The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury

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Object

The objective of this study was to evaluate the invasiveness of microendoscopic discectomy (MED) in comparison with microscopic discectomy (MD) by measuring serum levels of creatine phosphokinase (CPK)-MM and lactate dehydrogenase (LDH)-5, and by comparing visual analog scale (VAS) scores of postoperative pain.

Methods

This study included a group of 15 patients who underwent surgery using MED and 15 patients who underwent surgery using MD, both for single-level unilateral herniated nucleus pulposus. The CPK-MM and LDH-5 levels were measured at admission and after 1, 3, and 5 days postoperatively. Pain assessment was recorded using scores raging from 0 to 10 on a subjective VAS at admission and at 1, 3, and 5 days postoperatively.

Results

The mean CPK-MM levels were lower for the MED group than for the MD group at both 3 (576.1 ± 286.3 IU/L compared with 968.1 ± 377.8 IU/L) and 5 days (348.1 ± 231.0 IU/L compared with 721.7 ± 463.2) postoperatively (p < 0.05). The mean VAS scores for postoperative back pain were lower in the MED group than in the MD group, both at 1 (3.3 ± 2.3 compared with 5.8 ± 1.5) and 5 days (1.9 ± 1.1 compared with 3.6 ± 1.1) postoperatively (p < 0.01).

Conclusions

The MED procedure is less invasive than MD, and causes less muscle damage and less back pain.

Abbreviations used in this paper:BMI = body mass index; CPK = creatine phosphokinase; LDH = lactate dehydrogenase; MED = microendoscopic discectomy; MD = microscopic discectomy; VAS = visual analog scale.

Article Information

Address correspondence to: Keung Nyun Kim, M.D., Ph.D., Department of Neurosurgery, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Republic of Korea. email: knkim@yumc.yonsei.ac.kr.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Line graph showing differences in mean CPK-MM serum levels between the two treatment groups. Mean CPK-MM serum levels increased after surgery and reached a peak 3 days postoperatively. The mean serum CPK-MM levels of the MED group were significantly lower than those of the MD group at both 3 (p = 0.015) and 5 days (p = 0.021) postoperatively.

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    Line graph showing no significant differences in LDH-5 serum levels between the two treatment groups at any time point.

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    Bar graph showing preoperative and postoperative differences in VAS scores of back pain between the two treatment groups. The mean VAS scores of the MED group were significantly lower than those of the MD group at both 1 (p = 0.003) and 5 days (p = 0.00) postoperatively.

  • View in gallery

    Bar graph showing no significant differences in preoperative or postoperative VAS scores of leg pain between the two treatment groups at any time, indicating that decompression of the nerve roots was achieved equally well by both procedures.

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