[Lumbar disk hernia: microsurgery--yes or no?]

Abstract

Microsurgery has been performed in about three-quarters of 5,000 patients operated on since 1973 for herniation of a lumbar disc. The findings obtained in two groups of patients who had undergone primary surgery, in the one group by classical methods, in the other by microsurgery, are compared. The two groups were similar in respect of age and sex distribution, localisation of the discal hernia, duration of signs and symptoms and follow-up time. Results classified "very good" were seen more often in the microsurgery group, where no improvement or postoperative aggravation of the signs was relatively rare. The difference compared with the group treated by conventional surgery was mainly in respect of appearance of a postoperative vertebral syndrome, and not so much with regard to the radicular pain syndrome and radicular motor deficits. Unlike some other researchers, we found no difference between the two groups in respect of frequency of local reoperation or of spondylodiscitis. In patients whose disc hernia is mainly of a soft consistency, unilateral and at a single level only, microsurgery requires a shorter access, involves less damage to tissues, allows a better haemostasis and good surgical visualisation. The operation is minimally invasive, the area involved more or less extensive depending on the individual pathology. Magnification under good lighting is indicated in all cases.