A Canadian study has found that there are no long-term beneficial outcomes between minimally invasive and open discectomies. In fact, minimally invasive surgery for discectomies may be associated with greater risks of neurologic injury and incidental damage to the covering of the spinal cord, according to a McMaster University press release.
Nathan Evaniew, a research fellow in orthopedics and a Ph.D. student in health research methodologies at McMaster University’s Michael G. DeGroote School of Medicine in Hamilton, Ontario, led the study.
“Surgeons already perform open discectomies through relatively small incisions. Selecting the right patients and providing technically adequate nerve-root decompression are probably the most important determinants of long-term outcomes, ” said Evaniew in the press release. “We were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies.”
The study concluded that “current evidence does not support the routine use of minimally invasive surgery to remove herniated disc material pressing on the nerve root or spinal cord in the neck or lower back.”
On the positive side, the researchers found that minimally invasive surgery for cervical or lumbar discectomy may speed up recovery and reduce post-operative pain. “Surgeons already perform open discectomies through relatively small incisions. Selecting the right patients and providing technically adequate nerve-root decompression are probably the most important determinants of long-term outcomes, ” said Evaniew.
In their study Evaniew and his fellow researchers searched the MEDLINE, Embase and Cochrane Library databases of relevant randomized controlled trials and reviewed four trials involving 431 patients in the cervical discectomy group, and 10 trials involving 1, 159 patients in the lumbar discectomy group. They noted that both forms of spinal surgery are technically difficult to master, with difficult learning curves. They urged further well-designed trials on both procedures.
I’m sure literature like this existed when arthroscopy began replacing open joint surgery and were used by some of us as evidence to maintain the status quo which can stall innovation… As the senior neurosurgeon in an almost 100% MIS multispecialty Ortho/Neuro spine practice for over ten years ( where we routinely perform multilevel TLIFs, instrumented lateral fusions, hardware removal, decompressions, intra and extradural tumors , cervical forams etc all via unilateral or bilateral paramedian, muscle sparing MIS approaches) these complications exist with either approach. The rub is MIS has an extremely steep learning curve and experience must be gained through cadaveric practice, volume and persistence not just confidence in usual surgical technique which can impart a false sense of security when initial deciding to adopt MIS. This usually leads to abandonment after a few “less than ideal” cases or taking twice as long to do something which may be even less tolerable to our egos. At this point when we feel at a disadvantage regarding retraction, visualization and preservation of normal anatomy on the rare occasions we need to perform an open procedure. Obviously MIS isn’t the solution for all spine procedures but definitely, in my experience, for most. And even if outcomes are equal I’d much rather the smaller incision and quicker initial recovery times and so do my patients.
Respectfully,
Mark A. Testaiuti, MD, FAANS, Coastal Spine, PC Mount Laurel, NJ