Which is Better in Laborers? A Comparison Between Open and Micro Endoscopic Discectomy
Volume 1 | Issue 1 | October 2020-March 2021 | page: 8-12 | Hitesh N. Modi, Tushar Kunder, Neel Bhavsar, Pankaj R. Patel
Authors: Hitesh N. Modi [1][2], Tushar Kunder [1], Neel Bhavsar [1], Pankaj R. Patel [1]
[1] Department of Orthopaedics, NHL Municipal Medical College
and Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
[2] Department of Spine Surgery, Zydus Hospital and Healthcare
Research Pvt. Ltd., Ahmedabad, Gujarat, India .
Address of Correspondence
Dr. Hitesh N. Modi,
Spine Surgeon, Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
Spine Surgeon, Zydus Hospital and Healthcare Research Pvt. Ltd., Ahmedabad, Gujarat, India .
E-mail: modispine@gmail.com; drmodihitesh@gmail.com
Abstract
Introduction: None of the studies compared the results of open lumbar discectomy (OLD) and microendoscopic discectomy (MED) surgeries in laborers. The aim of this study was to compare the clinical and functional impact of OLD versus MED surgery in laborers to find out which is better.
Materials and Methods: This retrospective study was performed in 91 laborers (54 males and 37 females) who underwent OLD (n = 41) versus MED (n = 50) for the single- or double-level lumbar disc herniation (LDH). All patients were operated at a single institute after a failure of conservative trial for 6 weeks. Patients with associated severe disc degeneration, stenosis, instabilities, or other pathologies were excluded from the study. The clinical results were evaluated with Oswestry Disability Index (ODI), visual analog score (VAS), and duration of return back to work.
Results: The average age of the study group was 39.8 ± 12.1 years. Average follow-up was 50.2 ± 13.9 months. The entire study group comprised manual labor work such as farming or loading work with an average income of US $53.6 ± 14.6 (approximately INR 4000) per month. The patients belonged to low socioeconomic status as per modified Kuppuswamy scale. The post-operative VAS scores were significantly reduced in both MED (7.6–2.0) and open discectomies (7.2–2.1). Improvement ODI scores also showed similar trends for MED (57.3–20.6) and for open discectomies (55.1–20.1). Average duration to return to work was significantly less in the MED group in comparison to the OLD group (18.0 vs. 25.5 days). There were total 4 (4.4%) complications perioperatively. There were one superficial wound infection in the OLD and one dural tear in the MED group. Both were managed conservatively. There was one patient from each group having recurrent disc herniation that was managed conservatively. There were one patient from the MED and two patients from the OLD group who could not return to their previous work or had to modify their work due to back pain.
Conclusion: Although clinical improvement after discectomy surgery in laborers is similar, MED is a promising alternative to OLD in laborers with respect to return to work earlier. Such studies may further throw light in differential management of laborer population with MEDs versus OLD.
Keywords: Lumbar disc herniation; Laborers; Discectomy technique; Early return to work.
References
1. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet 2012;379:482-91.
2. McCall IW. Lumbar herniated disks. Radiol Clin North Am 2000;38:1293-309.
3. Van Boxem K, Cheng J, Patijn J, Van Kleef M, Lataster A, Mekhail N, et al. 11. Lumbosacral radicular pain. Pain Pract 2010;10:339-58.
4. Yoke CO, Ann TK. Study of lumbar disc pathology among a group of dockworkers. Ann Acad Med Singap 1979;8:81-5.
5. Yadav RI, Long L, Yanming C. Comparison of the effectiveness and outcome of microendoscopic and open discectomy in patients suffering from lumbar disc herniation. Medicine (Baltimore) 2019;98:e16627.
6. Kulkarni AG, Bassi A, Dhruv A. Microendoscopic lumbar discectomy: Technique and results of 188 cases. Indian J Orthop 2014;48:81-7.
7. He J, Xiao S, Wu Z, Yuan Z. Microendoscopic discectomy versus open discectomy for lumbar disc herniation: A meta-analysis. Eur Spine J 2016;25:1373-81.
8. Rompe JD, Eysel P, Zöllner J, Heine J. Prognostic criteria for work resumption after standard lumbar discectomy. Eur Spine J 1999;8:132-7.
9. Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.
10. Hoy DG, Smith E, Cross M, Sanchez-Riera L, Buchbinder R, Blyth FM, et al. The global burden of musculoskeletal conditions for 2010: An overview of methods. Ann Rheum Dis 2014;73:982-9.
11. Rothoerl RD, Woertgen C, Brawanski A. When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 2002;25:162-5.
12. Foley KT. Microendoscopic discectomy. Tech Neurosurg 1997;3:301-7.
13. Tullberg T, Isacson J, Weidenhielm L. Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study. Spine (Phila Pa 1976) 1993;18:24-7.
14. Muramatsu K, Hachiya Y, Morita C. Postoperative magnetic resonance imaging of lumbar disc herniation: Comparison of microendoscopic discectomy and Love’s method. Spine (Phila Pa 1976) 2001;26:1599-605.
15. Schizas C, Tsiridis E, Saksena J. Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations. Neurosurgery 2005;57:357-60.
16. Shin DA, Kim KN, Shin HC, Yoon DH. The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 2008;8:39-43.
17. Garg B, Nagraja UB, Jayaswal A. Microendoscopic versus open discectomy for lumbar disc herniation: A prospective randomised study. J Orthop Surg (Hong Kong) 2011;19:30-4.
18. Bhatia PS, Chhabra HS, Mohapatra B, Nanda A, Sangodimath G, Kaul R. Microdiscectomy or tubular discectomy: Is any of them a better option for management of lumbar disc prolapse. J Craniovertebr Junction Spine 2016;7:146-52.
19. Brock M, Kunkel P, Papavero L. Lumbar microdiscectomy: Subperiosteal versus transmuscular approach and influence on the early postoperative analgesic consumption. Eur Spine J 2008;17:518-22.
20. Mayer HM, Brock M. Percutaneous endoscopic discectomy: Surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993;78:216-25.
21. Bookwalter JW 3rd, Busch MD, Nicely D. Ambulatory surgery is safe and effective in radicular disc disease. Spine (Phila Pa 1976) 1994;19:526-30.
22. Caspar W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y. The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedure. Neurosurgery 1991;28:78-86.
23. Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM, et al. Microendoscopic lumbar discectomy: Technical note. Neurosurgery 2002;51:S129-36.
24. Fujii Y, Yamashita K, Sugiura K, Ishihama Y, Manabe H, Tezuka F, et al. Early return to activity after minimally invasive full endoscopic decompression surgery in medical doctors. J Spine Surg 2020;6:S294-9.
How to Cite this Article: Modi HN, Kunder T, Bhavsar N, Patel PR | Which is Better in Laborers? A Comparison Between Open and Micro Endoscopic Discectomy| Back Bone: The Spine Journal | October 2020- March 2021; 1(1): 8-12. |
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