gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Minimal access trocar microdiscectomy versus standard microsurgical disc operation of the lumbar spine: a prospective, randomized, double-blind study

Meeting Abstract

  • Steffen Fleck - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald
  • Marc Matthes - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald
  • Jan-Uwe Müller - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald
  • Dennis Päsler - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald
  • Henry W. S. Schroeder - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Greifswald, Greifswald

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.03.05

doi: 10.3205/13dgnc022, urn:nbn:de:0183-13dgnc0227

Veröffentlicht: 21. Mai 2013

© 2013 Fleck et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Minimally invasive spinal techniques have been increasingly used in recent years to decrease operation-related musculoskeletal trauma. Minimal access trocar microdiscectomy (MAMD) may reduce lower back pain and increase functional outcome by decreasing post-operative pain. The purpose of this prospective randomized double-blind study was to compare the safety, efficacy, post-operative pain rating, and functional outcome of patients following MAMD and standard microsurgical disc (MSD) operations.

Method: An independent observer reviewed the treatment of 50 patients (preop. and postop. at discharge) (32 females, 18 males; age range 23-78 yrs., mean 44,62 yrs. (±12,66)) who underwent surgery for both contained and uncontained lumbar disc herniation. Two neurosurgeons performed the operations. Up to date, 35 patients were assessed both post-operatively at 1 month, 6 months, and 1 year. Lower back pain and functional outcome were evaluated using the Visual Analogue Scale (VAS), Hannover Functional Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH-R), and the Oswestry Disability Questionnaire. The t-test and Wilcoxon rank sum test were used for statistical analyses (SAS Version 9.1).

Results: 50 patients were enrolled. Up to date, 35 have completed the 3 follow-up assessments. There were 2 MSD conversions. No complications occurred during surgery and the operation times were 47,16 (±16,60) min. (MSD; blood loss 39,44 (24,37) mL), and 64,04 (±24,10) min. (MAMD; blood loss 45,00 (61,14) mL) (p=0.007). Leg and lower back pain was significantly reduced following both the MAMD and MSD procedures (leg pain: p<0.0001; lumbar pain: p=0.0007). Follow-up (4 weeks and 6 months) revealed that patients who underwent MAMD had significantly less lumbar pain (p=0.01 and p=0.03). Functional outcome did not differ across groups. However, no statistical functional or pain differences have been observed on long-term follow-up after 12 months (p=0.09).

Conclusions: MAMD is as effective as the standard lumbar MSD procedure. MAMD has short-term advantages but both techniques are equally efficacious after 1 year. For surgeons accustomed to trocar techniques, MAMD seems to be a safe procedure.