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Published on: August 7, 2018
Propensity matched outcome analysis following microdiscectomy versus interlaminar endoscopic discectomy for L5-S1
Ajoy Prasad Shetty1, Thirumurugan Arumugam1, Karthik Ramachandran1
1Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India.
Purpose:
The main purpose of the study is to perform a propensity-matched functional outcome analysis following microdiscectomy (MD) versus interlaminar endoscopic lumbar discectomy (IELD) for L5-S1 disc herniation. Although many studies have compared endoscopic lumbar discectomy and microdiscectomy, few have compared the outcomes of microdiscectomy (MD) and interlaminar endoscopic discectomy (IELD) at the L5-S1 level.
Methods:
This is a propensity-matched analysis of 100 patients (50 MD patients, 50 IELD patients) based on baseline covariates with a minimum of one-year follow-up. Patient-reported outcome measures were obtained from EMR during follow-up visits. Back pain and sciatic pain were assessed by the Visual Analogue Scale (VAS-B and VAS-L). Functional outcome was assessed using Oswestry Disability Index (ODI) Score and 12-item Short Form Survey (SF-12) score. Data were obtained at baseline (pre-op) and at 0, 1, 3, and 12 months post-operatively.
Results:
Mean operative time was significantly lower (p < 0.001) in the IELD group (44 min) compared to the MD group (59 min). Mean VAS-B at the immediate and 1-month postoperative period was significantly (p < 0.001) lower in the IELD group (0.36, 0.24) when compared with the MD group (1.74, 1.16). There was no significant difference between IELD and MD groups with regard to improvement in sciatic pain (VAS-L). ODI scores at 1 month and 3 months post-operative period were significantly (p < 0.001) lower in the IELD group (30.1, 23.2) when compared with the MD group (41, 27.5). However, there was no significant difference between the two groups with regards to VAS-B, ODI, and SF-12 at 1-year follow-up.
Conclusion:
Our findings indicate that the IELD group achieved better immediate and early postoperative outcomes despite no significant difference at one-year follow-up.
Insights
Interlaminar endoscopic lumbar discectomy (IELD) offers faster pain relief for L5-S1 disc herniation compared to microdiscectomy (MD). While IELD shows better early results, both treatments yield similar outcomes at one year.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Minimally Invasive Spine Procedures
Background:
- L5-S1 disc herniation is a common cause of low back pain and sciatica.
- Microdiscectomy (MD) and interlaminar endoscopic lumbar discectomy (IELD) are surgical options.
- Limited comparative outcome data exists specifically for L5-S1 herniations comparing MD and IELD.
Purpose of the Study:
- To conduct a propensity-matched analysis comparing functional outcomes of MD and IELD for L5-S1 disc herniation.
- To evaluate patient-reported pain and disability scores post-surgery.
- To determine the long-term efficacy of each surgical approach at the L5-S1 level.
Main Methods:
- Propensity-matched analysis of 100 patients (50 MD, 50 IELD) with L5-S1 disc herniation.
- Minimum one-year follow-up with data collected from electronic medical records.
- Assessment of back pain (VAS-B) and sciatic pain (VAS-L), Oswestry Disability Index (ODI), and SF-12 scores at baseline and multiple postoperative time points (0, 1, 3, 12 months).
Main Results:
- Mean operative time was significantly lower for IELD (44 min) versus MD (59 min).
- IELD group showed significantly lower back pain (VAS-B) at immediate and 1-month postoperative periods.
- The IELD group demonstrated significantly lower Oswestry Disability Index (ODI) scores at 1 and 3 months postoperatively.
- No significant differences in VAS-B, ODI, or SF-12 scores were observed between groups at the 1-year follow-up.
Conclusions:
- Interlaminar endoscopic lumbar discectomy (IELD) provides superior early postoperative pain relief and functional improvement for L5-S1 disc herniation compared to microdiscectomy (MD).
- While IELD demonstrates advantages in the initial recovery phase, both techniques achieve comparable long-term functional outcomes at one year.
- The findings suggest IELD may be a beneficial alternative for patients seeking quicker symptom resolution after surgery for L5-S1 disc herniation.
