Examining the effectiveness of conventional microdiscectomy and tubular disectomy surgeries for treatment of sciatica symptoms resulting from a herniated disc, a recent study found and opined that the minimally invasive, tubular surgery did not result in better outcomes for patients despite such claims in the past.

The Sciatica Micro-Endoscopic Diskectomy randomized controlled trial was conducted with the goal of determining patient outcomes and recovery times for the following surgeries treating leg pain symptomatic of sciatica from herniated discs:

  • conventional microdiscectomy. The most commonly performed surgery for patients with sciatic leg pain from disc herniation, microdiscectomy (also known as lumbar decompression surgery) entails the removal of a small portion of the bone over the nerve root and/or disc material under the nerve root to relieve neural impingement and provide more room to heal.
  • See How Microdiscectomy Surgery Is Performed

  • tubular discectomy. Introduced in 1997, tubular discectomy involves a similar procedure to the one described above, with the exception that it is performed through a tubular device. This type of herniated disc surgery has been described as producing less tissue damage and resulting in a faster rate of recovery, the latter point serving as the basis of examination for the Sciatica Micro-Endoscopic Discectomy trial.

Performed by researchers in the Netherlands, this trial involved 328 patients (ages 18 to 70 years) who:

  • had persistent leg pain from lumbar herniated discs for more than 8 weeks
  • were hospitalized in 7 general hospitals in the Netherlands from January 2005 to October 2006
  • were randomized to either a tubular discectomy (approximately 167 patients) or conventional microdiscectomy (161 patients).

A blind follow up was conducted a year later, with functional ability, pain and a self-view of recovery assessed via a series of questionnaires and surveys.

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Findings on Microdiscectomy and Tubular Discectomy

According to the study, conventional microdiscectomy produced more favorable results than tubular discectomy after one year for:

  • functionality. The mean score on the Roland-Morris Disability Questionnaire (RDQ), which has a 0-23 score range with higher scores indicative of worse functional status, was 3.4 for conventional microdiscectomy and 4.7 for tubular discectomy.
  • leg pain. On the visual analog scale, the 1-year mean difference was in favor of conventional microdiscectomy (with scores of 4.2 mm for leg pain and 3.5 mm for back pain).
  • self-reports of recovery. 120 of 151 patients (79%) who had conventional microdiscectomy reported good recovery a year later while 107 of 156 of patients (69%) who had tubular discectomy reported good recovery a year after the minimally-invasive procedure.

It should be known that this randomized control trial by no means knocks the validity of tubular disectomy as a minimally-invasive procedure for herniated discs; rather, it challenges certain claims like it increasing the rates of recovery.

Source: JAMA