Tubular Discectomy Versus Conventional Microdiscectomy for the Treatm

13/09/2011

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BACKGROUND: Transmuscular tubular discectomy has been introduced to increase the rate of recovery, although evidence is lacking.

OBJECTIVE: To evaluate the 2-year results of tubular discectomy compared with conventional microdiscectomy.

METHODS: 328 patients with persistent leg pain due to lumbar disc herniation were randomly assigned to undergo tubular discectomy (167 patients) or conventional microdiscectomy (161 patients). Main outcome measures were scores from Roland-Morris Disability Questionnaire for Sciatica (RDQ), visual analogue scale (VAS) for leg pain and low-back pain, and Likert self-rating scale of global perceived recovery.

RESULTS: Based on intention-to-treat analysis, there was no significant difference between tubular discectomy and conventional microdiscectomy in RDQ scores during 2 years after surgery (between-group mean difference ([DELTA]) = 0.6; 95% CI, -0.3 to 1.6). Patients treated with tubular discectomy reported more leg pain ([DELTA] = 3.3 mm; 95% CI, 0.2 to 6.2 mm) and more low-back pain ([DELTA] = 3.0 mm; 95% CI, -0.2 to 6.3 mm) than those patients treated with conventional microdiscectomy. At 2 years, 71% of patients assigned to tubular discectomy documented a good recovery versus 77% of patients assigned to conventional microdiscectomy (odds ratio 0.76; 95% CI, 0.45 to 1.28; P=0.35). Repeated surgery rate within 2 years after tubular discectomy and conventional microdiscectomy was 15% and 10%, respectively (P=0.22).

CONCLUSION: Tubular discectomy and conventional microdiscectomy resulted in similar functional and clinical outcome. Patients treated with tubular discectomy reported more leg pain and low-back pain, although the differences were small and not clinically relevant.

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