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. 2023 Jun;13(5):1293-1303.
doi: 10.1177/21925682211029863. Epub 2021 Jul 9.

Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network

Nathan Evaniew  1 , Andrew Bogle  1 , Alex Soroceanu  1 , W Bradley Jacobs  1 , Roger Cho  1 , Charles G Fisher  2 , Y Raja Rampersaud  3 , Michael H Weber  4 , Joel A Finkelstein  3 , Najmedden Attabib  5 , Adrienne Kelly  6 , Alexandra Stratton  7 , Christopher S Bailey  8 , Jerome Paquet  9 , Michael Johnson  10 , Neil A Manson  5 , Hamilton Hall  3 , Greg McIntosh  11 , Kenneth C Thomas  1
Affiliations

Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network

Nathan Evaniew et al. Global Spine J. 2023 Jun.

Abstract

Study design: Retrospective cohort study.

Objective: We evaluated the effectiveness of minimally invasive (MIS) tubular discectomy in comparison to conventional open surgery among patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN).

Methods: We performed an observational analysis of data that was prospectively collected. We implemented Minimum Clinically Important Differences (MCIDs), and we adjusted for potential confounders with multiple logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity (SAVES) protocol.

Results: Three hundred thirty-nine (62%) patients underwent MIS tubular discectomy and 211 (38%) underwent conventional open discectomy. There were no significant differences between groups for improvement of leg pain and disability, but the MIS technique was associated with reduced odds of achieving the MCID for back pain (OR 0.66, 95% CI 0.44 to 0.99, P < 0.05). We identified statistically significant differences in favor of MIS for each of operating time (MIS mean (SD) 72.2 minutes (30.0) vs open 93.5 (40.9)), estimated blood loss (MIS 37.9 mL (36.7) vs open 76.8 (71.4)), length of stay in hospital (MIS 73% same-day discharge vs open 40%), rates of incidental durotomy (MIS 4% vs open 8%), and wound-related complications (MIS 3% vs open 9%); but not for overall rates of reoperation.

Conclusions: Open and MIS techniques yielded similar improvements of leg pain and disability at up to 12 months of follow-up, but MIS patients were less likely to experience improvement of associated back pain. Small differences favored MIS for operating time, blood loss, and adverse events but may have limited clinical importance.

Keywords: disc herniation; discectomy; lumbar.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Illustrative cases: (a) intra-operative fluoroscopic image of a minimally invasive tubular lumbar discectomy performed at L5-S1 in a 34-year old female, and (b) intra-operative cross-table radiograph of a conventional open lumbar discectomy performed at L5-S1 in a 38-year old male.
Figure 2.
Figure 2.
Identification of the study cohort: 550 patients who underwent minimally invasive (MIS, n = 339) or open (n = 211) lumbar discectomy surgery. CSORN = Canadian Spine Outcomes and Research Network; PROMs = Patient-Reported Outcome Measures.
Figure 3.
Figure 3.
Pre-operative and 12-month post-operative Numerical Pain Rating Scale (NPRS) for (a) leg pain and (b) back pain, and (c) Oswestry Disability Index (ODI) scores patients who underwent minimally invasive (MIS) tubular lumbar discectomy (n = 339) or conventional open (OPEN) lumbar discectomy (n = 211). (a) NPRS leg pain (b) NPRS back pain (c) ODI.
Figure 4.
Figure 4.
Length of stay among patients who underwent minimally invasive (MIS) tubular lumbar discectomy (n = 339) or conventional open (OPEN) lumbar discectomy (n = 211). Zero days denotes day surgery
See this image and copyright information in PMC

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