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Micro vs. macrodiscectomy: Does use of the microscope reduce complication rates?
Meghan E Murphy1, Jeffrey S Hakim2, Panagiotis Kerezoudis1
1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, 200 1st St. SW, Rochester, MN, 55905, USA; Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, 200 1st St. SW, Rochester, MN, 55905, USA.
Clinical Neurology and Neurosurgery
|November 21, 2016
Summary
Microscope use in single-level discectomy increases operative time but does not affect complication rates. Surgeon discretion is advised, as both microscopic and macroscopic approaches are acceptable standards of care for this common spine surgery.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spine Surgery
Background:
- Single-level discectomy is a frequent spinal procedure.
- Surgeons vary in their use of intraoperative microscopes for discectomy.
- The study investigates the impact of microscope use on surgical outcomes.
Purpose of the Study:
- To determine if intraoperative microscope use in single-level discectomy is associated with improved patient outcomes.
- To compare complication rates and other outcomes between microdiscectomy and macrodiscectomy.
Main Methods:
- Retrospective cohort analysis of a multicenter surgical registry (2010-2014).
- Inclusion of patients undergoing elective single-level discectomies for degenerative spinal diagnoses.
- Univariate and multivariable logistic regression analyses comparing outcomes with and without microscope use.
Main Results:
- Microscope use was more common in older patients, Hispanic white patients, and those with specific comorbidities.
- Microdiscectomy was associated with significantly longer operative times (median 80 min vs. 74 min).
- No significant association was found between microdiscectomy and increased rates of complications, surgical site infections, dural tears, reoperation, or readmission.
Conclusions:
- Intraoperative microscope use in discectomy significantly increases operative time.
- Microscope use does not appear to decrease postoperative complication rates.
- The decision to use a microscope should remain at the surgeon's discretion, with both approaches considered acceptable standards of care.
