Tubular discectomy on par with microdiscectomy for treatment of lumbar disc herniation
Patients with lumbar disc herniation assigned to tubular discectomy and conventional microdiscectomy show no difference in long-term functional and clinical outcome, a recent study has found.
A total of 325 patients with a symptomatic lumbar disc herniation were randomized to either tubular discectomy (n=166) or conventional microdiscectomy (n=159) to assess the 5-year results of tubular vs microdiscectomy. Researchers performed repeated standardized follow-up measurements at 2, 4, 6, 8, 12, 26, 38, 52, 78, 104, 156, 208 and 260 weeks after randomization.
The main clinical outcomes were as follows: the Roland-Morris Disability Questionnaire for Sciatica (RDQ), Visual Analogue Scale for leg pain and low back pain, self-perceived recovery, and reoperation incidence.
No clinically significant difference was observed between tubular discectomy and conventional microdiscectomy with respect to the main endpoints at any point during the 5 years of follow-up. RDQ scores at 5 years were 4.3 (95 percent CI, 3.3 to 5.2) and 3.4 (2.4 to 4.5) in the tubular discectomy and conventional microdiscectomy group, respectively.
The 0.9 (‒0.6 to 2.2) mean difference was not significant. The mean difference for leg pain was 0.2 (‒5.5 to 6.0) and 0.4 (‒5.9 to 6.7) for back pain.
Complete or near-complete recovery of symptoms was reported in 77 percent of patients in the conventional discectomy group compared with 74 percent in the tubular discectomy group (p=0.79). The reoperation rate was 18 and 13 percent in the tubular and conventional discectomy group, respectively (p=0.29).
“Primary and secondary outcome measures did not support the hypothesized advantages of tubular discectomy over conventional microdiscectomy,” researchers said.