NEJMp078052

    Article  PubMed  CAS  Google Scholar 

  7. Deyo RA, Battie M, Beurskens AJHM, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23:2003–2013. doi:10.1097/00007632-199809150-00018

    Article  PubMed  CAS  Google Scholar 

  8. Gibson JN, Waddell G (2007) Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine 32:1735–1747. doi:10.1097/BRS.0b013e3180bc2431

    Article  PubMed  Google Scholar 

  9. Grob D, Bartanusz V, Jeszenszky D, Kleinstuck F, Lattig F, Porchet F, Mannion AF (2008) The patient’s perspective on complications after spine surgery. Eur Spine J (this issue)

  10. Hagg O, Fritzell P, Nordwall A, Group SLSS (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20

    PubMed  CAS  Google Scholar 

  11. Henriksen L, Schmidt K, Eskesen V, Jantzen E (1996) A controlled study of microsurgical versus standard lumbar discectomy. Br J Neurosurg 10:289–293. doi:10.1080/02688699650040160

    Article  PubMed  CAS  Google Scholar 

  12. Katayama Y, Matsuyama Y, Yoshihara H, Sakai Y, Nakamura H, Nakashima S, Ito Z, Ishiguro N (2006) Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech 19:344–347. doi:10.1097/01.bsd.0000211201.93125.1c

    Article  PubMed  Google Scholar 

  13. Lagarrigue J, Chaynes P (1994) Comparative study of disk surgery with or without microscopy. A prospective study of 80 cases. Neurochirurgie 40:116–120

    PubMed  CAS  Google Scholar 

  14. Landewe R, van der Heijde D (2007) Primer: challenges in randomized and observational studies. Nat Clin Pract Rheumatol 3:661–666. doi:10.1038/ncprheum0626

    Article  PubMed  Google Scholar 

  15. Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026. doi:10.1007/s00586-005-0911-9

    Article  PubMed  Google Scholar 

  16. McCulloch JA (1996) Focus issue on lumbar disc herniation: macro- and microdiscectomy. Spine 21:45S–56S. doi:10.1097/00007632-199601010-00010

    Article  PubMed  CAS  Google Scholar 

  17. Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–225

    Google Scholar 

  18. Nystrom B (1987) Experience of microsurgical compared with conventional technique in lumbar disc operations. Acta Neurol Scand 76:129–141

    Article  PubMed  CAS  Google Scholar 

  19. Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, Thomeer RT, Koes BW (2007) Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:2245–2256. doi:10.1056/NEJMoa064039

    Article  PubMed  CAS  Google Scholar 

  20. Sachdev VP (1991) Lumbar diskectomy under the operating microscope. Mt Sinai J Med 58:147–149

    PubMed  CAS  Google Scholar 

  21. Tullberg T, Isacson J, Weidenhielm L (1993) Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study. Spine 18:24–27. doi:10.1097/00007632-199301000-00005

    Article  PubMed  CAS  Google Scholar 

  22. Tureyen K (2003) One-level one-sided lumbar disc surgery with and without microscopic assistance: 1-year outcome in 114 consecutive patients. J Neurosurg 99:247–250

    PubMed  Google Scholar 

  23. Williams RW (1978) Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine 3:175–182. doi:10.1097/00007632-197806000-00015

    Article  PubMed  CAS  Google Scholar 

  24. Yasargil MG (1977) Microsurgical operation for herniated disc. Adv Neurosurg 4:81

    Google Scholar 

Download references

Conflict of interest statement

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    F. Porchet & V. Bartanusz

  2. Department of Spine Surgery, Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    F. S. Kleinstueck, F. Lattig, D. Jeszenszky & D. Grob

  3. Spine Center Division, Department of Research and Development, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    A. F. Mannion

Authors
  1. F. Porchet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Bartanusz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. S. Kleinstueck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Lattig
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Jeszenszky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Grob
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. F. Mannion
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. F. Mannion.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Porchet, F., Bartanusz, V., Kleinstueck, F.S. et al. Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry. Eur Spine J 18 (Suppl 3), 360–366 (2009). https://doi.org/10.1007/s00586-009-0917-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-009-0917-9

Keywords

Search

Navigation