Affiliation:
1. Department of Orthopaedics, University of Munich (LMU), Grosshadern Campus,Munich, Germany
Abstract
Background: Neuropathic pain originating from spinal disc herniations is a very common
problem. The majority of disc surgeries are performed to alleviate this pain once conservative
measures and targeted injections have failed. Endoscopic spinal surgery is increasingly popular
because it minimizes access trauma and hastens recovery from the intervention. This clinically
oriented review evaluates controlled studies that investigate the clinical results and the
complications of full-endoscopic lumbar and cervical procedures for symptomatic disc herniations
in comparison to a microsurgical standard procedure. This review focuses exclusively on modern,
full-endoscopic disc surgery irrespective of the specific access technique (e.g., interlaminar vs.
transforaminal) and irrespective of the spinal region.
Study Design: Comprehensive review of the literature.
Objective: To assess the clinical outcomes and complication rates of full-endoscopic disc
surgery compared to the microsurgical standard procedures.
Methods: A PubMed and Embase search was performed, considering entries up to January
2013. All 504 results were screened and categorized. Only 4 randomized controlled trials (RCTs)
and one controlled studies (CS) could finally be considered for evaluation. All 5 manuscripts
were meticulously analyzed with regards to randomization mode, inclusion/exclusion criteria,
clinical results, and complication rates.
Results: Overall, the endoscopic techniques had shorter operating times, less blood loss, less
operative site pain, and faster postoperative rehabilitation/shorter hospital stay/faster return
to work than the microsurgical techniques. There were no significant differences in the main
clinical outcome criteria between the endoscopic and the microsurgical techniques in any of
the trials. All 5 studies had fewer complications with the endoscopic technique and this was
statistically significant in 2 of the studies. One study showed a lower rate of revision surgeries
requiring arthrodesis with the endoscopic technique.
Limitations: All 5 studies that could be considered originate from experienced investigators
and all 4 RCTs came from one group. This limits the transferability of their results to surgeons
less experienced in endoscopic disc surgery.
Conclusions: The studies show that full-endoscopic disc surgery can achieve the same clinical
results in symptomatic cervical and lumbar disc herniations as the microsurgical standard
techniques. This does not appear to come at the price of higher complication rates.
Key words: Neuropathic pain, disc herniation, cervical, lumbar, endoscopic, endoscopy, review
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine
Cited by
50 articles.
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