The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

Clinical article

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Object

Advocates of minimally invasive discectomy (MID) have promoted this operation as an alternative to open discectomy (OD), arguing that there may be less injury to the paraspinal muscles, decreased postoperative pain, and a faster recovery time. However, a recently published large randomized controlled trial (RCT) comparing these approaches reported inferior relief of leg pain in patients undergoing MID. The authors conducted a meta-analysis to evaluate complications and improvement in leg pain in patients with radiculopathy enrolled in RCTs comparing OD to MID.

Methods

The authors performed a literature search using Medline and EMBASE of studies indexed between January 1990 and January 2011. Predetermined RCT eligibility included the usage of tubular retractors during MID, a minimum follow-up duration of 1 year, and quantification of pain with the visual analog scale (VAS). Trials that only evaluated patients with recurrent disc herniation were excluded. Data on operative parameters, complications, and VAS scores of leg pain were extracted by 2 investigators. A meta-analysis was performed assuming random effects to determine the difference in mean change for continuous outcomes and the risk ratio for binary outcomes.

Results

Six trials comprising 837 patients (of whom 388 were randomized to MID and 449 were randomized to OD) were included. The mean operative time was 49 minutes during MID and 44 minutes during OD; this difference was not statistically significant. Incidental durotomies occurred significantly more frequently during MID (5.67% compared with 2.90% for OD; RR 2.05, 95% CI 1.05–3.98). Intraoperative complications (incidental durotomies and nerve root injuries) were also significantly more common in patients undergoing MID (RR 2.01, 95% CI 1.07–3.77). The mean preoperative VAS score for leg pain was 6.9 in patients randomized to MID and 7.2 in those randomized to OD. With long-term follow-up (1–2 years postoperatively), the mean VAS score improved to 1.6 in both the MID and OD cohorts. There was no significant difference in relief of leg pain between the 2 approaches with either short-term follow-up (2–3 months postoperatively, 0.81 points on the VAS, 95% CI −4.71 to 6.32) or long-term follow-up (2.64 on the VAS, 95% CI −2.15 to 7.43). Reoperation for recurrent herniation was more common in patients randomized to the MID group (8.50% compared with 5.35% in patients randomized to the OD group), but this difference was not statistically significant (RR 1.56, 95% CI 0.92–2.66). Total complications did not differ significantly between the operations (RR 1.50, 95% CI 0.97–2.33).

Conclusions

The current evidence suggests that both OD and MID lead to a substantial and equivalent long-term improvement in leg pain. Adequate decompression, regardless of the operative approach used, may be the primary determinant of pain relief—the major complaint of many patients with radiculopathy. Incidental durotomies occurred significantly more frequently during MID, but total complications did not differ between the techniques.

Abbreviations used in this paper:MID = minimally invasive discectomy; OD = open discectomy; RCT = randomized controlled trial; VAS = visual analog scale.

Article Information

Address correspondence to: Ali Bydon, M.D., Department of Neurosurgery, Johns Hopkins University, 600 North Wolfe Street, Meyer 5-109, Baltimore, Maryland 21287. email: abydon1@jhmi.edu.

Please include this information when citing this paper: published online March 9, 2012; DOI: 10.3171/2012.1.SPINE11404.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Flow diagram depicting the literature search strategy used to retrieve the prospective RCTs evaluating the improvement in leg pain in patients with radiculopathy undergoing minimally invasive compared with open discectomy.

  • View in gallery

    Forest plots evaluating the long-term pain relief measured by the VAS score, short-term pain relief measured by the VAS score, operative time, total complications, rates of incidental durotomies, and reoperation for recurrent disc herniation in patients randomized to MID compared with those randomized to OD.

References

  • 1

    Ahn YKim JULee BHLee SHPark JDHong DH: Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy. Clinical article. J Neurosurg Spine 10:5956022009

    • Search Google Scholar
    • Export Citation
  • 2

    Ahn YLee SHPark WMLee HYShin SWKang HY: Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976) 29:E326E3322004

    • Search Google Scholar
    • Export Citation
  • 3

    Allen RTGarfin SR: The economics of minimally invasive spine surgery: the value perspective. Spine (Phila Pa 1976) 35:26 SupplS375S3822010

    • Search Google Scholar
    • Export Citation
  • 4

    Ambrossi GLMcGirt MJSciubba DMWitham TFWolinsky JPGokaslan ZL: Recurrent lumbar disc herniation after single-level lumbar discectomy: incidence and health care cost analysis. Neurosurgery 65:5745782009

    • Search Google Scholar
    • Export Citation
  • 5

    Anderson PA: Tubular discectomy resulted in greater leg and back pain and a lower rate of recovery than conventional microdiscectomy for sciatica. J Bone Joint Surg Am 92:4752010

    • Search Google Scholar
    • Export Citation
  • 6

    Anderson PAMcCormick PCAngevine PD: Randomized controlled trials of the treatment of lumbar disk herniation: 1983–2007. J Am Acad Orthop Surg 16:5665732008

    • Search Google Scholar
    • Export Citation
  • 7

    Arts MPBrand Rvan den Akker MEKoes BWBartels RHPeul WC: Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial. JAMA 302:1491582009

    • Search Google Scholar
    • Export Citation
  • 8

    Arts MPBrand Rvan den Akker MEKoes BWBartels RHTan WF: Tubular diskectomy vs conventional microdiskectomy for the treatment of lumbar disk herniation: 2-year results of a double-blind randomized controlled trial. Neurosurgery 69:1351442011

    • Search Google Scholar
    • Export Citation
  • 9

    Arts MPNieborg ABrand RPeul WC: Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine 7:2822862007

    • Search Google Scholar
    • Export Citation
  • 10

    Arts MPPeul WCBrand RKoes BWThomeer RT: Cost-effectiveness of microendoscopic discectomy versus conventional open discectomy in the treatment of lumbar disc herniation: a prospective randomised controlled trial [ISRCTN51857546]. BMC Musculoskelet Disord 7:422006

    • Search Google Scholar
    • Export Citation
  • 11

    Arts MPPeul WCKoes BWThomeer RT: Management of sciatica due to lumbar disc herniation in the Netherlands: a survey among spine surgeons. J Neurosurg Spine 9:32392008

    • Search Google Scholar
    • Export Citation
  • 12

    Atlas SJKeller RBWu YADeyo RASinger DE: Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine lumbar spine study. Spine (Phila Pa 1976) 30:9279352005

    • Search Google Scholar
    • Export Citation
  • 13

    Atlas SJTosteson TDBlood EASkinner JSPransky GSWeinstein JN: The impact of workers' compensation on outcomes of surgical and nonoperative therapy for patients with a lumbar disc herniation: SPORT. Spine (Phila Pa 1976) 35:89972010

    • Search Google Scholar
    • Export Citation
  • 14

    Benglis DMVanni SLevi AD: An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. Laboratory investigation. J Neurosurg Spine 10:1391442009

    • Search Google Scholar
    • Export Citation
  • 15

    Best NMSasso RC: Success and safety in outpatient microlumbar discectomy. J Spinal Disord Tech 19:3343372006

  • 16

    Brock MKunkel PPapavero L: Lumbar microdiscectomy: subperiosteal versus transmuscular approach and influence on the early postoperative analgesic consumption. Eur Spine J 17:5185222008

    • Search Google Scholar
    • Export Citation
  • 17

    Cenic ASne NLisi MOkrainac AReddy K: Bowel injury following lumbar discectomy using minimally invasive retractors. Can J Neurol Sci 34:4854872007

    • Search Google Scholar
    • Export Citation
  • 18

    Chang CPLee WSLee SC: Left internal iliac artery and vein tear during microendoscopic lumbar discectomy—a case report. Minim Invasive Ther Allied Technol 15:1551582006

    • Search Google Scholar
    • Export Citation
  • 19

    Chatterjee SFoy PMFindlay GF: Report of a controlled clinical trial comparing automated percutaneous lumbar discectomy and microdiscectomy in the treatment of contained lumbar disc herniation. Spine (Phila Pa 1976) 20:7347381995

    • Search Google Scholar
    • Export Citation
  • 20

    Chin KRMichener TA: Prospective evaluation of a 3-blade speculum cannula for minimally invasive lumbar microdiscectomy. J Spinal Disord Tech 19:2572612006

    • Search Google Scholar
    • Export Citation
  • 21

    Choi GLee SHBhanot ARaiturker PPChae YS: Percutaneous endoscopic discectomy for extraforaminal lumbar disc herniations: extraforaminal targeted fragmentectomy technique using working channel endoscope. Spine (Phila Pa 1976) 32:E93E992007

    • Search Google Scholar
    • Export Citation
  • 22

    Chou DWang VYKhan AS: Primary dural repair during minimally invasive microdiscectomy using standard operating room instruments. Neurosurgery 64:5 Suppl 23563592009

    • Search Google Scholar
    • Export Citation
  • 23

    Cole JS IVJackson TR: Minimally invasive lumbar discectomy in obese patients. Neurosurgery 61:5395442007

  • 24

    Dewing CBProvencher MTRiffenburgh RHKerr SManos RE: The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine (Phila Pa 1976) 33:33382008

    • Search Google Scholar
    • Export Citation
  • 25

    Egger MSmith GDAltman DG: Systematic Reviews in Health Care: Meta-analysis in Context LondonBMJ Publishing Group1995

  • 26

    Fallah AMassicotte EMFehlings MGLewis SJRampersaud YREbrahim S: Admission and acute complication rate for outpatient lumbar microdiscectomy. Can J Neurol Sci 37:49532010

    • Search Google Scholar
    • Export Citation
  • 27

    Fessler RGO'Toole JEEichholz KMPerez-Cruet MJ: The development of minimally invasive spine surgery. Neurosurg Clin N Am 17:4014092006

    • Search Google Scholar
    • Export Citation
  • 28

    Foley KTSmith MM: Microendoscopic discectomy. Tech Neurosurg 3:3013071997

  • 29

    Fourney DRDettori JRNorvell DCDekutoski MB: Does minimal access tubular assisted spine surgery increase or decrease complications in spinal decompression or fusion?. Spine (Phila Pa 1976) 35:9 SupplS57S652010

    • Search Google Scholar
    • Export Citation
  • 30

    Franke JGreiner-Perth RBoehm HMahlfeld KGrasshoff HAllam Y: Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial. Eur Spine J 18:99210002009

    • Search Google Scholar
    • Export Citation
  • 31

    Freudenstein DDuffner FBauer T: Novel retractor for endoscopic and microsurgical spinal interventions. Minim Invasive Neurosurg 47:1901952004

    • Search Google Scholar
    • Export Citation
  • 32

    German JWAdamo MAHoppenot RGBlossom JHNagle HA: Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy. Neurosurg Focus 25:2E202008

    • Search Google Scholar
    • Export Citation
  • 33

    Gibson JNWaddell G: Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine (Phila Pa 1976) 32:173517472007

    • Search Google Scholar
    • Export Citation
  • 34

    Gonzalez-Castro AShetty ANagendar KGreenough CG: Day-case conventional discectomy: a randomised controlled trial. Eur Spine J 11:67702002

    • Search Google Scholar
    • Export Citation
  • 35

    Gotfryd AAvanzi O: A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations. Int Orthop 33:11172009

    • Search Google Scholar
    • Export Citation
  • 36

    Haines SJJordan NBoen JRNyman JAOldridge NBLindgren BR: Discectomy strategies for lumbar disc herniation: results of the LAPDOG trial. J Clin Neurosci 9:4114172002

    • Search Google Scholar
    • Export Citation
  • 37

    Harrington JFFrench P: Open versus minimally invasive lumbar microdiscectomy: comparison of operative times, length of hospital stay, narcotic use and complications. Minim Invasive Neurosurg 51:30352008

    • Search Google Scholar
    • Export Citation
  • 38

    Härtl R: Comment to the article: “Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial”. Minim Invasive Neurosurg 53:95962010

    • Search Google Scholar
    • Export Citation
  • 39

    Henriksen LSchmidt KEskesen VJantzen E: A controlled study of microsurgical versus standard lumbar discectomy. Br J Neurosurg 10:2892931996

    • Search Google Scholar
    • Export Citation
  • 40

    Hermantin FUPeters TQuartararo LKambin P: A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 81:9589651999

    • Search Google Scholar
    • Export Citation
  • 41

    Higgins JPThompson SG: Quantifying heterogeneity in a meta-analysis. Stat Med 21:153915582002

  • 42

    Hsieh PCWang CH: Posterior endoscopic lumbar discectomy using a thoracoport as a tubular retractor. Minim Invasive Neurosurg 47:3193232004

    • Search Google Scholar
    • Export Citation
  • 43

    Huang TJHsu RWLi YYCheng CC: Less systemic cytokine response in patients following microendoscopic versus open lumbar discectomy. J Orthop Res 23:4064112005

    • Search Google Scholar
    • Export Citation
  • 44

    Husain MJha DKAgrawal SHusain NGupta RK: Conical working tube: a special device for endoscopic surgery of herniated lumbar discs. J Neurosurg Spine 2:2652702005

    • Search Google Scholar
    • Export Citation
  • 45

    Isaacs REPodichetty VFessler RG: Microendoscopic discectomy for recurrent disc herniations. Neurosurg Focus 15:3E112003

  • 46

    Jadad ARMoore RACarroll DJenkinson CReynolds DJGavaghan DJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 17:1121996

    • Search Google Scholar
    • Export Citation
  • 47

    Kafadar AKahraman SAkbörü M: Percutaneous endoscopic transforaminal lumbar discectomy: a critical appraisal. Minim Invasive Neurosurg 49:74792006

    • Search Google Scholar
    • Export Citation
  • 48

    Katayama YMatsuyama YYoshihara HSakai YNakamura HNakashima S: Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation: a prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech 19:3443472006

    • Search Google Scholar
    • Export Citation
  • 49

    Kim JMLee SHAhn YYoon DHLee CDLim ST: Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg 50:82852007

    • Search Google Scholar
    • Export Citation
  • 50

    Kogias EVougioukas VIHubbe UHalatsch ME: Minimally invasive approach for the treatment of lateral lumbar disc herniations. Technique and results. Minim Invasive Neurosurg 50:1601622007

    • Search Google Scholar
    • Export Citation
  • 51

    Kotil KAkcetin MBilge T: A minimally invasive transmuscular approach to far-lateral L5-S1 level disc herniations: a prospective study. J Spinal Disord Tech 20:1321382007

    • Search Google Scholar
    • Export Citation
  • 52

    Kotil KTunckale TTatar ZKoldas MKural ABilge T: Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine 6:1211252007

    • Search Google Scholar
    • Export Citation
  • 53

    Lau DHan SJLee JGLu DCChou D: Minimally invasive compared to open microdiscectomy for lumbar disc herniation. J Clin Neurosci 18:81842011

    • Search Google Scholar
    • Export Citation
  • 54

    Le HSandhu FAFessler RG: Clinical outcomes after minimal-access surgery for recurrent lumbar disc herniation. Neurosurg Focus 15:3E122003

    • Search Google Scholar
    • Export Citation
  • 55

    Lee DYLee SH: Learning curve for percutaneous endoscopic lumbar discectomy. Neurol Med Chir (Tokyo) 48:3833892008

  • 56

    Lee JKAmorosa LCho SKWeidenbaum MKim Y: Recurrent lumbar disk herniation. J Am Acad Orthop Surg 18:3273372010

  • 57

    Lee SHKang BUAhn YChoi GChoi YGAhn KU: Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine (Phila Pa 1976) 31:E285E2902006

    • Search Google Scholar
    • Export Citation
  • 58

    Lew SMMehalic TFFagone KL: Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 94:2 Suppl2162202001

    • Search Google Scholar
    • Export Citation
  • 59

    Limbrick DD JrWright NM: Verification of nerve root decompression during minimally-invasive lumbar microdiskectomy: a practical application of surgeon-driven evoked EMG. Minim Invasive Neurosurg 48:2732772005

    • Search Google Scholar
    • Export Citation
  • 60

    Liu WGWu XTGuo JHZhuang SYTeng GJ: Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol 33:7807862010

    • Search Google Scholar
    • Export Citation
  • 61

    Matsumoto MHasegawa TIto MAizawa TKonno SYamagata M: Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of Japanese Orthopaedic Association. J Orthop Sci 15:92962010

    • Search Google Scholar
    • Export Citation
  • 62

    Mayer HMBrock M: Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78:2162251993

    • Search Google Scholar
    • Export Citation
  • 63

    McGirt MJAmbrossi GLDatoo GSciubba DMWitham TFWolinsky JP: Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64:3383452009

    • Search Google Scholar
    • Export Citation
  • 64

    Midgley JPMatthew AGGreenwood CMLogan AG: Effect of reduced dietary sodium on blood pressure: a meta-analysis of randomized controlled trials. JAMA 275:159015971996

    • Search Google Scholar
    • Export Citation
  • 65

    Moliterno JAKnopman JParikh KCohan JNHuang QDAaker GD: Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy. Clinical article. J Neurosurg Spine 12:6806862010

    • Search Google Scholar
    • Export Citation
  • 66

    Muramatsu KHachiya YMorita C: Postoperative magnetic resonance imaging of lumbar disc herniation: comparison of microendoscopic discectomy and Love's method. Spine (Phila Pa 1976) 26:159916052001

    • Search Google Scholar
    • Export Citation
  • 67

    Nakagawa HKamimura MUchiyama STakahara KItsubo TMiyasaka T: Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 10:2312352003

    • Search Google Scholar
    • Export Citation
  • 68

    Nowitzke AM: Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery 56:7557622005

  • 69

    O'Toole JEEichholz KMFessler RG: Minimally invasive far lateral microendoscopic discectomy for extraforaminal disc herniation at the lumbosacral junction: cadaveric dissection and technical case report. Spine J 7:4144212007

    • Search Google Scholar
    • Export Citation
  • 70

    O'Toole JEEichholz KMFessler RG: Surgical site infection rates after minimally invasive spinal surgery. Clinical article. J Neurosurg Spine 11:4714762009

    • Search Google Scholar
    • Export Citation
  • 71

    Oppenheimer JHDeCastro IMcDonnell DE: Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus 27:3E92009

    • Search Google Scholar
    • Export Citation
  • 72

    Palmer S: Use of a tubular retractor system in microscopic lumbar discectomy: 1 year prospective results in 135 patients. Neurosurg Focus 13:2E52002

    • Search Google Scholar
    • Export Citation
  • 73

    Parikh KTomasino AKnopman JBoockvar JHärtl R: Operative results and learning curve: microscope-assisted tubular microsurgery for 1- and 2-level discectomies and laminectomies. Neurosurg Focus 25:2E142008

    • Search Google Scholar
    • Export Citation
  • 74

    Park PUpadhyaya CGarton HJFoley KT: The impact of minimally invasive spine surgery on perioperative complications in overweight or obese patients. Neurosurgery 62:6936992008

    • Search Google Scholar
    • Export Citation
  • 75

    Pearson AMBlood EAFrymoyer JWHerkowitz HAbdu WAWoodward R: SPORT lumbar intervertebral disk herniation and back pain: does treatment, location, or morphology matter?. Spine (Phila Pa 1976) 33:4284352008

    • Search Google Scholar
    • Export Citation
  • 76

    Perez-Cruet MJFessler RGPerin NI: Review: complications of minimally invasive spinal surgery. Neurosurgery 51:5 SupplS26S362002

    • Search Google Scholar
    • Export Citation
  • 77

    Perez-Cruet MJFoley KTIsaacs RERice-Wyllie LWellington RSmith MM: Microendoscopic lumbar discectomy: technical note. Neurosurgery 51:5 SupplS129S1362002

    • Search Google Scholar
    • Export Citation
  • 78

    Peul WCvan Houwelingen HCvan den Hout WBBrand REekhof JATans JT: Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 356:224522562007

    • Search Google Scholar
    • Export Citation
  • 79

    Porchet FBartanusz VKleinstueck FSLattig FJeszenszky DGrob D: Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry. Eur Spine J 18:Suppl 33603662009

    • Search Google Scholar
    • Export Citation
  • 80

    Rahimi-Movaghar VRasouli MRVaccaro AR: Comparing surgical treatments for sciatica. JAMA 302:220222032009

  • 81

    Riesenburger RIDavid CA: Lumbar microdiscectomy and microendoscopic discectomy. Minim Invasive Ther Allied Technol 15:2672702006

  • 82

    Righesso OFalavigna AAvanzi O: Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations: results of a randomized controlled trial. Neurosurgery 61:5455492007

    • Search Google Scholar
    • Export Citation
  • 83

    Ruetten SKomp MMerk HGodolias G: Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:9319392008

    • Search Google Scholar
    • Export Citation
  • 84

    Ruetten SKomp MMerk HGodolias G: Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22:1221292009

    • Search Google Scholar
    • Export Citation
  • 85

    Ruetten SKomp MMerk HGodolias G: Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6:5215302007

    • Search Google Scholar
    • Export Citation
  • 86

    Ryang YMOertel MFMayfrank LGilsbach JMRohde V: Standard open microdiscectomy versus minimal access trocar microdiscectomy: results of a prospective randomized study. Neurosurgery 62:1741822008

    • Search Google Scholar
    • Export Citation
  • 87

    Ryang YMOertel MFMayfrank LGilsbach JMRohde V: Transmuscular trocar technique - minimal access spine surgery for far lateral lumbar disc herniations. Minim Invasive Neurosurg 50:3043072007

    • Search Google Scholar
    • Export Citation
  • 88

    Ryang YMRohde IInce AOertel MFGilsbach JMRohde V: Lateral transmuscular or combined interlaminar/paraisthmic approach to lateral lumbar disc herniation? A comparative clinical series of 48 patients. J Neurol Neurosurg Psychiatry 76:9719762005

    • Search Google Scholar
    • Export Citation
  • 89

    Salame KLidar Z: Minimally invasive approach to far lateral lumbar disc herniation: technique and clinical results. Acta Neurochir (Wien) 152:6636682010

    • Search Google Scholar
    • Export Citation
  • 90

    Sasani MOzer AFOktenoglu TCanbulat NSarioglu AC: Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg 50:91972007

    • Search Google Scholar
    • Export Citation
  • 91

    Schick UDöhnert J: Technique of microendoscopy in medial lumbar disc herniation. Minim Invasive Neurosurg 45:1391412002

  • 92

    Schick UDöhnert JRichter AKönig AVitzthum HE: Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 11:20262002

    • Search Google Scholar
    • Export Citation
  • 93

    Shin DAKim KNShin HCYoon H: The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 8:39432008

    • Search Google Scholar
    • Export Citation
  • 94

    Singh VManchikanti LBenyamin RMHelm SHirsch JA: Percutaneous lumbar laser disc decompression: a systematic review of current evidence. Pain Physician 12:5735882009

    • Search Google Scholar
    • Export Citation
  • 95

    Smith JSOgden ATShafizadeh SFessler RG: Clinical outcomes after microendoscopic discectomy for recurrent lumbar disc herniation. J Spinal Disord Tech 23:30342010

    • Search Google Scholar
    • Export Citation
  • 96

    Smith JSShaffrey CISansur CABerven SHFu KMBroadstone PA: Rates of infection after spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 36:5565632011

    • Search Google Scholar
    • Export Citation
  • 97

    Smolders DWang XDrevelengas AVanhoenacker FDe Schepper AM: Value of MRI in the diagnosis of non-clival, nonsacral chordoma. Skeletal Radiol 32:3433502003

    • Search Google Scholar
    • Export Citation
  • 98

    Song DPark P: Primary closure of inadvertent durotomies utilizing the U-Clip in minimally invasive spinal surgery. Spine (Phila Pa 1976) 36:E1753E17572011

    • Search Google Scholar
    • Export Citation
  • 99

    Tafazal SISell PJ: Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J 14:2872902005

  • 100

    Tait MJLevy JNowell MPocock CPetrik VBell BA: Improved outcome after lumbar microdiscectomy in patients shown their excised disc fragments: a prospective, double blind, randomised, controlled trial. J Neurol Neurosurg Psychiatry 80:104410462009

    • Search Google Scholar
    • Export Citation
  • 101

    Teli MLovi ABrayda-Bruno MZagra ACorriero AGiudici F: Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Eur Spine J 19:4434502010

    • Search Google Scholar
    • Export Citation
  • 102

    Than KDWang ACEtame ABLa Marca FPark P: Postoperative management of incidental durotomy in minimally invasive lumbar spinal surgery. Minim Invasive Neurosurg 51:2632662008

    • Search Google Scholar
    • Export Citation
  • 103

    Tomasino AParikh KSteinberger JKnopman JBoockvar JHärtl R: Tubular microsurgery for lumbar discectomies and laminectomies in obese patients: operative results and outcome. Spine (Phila Pa 1976) 34:E664E6722009

    • Search Google Scholar
    • Export Citation
  • 104

    Tonogai ISairyo KHigashino KSakai TKatoh SYasui N: Minimally invasive endoscopic removal of a herniated nucleus pulposus that had migrated to the S1 nerve root foramen. Minim Invasive Neurosurg 50:1731772007

    • Search Google Scholar
    • Export Citation
  • 105

    Tosteson ANSkinner JSTosteson TDLurie JDAndersson GBBerven S: The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 33:210821152008

    • Search Google Scholar
    • Export Citation
  • 106

    Voyadzis JMGala VCSandhu FAFessler RG: Minimally invasive approach for far lateral disc herniations: results from 20 patients. Minim Invasive Neurosurg 53:1221262010

    • Search Google Scholar
    • Export Citation
  • 107

    Wang B GPatel AARen PCheng I: An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations. Spine J 11:1221302011

    • Search Google Scholar
    • Export Citation
  • 108

    Watters WC IIIMcGirt MJ: An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J 9:2402572009

    • Search Google Scholar
    • Export Citation
  • 109

    Weinstein JNLurie JDTosteson TDSkinner JSHanscom BTosteson AN: Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA 296:245124592006

    • Search Google Scholar
    • Export Citation
  • 110

    Weinstein JNLurie JDTosteson TDTosteson ANBlood EAAbdu WA: Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 33:278928002008

    • Search Google Scholar
    • Export Citation
  • 111

    Weinstein JNTosteson TDLurie JDTosteson ANHanscom BSkinner JS: Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 296:244124502006

    • Search Google Scholar
    • Export Citation
  • 112

    Wu XZhuang SMao ZChen H: Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine (Phila Pa 1976) 31:268926942006

    • Search Google Scholar
    • Export Citation
  • 113

    Yeom JSKim KHHong SWPark KWChang BSLee CK: A minimally invasive technique for L5-S1 intraforaminal disc herniations: microdiscectomy with a tubular retractor via a contralateral approach. J Neurosurg Spine 8:1931982008

    • Search Google Scholar
    • Export Citation
  • 114

    Yeung ATTsou PM: Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27:7227312002

    • Search Google Scholar
    • Export Citation
  • 115

    Yeung ATYeung CA: Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am 38:3633722007

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