Open AccessMinimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network
Author(s) -
Nathan Evaniew,
Andrew Bogle,
Alex Soroceanu,
W. Bradley Jacobs,
Roger Cho,
Charles Fisher,
Y. Raja Rampersaud,
Michael H. Weber,
Joel Finkelstein,
Najmedden Attabib,
Adrienne Kelly,
Alexandra Stratton,
Chris Bailey,
Jérôme Paquet,
Michael G. Johnson,
Neil Manson,
Hamilton Hall,
Greg McIntosh,
Kenneth Thomas
Publication year - 2021
Publication title -
global spine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.398
H-Index - 26
eISSN - 2192-5690
pISSN - 2192-5682
DOI - 10.1177/21925682211029863
Subject(s) - medicine , discectomy , surgery , observational study , confounding , cohort study , back pain , lumbar , retrospective cohort study , adverse effect , low back pain , alternative medicine , pathology
Study Design: Retrospective cohort study.Objective: We evaluated the effectiveness of minimally invasive (MIS) tubular discectomy in comparison to conventional open surgery among patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN).Methods: We performed an observational analysis of data that was prospectively collected. We implemented Minimum Clinically Important Differences (MCIDs), and we adjusted for potential confounders with multiple logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity (SAVES) protocol.Results: Three hundred thirty-nine (62%) patients underwent MIS tubular discectomy and 211 (38%) underwent conventional open discectomy. There were no significant differences between groups for improvement of leg pain and disability, but the MIS technique was associated with reduced odds of achieving the MCID for back pain (OR 0.66, 95% CI 0.44 to 0.99, P < 0.05). We identified statistically significant differences in favor of MIS for each of operating time (MIS mean (SD) 72.2 minutes (30.0) vs open 93.5 (40.9)), estimated blood loss (MIS 37.9 mL (36.7) vs open 76.8 (71.4)), length of stay in hospital (MIS 73% same-day discharge vs open 40%), rates of incidental durotomy (MIS 4% vs open 8%), and wound-related complications (MIS 3% vs open 9%); but not for overall rates of reoperation.Conclusions: Open and MIS techniques yielded similar improvements of leg pain and disability at up to 12 months of follow-up, but MIS patients were less likely to experience improvement of associated back pain. Small differences favored MIS for operating time, blood loss, and adverse events but may have limited clinical importance.