Artikel
Effectiveness of a less invasive approach technique in comparison to the microsurgical technique in operative treatment of lumbar disc herniation
Effektivität einer weniger invasiven Zugangstechnik im Vergleich zur mikrochirurgischen Technik bei der operativen Behandlung des lumbalen Bandscheibenvorfalls
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Autoren
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R. Greiner-Perth
- Klinik für Wirbelsäulenchirurgie, orthopädische Chirurgie und Neurotramatologie, SRH Waldklinikum Gera
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Y. Allam
- Klinik für Wirbelsäulenchirurgie, orthopädische Chirurgie und Neurotramatologie, SRH Waldklinikum Gera
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J. Franke
- Klinik für Orthopädie, Otto-von-Guericke Universität Magdeburg
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: The microsurgical nucleotomy (MC) currently is regarded as “gold standard” in operative treatment of lumbar disc herniation. To reduce the muscular trauma of the approach further we developed the technique: “microscopically assisted percutaneous nucleotomy” (MAPN).
Methods: This is a prospective randomized study including fifty patients. Twenty five by twenty five patients were operated in the aforementioned both techniques. Parameters for comparison were intraoperative data like surgical time, time for the approach, time for closure, blood loss and complications as well as early postoperative results such as Visual Analogue Scale (VAS) differentiated for leg and back pain and analgesics consumption.
Results: The overall sugical time was 46 minutes, in MAPN-technique 33.5 and in MC-technique 57 minutes (p<0.001). The reason for this is distinct shorter time for approach and for closure in MAPN. The mean blood loss in MAPN amounts 21ml, in MC 59ml (p<0.001). There were one dural tear in MC and two in MAPN without further consequences. No other complication was recorded. In each group the pain parameters (VAS leg and back pain) improved significantly (p<0.001) when the postoperative situation was compared to the preoperative one. There was no significant difference between both groups. However we found a significant (p<0.001) distinction in analgesics consumption at the early postoperative time (first 48 hours after surgery). The mean morphine equivalent dosage in MAPN was 1.28mg and in MC 5.4mg.
Conclusions: Analysing these results we believe that the MAPN-technique may be a proper alternative to the commonly used MC-technique in lumbar disc surgery. Further investigations in other institutions are under way to allow a definitive statement.
