gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Long-term results of a prospective, randomized trial: Standard open microsurgical approach versus a minimally invasive access approach for lumbar disc herniation

Meeting Abstract

  • J. Gempt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • M. Jonek - Neurochirurgische Klinik, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule Aachen, Deutschland
  • F. Ringel - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • P. Wolf - Klinikum rechts der Isar, Technische Universität München, Institut für Medizinische Statistik und Epidemiologie, München, Deutschland
  • Y.M. Ryang - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland; Neurochirurgische Klinik, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocDI.02.03

DOI: 10.3205/11dgnc108, URN: urn:nbn:de:0183-11dgnc1081

Published: April 28, 2011

© 2011 Gempt et al.
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Outline

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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.