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Minimal Incision, Multifidus-sparing Microendoscopic Diskectomy Versus Conventional Microdiskectomy for Highly
1From the Orthopaedic Department, Zagazig University, Zagazig, Sharkia, Egypt.
Background:
Highly migrated intracanal disk herniation is not among the exclusion criteria of the interlaminar microendoscopic diskectomy (MED) procedure. The goal of this prospective, randomized, controlled study was to compare the effect of the size of the skin incision and the method of handling the multifidus muscle on the results of the interlaminar MED procedure versus conventional microdiskectomy in retrieving highly migrated intracanal disk herniations.
Methods:
Seventy-three patients with highly migrated intracanal lumbar disk herniations treated with either minimal incision, multifidus-sparing MED or conventional microdiskectomy were observed for 2 years. Primary (clinical) outcomes data included the results of the Numerical Rating Scale (NRS) for back and leg pain and the Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary objective outcomes data included surgical time, blood loss, postoperative analgesics, length of hospital stay, time to return to work, the rates of revision surgery complications, and the results of the patient satisfaction index (PSI) and the modified MacNab criteria.
Results:
At final follow-up, relief of leg pain was statistically significant for both groups. NRS back pain, ODI, PSI, and the modified MacNab criteria showed no improvement in the conventional microdiskectomy group. Secondary outcomes data in the MED group were significantly better than those for the control group.
Conclusions:
Highly migrated intracanal lumbar disk herniations can be sufficiently retrieved using minimal incision, multifidus-sparing MED, which is an effective alternative to conventional microdiskectomy. The minimal skin incision and multifidus-sparing approach of the MED had a positive effect on clinical outcomes, which were stable throughout the 2-year follow-up period.
Level Of Evidence:
Therapeutic level II.
Insights
Minimal incision, multifidus-sparing microendoscopic diskectomy (MED) effectively treats highly migrated intracanal disk herniations. This approach offers better clinical outcomes than conventional microdiskectomy over a 2-year follow-up.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Minimally Invasive Spine Surgery
Background:
- Highly migrated intracanal disk herniations are treatable with interlaminar microendoscopic diskectomy (MED).
- The study investigated the impact of skin incision size and multifidus muscle handling in MED for these herniations.
Purpose of the Study:
- To compare interlaminar MED with conventional microdiskectomy for highly migrated intracanal disk herniations.
- To evaluate the effect of minimal incision and multifidus-sparing techniques on surgical outcomes.
Main Methods:
- A prospective, randomized, controlled study of 73 patients with highly migrated lumbar disk herniations.
- Comparison of minimal incision, multifidus-sparing MED versus conventional microdiskectomy over 2 years.
- Outcomes assessed using Numerical Rating Scale (NRS) for pain, Oswestry Disability Index (ODI), and patient satisfaction.
Main Results:
- Both groups achieved significant leg pain relief.
- The MED group showed significantly better secondary outcomes (surgical time, blood loss, recovery) compared to conventional microdiskectomy.
- No improvement in back pain, disability, or satisfaction was observed in the conventional microdiskectomy group.
Conclusions:
- Minimal incision, multifidus-sparing MED is an effective alternative for highly migrated intracanal lumbar disk herniations.
- This approach positively impacts clinical outcomes, maintaining stability over a 2-year period.
- The technique offers advantages over conventional microdiskectomy for this specific patient group.
