gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

Effectiveness of a less invasive approach technique in comparison to the microsurgical technique in operative treatment of lumbar disc herniation: a prospective randomized study

Meeting Abstract

  • corresponding author J. Franke - Orthop.Universitätsklinik Magdeburg, Magdeburg
  • H. Boehm - Bad Berka
  • H. Grasshoff - Magdeburg
  • R. Greiner-Perth - Gera

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novW1.10

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Veröffentlicht: 13. Juni 2005

© 2005 Franke et al.
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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). Through a 15mm skin incision the paraspinal muscles fibres are gently spread by a set of dilators. Then a threaded working channel with an outer diameter of 11mm is inserted by clockwise rotation. All further steps are done under the operative microscope. The study presented here aimed for evaluating the effectiveness of MAPN in comparison with the microsurgical technique (MC).

Material and 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.


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.


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.