Article
Long-term results of a prospective, randomized trial: Standard open microsurgical approach versus a minimally invasive access approach for lumbar disc herniation
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Published: | April 28, 2011 |
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Objective: Microsurgery of lumbar disc herniation is one of the most common neurosurgical procedures. We present long-term follow-up results of a standard open approach (SO) compared to a minimally invasive trocar approach (MIT) for microsurgery of single level lumbar disc herniation in a prospective randomized trial.
Methods: We randomized 45 patients into 2 groups (23 and 22 patients, respectively). Group 1 (9 female, 14 male, median 36 years) received SO, group 2 (14 female, 8 male, median 39 years) MIT. Operating time, intraoperative blood loss, complication rate, surgical outcome, postoperative pain relief evaluated on a visual analogue scale (VAS), Oswestry disability index (ODI), quality of life (SF-36), and postoperative scar tissue formation on MRI were analyzed. Mean follow-up time was 32 months postoperatively. 7 patients were lost to follow-up.
Results: Long-term follow-up examinations revealed a significant pain relief (p < 0.05) in both groups (mean VAS reduction in SO: from 6.7 to 2.0; MIT: 6.8 to 1.9). Good to excellent results were achieved according to the ODI (SO: decrease of mean ODI from 56.6 to 18.5; MIT: 53.1 to 12.9). Postoperative scar tissue formation evaluated by MRI displayed a significant increase of scar tissue formation in the SO group compared to the MIT group (p < 0.05).
Conclusions: According to long-term follow-up examinations the minimally invasive trocar technique is a valid alternative to the standard open approach. We observed significantly less scar tissue formation in MIT versus SO. Good clinical results in both groups and slightly but not statistically significant better clinical results could be achieved in MIT compared to SO.