Prospective Cohort Study for Discectomy for Herniated Lumbar Disc in Resource Limited Hospital in Rural and Urban City : Loupe Vs Microscope

Volume 4 | Issue 1 | April 2023 – September 2023 | page: 14-19 | Ankitkumar A. Desai, Siddharth Patel, Kamlesh Jain, Keyur Buddhdev, Shubhdeepsingh Chugh


Authors: Ankitkumar A. Desai [1], Siddharth Patel [1], Kamlesh Jain [1], Keyur Buddhdev [1], Shubhdeepsingh Chugh [1]

[1] Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.

Address of Correspondence

Dr. Ankitkumar Arunbhai Desai,
Consultant Spine Surgeon, Department of Orthopaedics, Haria L.G. Rotary Hospital, Vapi, Gujarat, India.


Introduction: In resource limited Hospital in rural and urban city where microscopes are not readily available, I hypothesize that if properly used, good magnifying loupes could offer comparable results to the microscope in relieving rediculpathy which is the primary goal of discectomy.
Material and Methods: Prospective cohort study was conducted on 49 single level lumbar disc prolapsed patients with ridiculer leg pain between January 2017 and March 2021. The microscope was used in 15 patients (29.9%) and loupe in 34 cases (70.1%). Pre-operative assessment clinical examination with spine assessment. Surgical indications included failure of at least 6 weeks medical , physio treatment, pain or progressive neurological deficits. Micro lumbar discectomy was done in all patients. Per-and post operative parameters recorded included: length of the incision, operative time, blood loss, the presence of a wound drain, length of hospital stay, leg and back pain before discharge and in follow up visits and complications. visual analogue scale (VAS) used as a tool.
Results: The demographic, clinical characteristic , radiological characteristics and surgical technique were similar and comparable (p>0.05). The mean length of the incision was 2.5 cm for the microscope group and 3 to 3.5 cm for the loupes group (P value =0.0007).There wasn’t any statistically significant difference in both groups as regard the blood loss (p=1), complication rate and length of hospital stay (p=0.21). There wasn’t any statistically significant difference in VAS score for leg pain (p=0.32) and low back pain (p=0.46). Radicular pain recurred in equal proportion in both groups (p=0.17). 13 (86.2%) in the microscope and 32 (92.6%) in the loupe group had a 3 months post-operative VAS of zero (p=0.32).
Conclusion: Operative microscope and loupes are both justifiable alternative device in lumbar micro discectomy since both have similar and comparable outcome. In rural n urban city hospitals with less resources & less access to microscopes and other minimally invasive equipment such as the endoscope, MLD system or tubular with proven safety and effectiveness over macro disectomy , loupes are safe and effective tools for in lumbar discectomy. Operating Microscopes is more surgeon friendly as it’s gives good viewing angle without or less Work-related Musculoskeletal Disorders (WMSD).
Keywords: Microdiscectomy, Loupe, Microscope, Work-related Musculoskeletal Disorders (WMSD) Rapid Upper Limb Assessment (RULA).


1. Abou-Zeid A, Palmer J, Gnanalingham K. Day case lumbar discectomy–viable option in the UK? Br J Neurosurg 28:320-3, 2014.
2. Pearson AM, Blood EA, Frymoyer JW, Herkowitz H, Abdu WA, Woodward R, et al. SPORT lumbar intervertebral disk herniation and back pain: does treatment, location, or morphology matter? Spine 15;33:428-35,2008.
3. Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 14; 336:1355-8, 2008.
4. Rothoerl RD, Woertgen C, Brawanski A. When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25:162-5, 2002.
5. Schoenfeld AJ, Weiner BK. Treatment of lumbar disc herniation: Evidence-based practice. Int J Gen Med 3:209-14. 2010.
6. Koebbe CJ, Maroon JC, Abla A, El-Kadi H, Bost J. Lumbar microdiscectomy: a historical perspective and current technical considerations. Neurosurg Focus 15; 13:E4,2002.
7. Newsome RJ, May S, Chiverton N, Cole AA. A prospective, randomised trial of immediate exercise following lumbar microdiscectomy: a preliminary study. Physiotherapy 95: 273-9,2009.
8. Tureyen K. One-level one-sided lumbar disc surgery with and without microscopic assistance: 1- year outcome in 114 consecutive patients. J Neurosurg 99: S247-50, 2003.
9. Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev 9:CD010328. 2014.
10. Riesenburger RI, David CA. Lumbar microdiscectomy and microendoscopic discectomy. Minim Invasive Ther Allied Technol 15:267-70. 2006.
11. Schick U, Dohnert J, Richter A, Konig A, Vitzthum HE. Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 11:20-6,2002.
12. Cenic A, Kachur E. Lumbar discectomy: a national survey of neurosurgeons and literature review. Can J NeurolSci 36:196-200, 2009.
13. Kumar SS, Mourkus H, Farrar G, Yellu S, Bommireddy R. Magnifying loupes versus microscope for microdiscectomy and microdecompression. J Spinal Disord Tech 25: E235-39,2012.
14. Alberto Pispero , Marco Marcon , Carlo Ghezziet al. Posture Assessment in Dentistry for Different Visual Aids Using 2D Markers. Sensors2021, 21(22), 7717.

How to Cite this Article: Desai AA, Patel S, Jain K, Buddhdev K, Chugh S Prospective | Cohort Study for Discectomy for Herniated Lumbar Disc in Resource Limited Hopital in Rural and Urban City : Loupe Vs Microscope | Back Bone: The Spine Journal | April 2023-September 2023; 4(1): 14-19 |

(Abstract Text HTML)      (Download PDF)