Comparison of clinical outcomes of Endoscopic vs Microscopic lumbar discectomy: A prospective randomized controlled study

Abstract

To compare clinical and functional outcomes of Endoscopic and Microscopic lumbar discectomy in patients with L3-L4, L4-L5, L5-S1 intervertebral disc prolapse. 50 patients planned for surgical discectomy, were randomized by selecting every alternate case for either ED or MD, and their outcomes were compared on basis of Pain relief by VAS at pre op and at 6 months POD, difference in surgical time, complications, number of days of stay at the hospital, patient satisfaction assessment and time to return to work.On comparing the VAS scores of both the groups at preop and at 6-month post op period, the average VAS is reduced by 74% in the Endoscopic groups (Mean VAS (preop)= 8.76 +/- 1.12 to Mean VAS (at 6months) = 1.36 +/- 1.15) while it reduced by 72.4% (Mean VAS (preop)= 8.56+/- 1.12 to Mean VAS (at 6months) = 1.36 +/- 1.142) in the microscopic group. The mean time for ED is 81.4 minutes (SD=15.38) and for MD is 85.20 minutes (SD= 19.36). 80% patients iMD patients got discharged by POD3 compared to 64% in ED. Satisfaction rates by McNab criteria in ED is 72% and in MD 64%. 60% patients with ED went back to work within POD30 compared to 40% in MD group. Both the techniques are effective and safe for lumbar discectomy, but when it comes to patient satisfaction and return to work, endoscopic method has a slight advantage whereas in levels above L4/L5 and far lateral discs, microscopic technique is the technically better choice.