Full-Endoscopic Interlaminar Versus Microsurgical Operations in Lumbar Compressive Lesions Surgery: Prospective Randomized Trial of Overall 570 Patients

Abstract

Introduction: Full-endoscopic operations of lumbar spine are truly minimally invasive surgical procedures and they have become the standard because of their intraoperative and postoperative advantages.Aim: To compare clinical outcomes of full-endoscopic interlaminar technique to conventional microdiscectomy performed during 3 year period.Materials and Methods: A series of 350 patients underwent full-endoscopic interlaminar lumbar discectomy, comparing 220 patients with microdiscectomy and spinal canal decompression, during a 3-year period, is analysed. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain were measured preoperatively and at 1, 6, 12, 24 months.Results: All outcome measures improved significantly in both groups (p<0.001). In the full-endoscopic group 88% of the patients no longer had leg pain, and 7% had only occasional pain, postoperatively. In the microdiscectomy (MI) group 78.1% had significant improvement, 13.6% had improvement with occasional pain, and 8% had no improvement. The recurrence rate was 8%. Resection of the herniated disc and sufficient decompression was technically possible in all cases. The overall complication rate (16.4%), and recurrence-reoperation rate (11.8%) was significantly higher in the MI group.Conclusion: The clinical results of the full-endoscopic technique are at least equal to those of the conventional microsurgical discectomy with advantages such as reduced traumatization, improved patient mobility, and lower complication and recurrence rate. With the possibility of selecting the most adequate approach, lumbar disc herniations inside and outside the spinal canal, can be sufficiently removed using the full-endoscopic technique, when taking the appropriate indication criteria into account.