Minimally Invasive Surgery Shows No Benefit in Discectomy

Minimally invasive surgery (MIS) for cervical or lumbar discectomy does not improve long-term function or reduce extremity pain, according to a new review.

Researchers at McMaster University (Hamilton, ON, Canada) searched MEDLINE, Embase, and the Cochrane Library for reports of randomized controlled studies of MIS versus open surgery comparing functional outcomes, pain, complications, and reoperations among patients undergoing cervical or lumbar discectomy. In all, four trials involving 431 patients in the cervical discectomy group and 10 trials involving 1,159 patients in the lumbar discectomy group underwent a subsequent meta-analysis.

The results showed that while MIS may speed up functional recovery and reduce postoperative pain, it did not improve long-term function or reduce long-term extremity pain, when compared with open surgery. The evidence also suggested overall higher rates of nerve-root injury, incidental durotomy, and reoperation with MIS. They also found that infections were more common with open surgery than with MIS, although the difference was not statistically significant. The study was published on November 27, 2014, in CMAJ Open.

“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 lead author Nathan Evaniew, MD, of the division of orthopedic surgery. “So, we were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies.”

“Many spinal surgery procedures are known to have difficult learning curves, and surgeons embarking on minimally invasive surgical techniques should obtain specialized training to minimize complications,” concluded Dr. Evanview and colleagues. “Conventional open techniques for spinal surgery are themselves technically demanding, and minimally invasive techniques are likely even more challenging.”

Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less morbid, but they require specialized equipment and may involve increased risks for technical complications.

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