[Effectiveness comparison of two surgical procedures on lumbar disc protrusion]

To compare the effectiveness of microdiscectomy and macrodiscectomy on the single-level lumbar disc protrusion (LDP).

Between November 2002 and October 2005, 241 patients with LDP underwent 2 surgical procedures: microdiscectomy (group A, 93 cases) and macrodiscectomy (group B, 148 cases). All patients had single-level LDP. In group A, there were 51 males and 42 females with an average age of 32.3 years (range, 18-47 years); there were 23 cases of protrusion, 52 cases of prolapse, and 18 cases of sequestration with an average disease duration of 8.5 months (range, 1-18 months), including 8 cases at L2,3 level, 11 cases at L3,4 level, 35 cases at L4,5 level, and 39 cases at L5, S1 level. In group B, there were 81 males and 67 females with an average age of 31.8 years (range, 16-50 years); there were 37 cases of protrusion, 85 cases of prolapse, and 26 cases of sequestration with an average disease duration of 9.3 months (range, 1-20 months), including 9 cases at L2,3 level, 15 cases at L3,4 level, 63 cases at L4,5 level, and 61 cases at L5, S1 level. There was no significant difference in age, sex, segment level, type, or disease duration between 2 groups (P > 0.05).

Immediate back and sciatic pain relief was achieved in 225 (93.4%) patients after operation. The satisfactory rates were 91.4% in group A and 87.8% in group B at 1 week after operation, showing no significant difference (P > 0.05). The length of incision, amount of bleeding, amount of drainage, and hospitalization time in group A were significantly fewer than those in group B (P < 0.05); while the operative time in group A was longer than that in group B, but showing no significant difference (P > 0.05). Dural laceration occurred in 4 cases of group A and 5 cases of group B, superficial infections of incision occurred in 5 cases of group B and intervertebral space infections occurred in 4 cases of group B, and epidural hematoma occurred in 1 case of group A. The perioperative complication rate (5.4%, 5/93) in group A was significantly lower (P < 0.05) than that in group B (9.5%, 14/148). LDP recurred in 4 cases (4.3%) of group A and in 9 cases (6.1%) of group B postoperatively, showing no significant difference (P > 0.05); of them, 11 cases received second operation and 2 cases were treated conservatively. All cases were followed up 36-77 months (mean, 51.4 months). There were significant differences in visual analog scale (VAS) and Oswestry disability index (ODI) between 2 groups at the last follow-up and preoperation (P > 0.05), but there was significant difference in VAS at 1 week postoperatively between 2 groups (P < 0.05). VAS and ODI were obviously improved at 1 week and last follow-up when compared with preoperation (P < 0.05). There was no significant difference in the improvement rates of VAS and ODI between 2 groups at last follow-up (P > 0.05). According to clinical evaluation of Modified Macnab criteria, the excellent and good rate was 90.3% in group A and 86.5% in group B at final follow-up (P > 0.05).

Both macrodiscectomy and microdiscectomy are effective for LDP, furthermore microdiscectomy is less invasive than macrodiscectomy. Microdiscectomy is recommended to treat single-level LDP.