A two-year outcomes and complications of various techniques of lumbar discectomy; A multicentric retrospective study.

Abstract

OBJECTIVES\nVarious techniques of performing lumbar discectomy are prevalent, each having its rationale and claimed benefits. The authors ventured to assess the perioperative factors, outcomes, and complications of each procedure and compare among them with 946 patients contributed by 10 centers and performed by experienced surgeons.\n\n\nMETHODS\nThis was a retrospective study of patients operated using open discectomy (OD), microdiscectomy (MD), microendoscopic discectomy (MED), interlaminar endoscopic lumbar discectomy (IELD), transforaminal endoscopic lumbar discectomy (TELD), and Destandau techniques (DT) with a minimum follow-up of 2 years. The inclusion criteria were age>18 years, failed conservative treatment for 4-6 weeks, and the involvement of single lumbar level.\n\n\nRESULTS\nThere was a significant improvement in the Visual Analogue Scale (VAS) of back, leg, and Oswestry Disability Index (ODI) scores post-operatively across the board, with no significant difference between them. Minimally invasive procedures (MED, IELD, TELD, and DT) had shorter operation time, hospital stay, better cosmesis and decreased blood loss compared to open procedures (OD and MD). The overall complication rate was 10.1%. The most common complication was recurrence (6.86%), followed by re-operation (4.3%), CSF leak (2.24%), wrong level surgery (0.74%), superficial infection (0.62%) and deep infection (0.37%). There were minor differences in incidence of complications between techniques.\n\n\nCONCLUSION\nAlthough minimally invasive techniques have some advantages over the open techniques in the peri-operative factors, all the techniques are effective and provide similar pain relief and functional outcomes at the end of two years. The various rates of individual complications provide a reference value for future studies.