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Journal articles on the topic 'Microdiscectomy'

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Published: 4 June 2021
Last updated: 11 February 2022

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1

Bloomberg, T. J. "Microdiscectomy." BMJ 297, no. 6646 (August 13, 1988): 481. http://dx.doi.org/10.1136/bmj.297.6646.481-b.

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2

Truumees, Eeric, Matthew Geck, John K. Stokes, and Devender Singh. "Lumbar Microdiscectomy." JBJS Essential Surgical Techniques 6, no. 1 (January 27, 2016): e3. http://dx.doi.org/10.2106/jbjs.st.n.00093.

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3

Rogers, L. A. "Outpatient microdiscectomy." Neurosurgery 23, no. 1 (July 1988): 128. http://dx.doi.org/10.1097/00006123-198807000-00028.

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4

Kroll, Derek. "Lumbar microdiscectomy." Techniques in Regional Anesthesia and Pain Management 17, no. 2 (April 2013): 36–38. http://dx.doi.org/10.1053/j.trap.2014.01.005.

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5

Kambin, Parviz, and Alexander Vaccaro. "Arthroscopic microdiscectomy." Spine Journal 3, no. 3 (May 2003): 60–64. http://dx.doi.org/10.1016/s1529-9430(02)00558-2.

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6

Gulati, Yash. "Lumbar Microdiscectomy." Apollo Medicine 1, no. 1 (September 2004): 29–32. http://dx.doi.org/10.1016/s0976-0016(12)60037-4.

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7

Oskouian, Rod J., J. Patrick Johnson, and John J. Regan. "Thoracoscopic Microdiscectomy." Neurosurgery 50, no. 1 (January 1, 2002): 103–9. http://dx.doi.org/10.1097/00006123-200201000-00018.

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ABSTRACT THE THORACOSCOPIC APPROACH for the microsurgical removal of herniated thoracic discs is described, and perioperative management is also discussed. The microsurgical techniques used for decompression of the spinal canal in the thoracic spine are presented in detail. The diagnostic imaging, surgical positioning, approach, port placement, localization of the thoracic level, exposure of the surgical field, excision of the rib head, exposure with removal of the herniated disc, and postoperative management are outlined. Surgical and operative “pearls” in thoracoscopic spinal surgery for removing herniated thoracic discs when possible are described and illustrated.
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Oskouian, Rod J., J. Patrick Johnson, and John J. Regan. "Thoracoscopic Microdiscectomy." Neurosurgery 50, no. 1 (January 2002): 103–9. http://dx.doi.org/10.1227/00006123-200201000-00018.

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9

Kambin, Parviz. "Arthroscopic microdiscectomy." Arthroscopy: The Journal of Arthroscopic & Related Surgery 8, no. 3 (September 1992): 287–95. http://dx.doi.org/10.1016/0749-8063(92)90058-j.

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10

Ryang, Yu-Mi, Markus F. Oertel, Lothar Mayfrank, Joachim M. Gilsbach, and Veit Rohde. "STANDARD OPEN MICRODISCECTOMY VERSUS MINIMAL ACCESS TROCAR MICRODISCECTOMY." Neurosurgery 62, no. 1 (January 1, 2008): 174–82. http://dx.doi.org/10.1227/01.neu.0000311075.56486.c5.

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Abstract OBJECTIVE Minimal access surgery as a less invasive alternative to standard macro- and microsurgical approaches is becoming increasingly popular in the management of traumatic and degenerative spine diseases. However, data is lacking if minimal access spine surgery is indeed beneficial. This prospective randomized study was conducted to compare efficiency, safety, and outcome of standard open microsurgical discectomy (SOMD) for lumbar disc herniation with microsurgical discectomy using an 11.5 mm trocar system for minimal access to the spine. METHODS Sixty patients were randomized to two groups of 30 patients each. Group 1 was treated by SOMD, and Group 2 was treated by minimal access microsurgical discectomy (MAMD). Perioperative parameters and pre- and postoperative clinical findings including sensory or motor deficits and pain according to the visual analog scale, Oswestry Disability Index scores, and Short Form-36 results were assessed. All patients were followed for at least 6 months postoperatively (mean, 16 mo). RESULTS Preoperatively, no statistically significant intergroup differences could be detected proving the comparability of both groups. Postoperatively, significant improvement of neurological symptoms and pain as measured by the visual analog scale, Oswestry Disability Index, and Short Form-36 scores could be achieved in both groups. In regard to operative time, intraoperative blood loss, and complication rate, slightly better results were observed in the MAMD group. CONCLUSION SOMD and MAMD allow achievement of significant improvement of pain and neurological deficits in patients with lumbar disc herniations. Differences in operative time, blood loss, and complication rates were statistically not significant in MAMD compared with SOMD, indicating that, at least in lumbar disc surgery, minimal access trocar techniques are a viable alternative to standard spinal approaches.
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11

Quigley, Matthew. "Standard Open Microdiscectomy versus Minimal Access Trocar Microdiscectomy." Neurosurgery 63, no. 6 (December 1, 2008): E1209. http://dx.doi.org/10.1227/01.neu.0000315871.64824.52.

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12

Ryang, Yu-Mi. "Standard Open Microdiscectomy versus Minimal Access Trocar Microdiscectomy." Neurosurgery 63, no. 6 (December 1, 2008): E1209. http://dx.doi.org/10.1227/01.neu.0000315872.41953.3d.

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13

Clark, Aaron J., Michael M. Safaee, Nickalus R. Khan, Matthew T. Brown, and Kevin T. Foley. "Tubular microdiscectomy: techniques, complication avoidance, and review of the literature." Neurosurgical Focus 43, no. 2 (August 2017): E7. http://dx.doi.org/10.3171/2017.5.focus17202.

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OBJECTIVEMicroendoscopic discectomy is a minimally invasive surgery technique that was initially described in 1997. It allows surgeons to work with 2 hands through a small-diameter, operating table–mounted tubular retractor, and to apply standard microsurgical techniques in which a small skin incision and minimal muscle dissection are used. Whether the surgeon chooses to use an endoscope or a microscope for visualization, the technique uses the same type of retractor and is thus called tubular microdiscectomy. The goal in this study was to review the current literature, examine the level of evidence supporting tubular microdiscectomy, and describe surgical techniques for complication avoidance.METHODSThe authors performed a systematic PubMed review using the terms “microdiscectomy trial,” “tubular and open microdiscectomy,” “microendoscopic open discectomy,” and “minimally invasive open microdiscectomy OR microdiskectomy.” Of 317 references, 10 manuscripts were included for analysis based on study design, relevance, and appropriate comparison of open to tubular discectomy.RESULTSSimilar and very favorable clinical outcomes can be expected from tubular and standard microdiscectomy. Studies have demonstrated equivalent operating times for both procedures, with lower blood loss and shorter hospital stays associated with tubular microdiscectomy. Furthermore, postoperative analgesic usage has been shown to be significantly lower after tubular microdiscectomy. Overall rates of complications are no different for tubular and standard microdiscectomy.CONCLUSIONSProspective randomized trials have been used to evaluate outcomes of common minimally invasive lumbar spine procedures. For lumbar discectomy, Level I evidence supports equivalently good outcomes for tubular microdiscectomy compared with standard microdiscectomy. Likewise, Level I data indicate similar safety profiles and may indicate lower blood loss for tubular microdiscectomy. Future studies should examine the comparative value of these procedures.
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14

Papavero, Luca, and Wolfhard Caspar. "The lumbar microdiscectomy." Acta Orthopaedica Scandinavica 64, sup251 (January 1993): 34–37. http://dx.doi.org/10.3109/17453679309160112.

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15

Koutrouvelis, Panos G., and Edward Lang. "Stereotactic Lumbar Microdiscectomy." Neurosurgery Clinics of North America 7, no. 1 (January 1996): 49–58. http://dx.doi.org/10.1016/s1042-3680(18)30404-2.

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16

Mathews, Hallett H. "Transforaminal Endoscopic Microdiscectomy." Neurosurgery Clinics of North America 7, no. 1 (January 1996): 59–64. http://dx.doi.org/10.1016/s1042-3680(18)30405-4.

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17

Oskouian, Rod J., and J. Patrick Johnson. "Endoscopic thoracic microdiscectomy." Journal of Neurosurgery: Spine 3, no. 6 (December 2005): 459–64. http://dx.doi.org/10.3171/spi.2005.3.6.0459.

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Object. The purpose of this clinical study was to evaluate prospectively surgical and neurological outcomes after endoscopic thoracic disc surgery. Methods. The authors assessed the following quantifiable outcome data in 46 patients: operative time, blood loss, duration of chest tube insertion, narcotic use, hospital length of stay (LOS), and long-term follow-up neurological function and pain-related symptoms. In patients who presented with myelopathy there was a postoperative improvement of two Frankel grades. Pain related to radiculopathy was improved by 75% and in one patient it worsened postoperatively. The authors also present operative data, surgical outcomes, and complications. Conclusions. Thoracoscopic discectomy can be used to achieve acceptable results. It has several distinct advantages such as reduced postoperative pain, morbidity, and LOS compared with traditional open procedures.
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18

Pai, S. Balaji, G. Raghuram, and BG Srihari. "Posterior Cervical Microdiscectomy." Journal of Spinal Surgery 2, no. 2 (2015): 33–36. http://dx.doi.org/10.5005/jp-journals-10039-1052.

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19

Maroon, J. C., and A. Abla. "Microdiscectomy versus chemonucleolysis." Neurosurgery 16, no. 5 (May 1985): 644???9. http://dx.doi.org/10.1097/00006123-198505000-00010.

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20

Wilkinson, H. A. "Microdiscectomy vs. chemonucleolysis." Neurosurgery 17, no. 6 (December 1985): 1016. http://dx.doi.org/10.1097/00006123-198512000-00028.

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21

Richter, Erich O., Arthur J. Ulm, David A. Peace, and Jeffrey S. Henn. "Minimally invasive microdiscectomy." Operative Techniques in Neurosurgery 7, no. 2 (June 2004): 50–55. http://dx.doi.org/10.1053/j.otns.2004.11.003.

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22

Aydin, Yunus, Ibrahim M. Ziyal, Cengiz S. Türkrnen, Alper R. Kaya, and Hüdai Duman. "Modified lumbar microdiscectomy." Clinical Neurology and Neurosurgery 99 (July 1997): S219. http://dx.doi.org/10.1016/s0303-8467(97)82285-8.

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23

Moreland, Douglas, P. Jeffrey Lewis, and James Egnatchik. "Outpatient lumbar microdiscectomy." Spine Journal 2, no. 5 (September 2002): 124. http://dx.doi.org/10.1016/s1529-9430(02)00221-8.

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24

Maroon, Joseph C., and Adnan Abla. "Microdiscectomy versus Chemonucleolysis." Neurosurgery 16, no. 5 (May 1, 1985): 644–49. http://dx.doi.org/10.1227/00006123-198505000-00010.

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Abstract A retrospective analysis of 50 consecutive patients treated with chemonucleolysis and 50 treated with microlumbar discectomy was carried out. Similar clinical criteria for the diagnosis of “virgin” herniated lumbar discs were used. All patients had low back or radicular pain unrelieved by a minimum of 4 weeks of conservative therapy. Physical findings included a positive straight leg raising sign, weakness of the appropriate muscle groups, and a sensory loss or evidence of depressed reflexes. All had myelograms or computed tomographic scans demonstrating an extradural defect. Compensation cases were eliminated. Results demonstrated a 90% marked improvement in the microdiscectomy category and a 58% marked improvement in the chemonucleolysis group. Four per cent of the microdiscectomy patients were unimproved, and 18% of the chemonucleolysis group required a subsequent surgical procedure. The average postoperative hospital stay was 3 days for both groups. Because of the necessity for reoperations in the chemonucleolysis group, chemonucleolysis seemed less cost-effective than microdiscectomy.
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25

Oskouian, Rod J., and J. Patrick Johnson. "Endoscopic thoracic microdiscectomy." Neurosurgical Focus 18, no. 3 (March 2005): 1–8. http://dx.doi.org/10.3171/foc.2005.18.3.12.

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Object The purpose of this investigation was to evaluate surgical and neurological outcomes in thoracic disc surgery in a prospective fashion. Methods Quantifiable outcome data such as operating time, blood loss, duration of chest tube drainage, narcotic drug use, length of hospital stay (LOS), and long-term follow up of neurological function and pain-related symptoms were collected prospectively. In patients with myelopathy there was an improvement of two Frankel grades in the thoracoscopic discectomy group and one Frankel grade in the patients treated with thoracotomy; however, patients in the thoracotomy group were significantly worse preoperatively. None of the patients experienced worsened pain, and pain related to radiculopathy was improved by 75% in the thoracoscopic group. Conclusions Thoracoscopic discectomy yields acceptable surgical results and has several distinct advantages, with reduced postoperative pain, morbidity, and LOS.
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26

Mostafa Elkatatny, Amr Abdelmonam Abdelaziz, Tarek M. Hamdy, and Khaled Mamoun Moenes. "Comparison between Results of Microdiscectomy and Open Discectomy in Management of High-Level Lumbar Disc Prolapse." Open Access Macedonian Journal of Medical Sciences 7, no. 17 (August 30, 2019): 2851–57. http://dx.doi.org/10.3889/oamjms.2019.679.

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AIM: This work aims to compare between results of microdiscectomy and open discectomy in management of high-level lumbar disc prolapse. METHODS: This is a controlled randomised study, where patients having upper lumbar disc herniations were evaluated preoperatively both clinically and radiologically, randomisation was planned to perform open discectomy in odd number patients and to perform microdiscectomy in even number patients, patients were evaluated and followed up for deficits and outcomes. RESULTS: We operated ten patients in this study, five cases were operated upon with microdiscectomy, and five cases were operated upon with open discectomy, the median age of presentation in this study was 44 years, there were five males and five females, postoperative pain improvement was better in microdiscectomy. Hospital stay, blood loss, bone loss and postoperative complications were less in microdiscectomy. CONCLUSION: Microdiscectomy allows good surgical visualisation and is less traumatic to the involved tissues. The results of this study indicated that microsurgery reduces hospitalisation time, improves the overall surgery-related outcome. The main differences between the two procedures were the length of the incision and blood loss. We found that lumbar microdiscectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents.
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Saxena, Ankur, and Sam Eljamel. "Preoperative “group and save” in lumbar microdiscectomy: is it necessary?" Journal of Neurosurgery: Spine 15, no. 6 (December 2011): 686–88. http://dx.doi.org/10.3171/2011.8.spine11510.

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Object “Group and save” (type and screen) is commonly requested preoperatively in lumbar microdiscectomy. On average, less than 100 ml of blood is lost during lumbar microdiscectomy, and blood transfusion guidelines and resuscitation practice recommend that no transfusion would be required in almost all healthy patients with less than 750 ml of blood loss. The authors performed an audit of 319 consecutive lumbar microdiscectomies to determine if the practice of group and save can be justified. A telephone survey of the United Kingdom (UK) neurosurgical units to establish current UK neurosurgical practice was also conducted. Methods A telephone survey of all UK neurosurgical units and an audit of all patients who underwent primary lumbar microdiscectomy at our institution over a period of 2 consecutive years was performed. The health records of all patients were retrieved and critically reviewed. Information about hemoglobin measurements before and after surgery, group and save, and blood transfusion were collected. Results Thirty-two UK neurosurgical units were surveyed by telephone, with a 100% response rate. Group and save was commonly performed prior to lumbar microdiscectomy in 28 units (87.5%). The records of 319 consecutive patients who underwent lumber microdiscectomy were reviewed. All patients had group and save prior to lumbar microdiscectomy. No patient required a blood transfusion during or after surgery. The mean decrease in hemoglobin concentration was 0.8 g/dl in 121 patients who had postoperative hemoglobin measurements. Conclusions Blood transfusion and hemoglobin decrease following lumbar microdiscectomy is exceptionally rare. Group and save and postoperative hemoglobin measurements are therefore nonessential in all patients undergoing lumbar microdiscectomy, with potentially significant cost savings from not performing these tests.
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Lee, Michael J. "Anular Repair After Microdiscectomy?" JBJS Orthopaedic Highlights: Spine Surgery 2, no. 11 (November 6, 2013): e1. http://dx.doi.org/10.2106/jbjs.ss.m.00397.

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29

Williams, Robert Warren. "Lumbar Disc Disease: Microdiscectomy." Neurosurgery Clinics of North America 4, no. 1 (January 1993): 101–8. http://dx.doi.org/10.1016/s1042-3680(18)30611-9.

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30

Obenchain, Theodore G. "Speculum lumbar extraforaminal microdiscectomy." Spine Journal 1, no. 6 (November 2001): 415–20. http://dx.doi.org/10.1016/s1529-9430(01)00149-8.

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31

Fountas, Kostas N., Eftychia Z. Kapsalaki, Kim W. Johnston, Hugh F. Smisson, Robert L. Vogel, and Joe Sam Robinson. "Postoperative Lumbar Microdiscectomy Pain." Spine 24, no. 18 (September 1999): 1958. http://dx.doi.org/10.1097/00007632-199909150-00016.

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32

Kerray, Fiona M., and Andrew L. Tambyraja. "Iliocaval Fistula After Microdiscectomy." European Journal of Vascular and Endovascular Surgery 57, no. 6 (June 2019): 875. http://dx.doi.org/10.1016/j.ejvs.2019.02.014.

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33

Chang, Hsuan-Kan, Huang-Chou Chang, Jau-Ching Wu, Tsung-Hsi Tu, Li-Yu Fay, Peng-Yuan Chang, Ching-Lan Wu, Wen-Cheng Huang, and Henrich Cheng. "Scoliosis may increase the risk of recurrence of lumbar disc herniation after microdiscectomy." Journal of Neurosurgery: Spine 24, no. 4 (April 2016): 586–91. http://dx.doi.org/10.3171/2015.7.spine15133.

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OBJECT The aim of this paper was to investigate the risk of recurrence of lumbar disc herniation (LDH) in patients with scoliosis who underwent microdiscectomy. METHODS A series of consecutive patients who underwent microdiscectomy for LDH was retrospectively reviewed. The inclusion criteria were young adults younger than 40 years who received microdiscectomy for symptomatic 1-level LDH. An exclusion criterion was any previous spinal surgery, including fusion or correction of scoliosis. The patients were divided into 2 groups: those with scoliosis and those without scoliosis. The demographic data in the 2 groups were similar. All medical records and clinical and radiological evaluations were reviewed. RESULTS A total of 58 patients who underwent 1-level microdiscectomy for LDH were analyzed. During the mean follow-up of 24.6 months, 6 patients (10.3%) experienced a recurrence of LDH with variable symptoms. The recurrence rate was significantly higher among the scoliosis group than the nonscoliosis group (33.3% vs 2.3%, p = 0.001). Furthermore, the recurrence-free interval in the scoliosis group was short. CONCLUSIONS Young adults (< 40 years) with uncorrected scoliosis are at higher risk of recurrent LDH after microdiscectomy.
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34

Shriver, Michael F., Jack J. Xie, Erik Y. Tye, Benjamin P. Rosenbaum, Varun R. Kshettry, Edward C. Benzel, and Thomas E. Mroz. "Lumbar microdiscectomy complication rates: a systematic review and meta-analysis." Neurosurgical Focus 39, no. 4 (October 2015): E6. http://dx.doi.org/10.3171/2015.7.focus15281.

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.
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Mariscalco, Michael W., Takayuki Yamashita, Michael P. Steinmetz, Ajit A. Krishnaney, Isador H. Lieberman, and Thomas E. Mroz. "Radiation Exposure to the Surgeon During Open Lumbar Microdiscectomy and Minimally Invasive Microdiscectomy." Spine 36, no. 3 (February 2011): 255–60. http://dx.doi.org/10.1097/brs.0b013e3181ceb976.

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Wang, Yinqing, Zeyan Liang, Jianfeng Wu, Songjie Tu, and Chunmei Chen. "Comparative Clinical Effectiveness of Tubular Microdiscectomy and Conventional Microdiscectomy for Lumbar Disc Herniation." SPINE 44, no. 14 (July 2019): 1025–33. http://dx.doi.org/10.1097/brs.0000000000003001.

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37

Ghaly, Ramsis F., Zinaida Perciuleac, Kenneth D. Candido, and Nebojsa Nick Knezevic. "Interventionist performs a “sham” lumbar microdiscectomy: Should interventionalists be performing spinal surgery?" Surgical Neurology International 11 (December 29, 2020): 467. http://dx.doi.org/10.25259/sni_672_2020.

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Background: Neurosurgeons and orthopedists, who have received specific training, should be the ones performing spinal surgery. Here, we present a case in which spinal surgeons secondarily (e.g., 6 months later) found that a patient’s first lumbar discectomy, performed by an interventional specialist, had been a “sham” procedure. Case Description: A 30-year-old male presented with sciatica attributed to a magnetic resonance imaging documented large, extruded disc at the L4-5 level. An interventional pain management specialist (IPMS) performed two epidural steroid injections; these resulted in an exacerbation of his pain. The IPMS then advised the patient that he was a surgeon and performed an “interventional” microdiscectomy. Secondarily, 6 months later, when the patient presented to a spinal neurosurgeon with a progressive cauda equina syndrome, the patient underwent a bilateral laminoforaminotomy and L4-L5 microdiscectomy. Of interest, at surgery, there was no evidence of scarring from the IPMS’ prior “microdiscectomy;” it had been a “sham” operation. Following the second surgery, the patient’s cauda equina syndrome resolved. Conclusion: IMPS, who are not trained as spinal surgeons should not be performing spinal surgery/ microdiscectomy.
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38

Krenn, Michael H., Sveva Ambrosetti-Giudici, Alois Pfenniger, Jürgen Burger, and Wolfgang Peter Piotrowski. "Minimally Invasive Intraoperative Stiffness Measurement of Lumbar Spinal Motion Segments." Operative Neurosurgery 63, suppl_4 (October 1, 2008): ONS309—ONS314. http://dx.doi.org/10.1227/01.neu.0000335144.87931.a1.

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Abstract Objective: To test a new tiny-tipped intraoperative diagnostic tool that was designed to provide the surgeon with reliable stiffness data on the motion segment during microdiscectomy. A decrease in stiffness after nuclectomy and a measurable influence of muscle tension were assumed. If the influence of muscle tension on the motion segment could at least be ruled out, there should be no difference with regard to stiffness between women and men. If these criteria are met, this new intraoperative diagnostic tool could be used in further studies for objective decision-making regarding additional stabilization systems after microdiscectomy. Methods: After evaluation of the influence of muscle relaxation during in vivo measurements with a spinal spreader between the spinous processes, 21 motion segments were investigated in 21 patients. Using a standardized protocol, including quantified muscle relaxation, spinal stiffness was measured before laminotomy and after nuclectomy. Results: The decrease in stiffness after microdiscectomy was highly significant. There were no statistically significant differences between men and women. The average stiffness value before discectomy was 33.7 N/mm, and it decreased to 25.6 N/mm after discectomy. The average decrease in stiffness was 8.1 N/mm (24%). Conclusion: In the moderately degenerated spine, stiffness decreases significantly after microdiscectomy. Control for muscle relaxation is essential when measuring in vivo spinal stiffness. The new spinal spreader was found to provide reliable data. This spreader could be used in further studies for objective decision-making about additional stabilization systems after microdiscectomy.
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39

Wilby, Martin J., Ashley Best, Eifiona Wood, Girvan Burnside, Emma Bedson, Hannah Short, Dianne Wheatley, et al. "Microdiscectomy compared with transforaminal epidural steroid injection for persistent radicular pain caused by prolapsed intervertebral disc: the NERVES RCT." Health Technology Assessment 25, no. 24 (April 2021): 1–86. http://dx.doi.org/10.3310/hta25240.

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Background Sciatica is a common condition reported to affect > 3% of the UK population at any time and is most often caused by a prolapsed intervertebral disc. Currently, there is no uniformly adopted treatment strategy. Invasive treatments, such as surgery (i.e. microdiscectomy) and transforaminal epidural steroid injection, are often reserved for failed conservative treatment. Objective To compare the clinical effectiveness and cost-effectiveness of microdiscectomy with transforaminal epidural steroid injection for the management of radicular pain secondary to lumbar prolapsed intervertebral disc for non-emergency presentation of sciatica of < 12 months’ duration. Interventions Patients were randomised to either (1) microdiscectomy or (2) transforaminal epidural steroid injection. Design A pragmatic, multicentre, randomised prospective trial comparing microdiscectomy with transforaminal epidural steroid injection for sciatica due to prolapsed intervertebral disc with < 1 year symptom duration. Setting NHS services providing secondary spinal surgical care within the UK. Participants A total of 163 participants (aged 16–65 years) were recruited from 11 UK NHS outpatient clinics. Main outcome measures The primary outcome was participant-completed Oswestry Disability Questionnaire score at 18 weeks post randomisation. Secondary outcomes were visual analogue scores for leg pain and back pain; modified Roland–Morris score (for sciatica), Core Outcome Measures Index score and participant satisfaction at 12-weekly intervals. Cost-effectiveness and quality of life were assessed using the EuroQol-5 Dimensions, five-level version; Hospital Episode Statistics data; medication usage; and self-reported cost data at 12-weekly intervals. Adverse event data were collected. The economic outcome was incremental cost per quality-adjusted life-year gained from the perspective of the NHS in England. Results Eighty-three participants were allocated to transforaminal epidural steroid injection and 80 participants were allocated to microdiscectomy, using an online randomisation system. At week 18, Oswestry Disability Questionnaire scores had decreased, relative to baseline, by 26.7 points in the microdiscectomy group and by 24.5 points in the transforaminal epidural steroid injection. The difference between the treatments was not statistically significant (estimated treatment effect –4.25 points, 95% confidence interval –11.09 to 2.59 points). Nor were there significant differences between treatments in any of the secondary outcomes: Oswestry Disability Questionnaire scores, visual analogue scores for leg pain and back pain, modified Roland–Morris score and Core Outcome Measures Index score up to 54 weeks. There were four (3.8%) serious adverse events in the microdiscectomy group, including one nerve palsy (foot drop), and none in the transforaminal epidural steroid injection group. Compared with transforaminal epidural steroid injection, microdiscectomy had an incremental cost-effectiveness ratio of £38,737 per quality-adjusted life-year gained and a probability of 0.17 of being cost-effective at a willingness to pay threshold of £20,000 per quality-adjusted life-year. Limitations Primary outcome data was invalid or incomplete for 24% of participants. Sensitivity analyses demonstrated robustness to assumptions made regarding missing data. Eighteen per cent of participants in the transforaminal epidural steroid injection group subsequently received microdiscectomy prior to their primary outcome assessment. Conclusions To the best of our knowledge, the NErve Root Block VErsus Surgery trial is the first trial to evaluate the comparative clinical effectiveness and cost-effectiveness of microdiscectomy and transforaminal epidural steroid injection. No statistically significant difference was found between the two treatments for the primary outcome. It is unlikely that microdiscectomy is cost-effective compared with transforaminal epidural steroid injection at a threshold of £20,000 per quality-adjusted life-year for sciatica secondary to prolapsed intervertebral disc. Future work These results will lead to further studies in the streamlining and earlier management of discogenic sciatica. Trial registration Current Controlled Trials ISRCTN04820368 and EudraCT 2014-002751-25. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 24. See the NIHR Journals Library website for further project information.
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Yamada, Hiroshi, Hideaki Yamamoto, Katsumasa Nakajima, and Masamitsu Nakajima. "Anterior Transvertebral Key-hole Microdiscectomy." Spinal Surgery 10 (1996): 54–59. http://dx.doi.org/10.2531/spinalsurg.10.54.

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Kambin, Parviz, and Lawrence F. Cohen. "Arthroscopic Microdiscectomy Versus Nucleotomy Techniques." Clinics in Sports Medicine 12, no. 3 (July 1993): 587–98. http://dx.doi.org/10.1016/s0278-5919(20)30416-6.

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Baig, Abdul, and Hugh Maurice. "Microdiscectomy - a day case audit." Spine Journal 15, no. 3 (March 2015): S75. http://dx.doi.org/10.1016/j.spinee.2014.12.108.

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HAGLUND, M. M., A. J. MOORE, H. MARSH, and D. UTTLEY. "Outcome after repeat lumbar microdiscectomy." British Journal of Neurosurgery 9, no. 4 (January 1995): 487–96. http://dx.doi.org/10.1080/02688699550041124.

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Yilmaz, Cem, Selma Ozgur Buyrukcu, Tufan Cansever, Salih Gulsen, Nur Altinors, and Hakan Caner. "Lumbar Microdiscectomy With Spinal Anesthesia." Spine 35, no. 11 (May 2010): 1176–84. http://dx.doi.org/10.1097/brs.0b013e3181be5866.

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Kambin, Parviz, Evan O??Brien, Linqiu Zhou, and Jonathan L. Schaffer. "Arthroscopic Microdiscectomy and Selective Fragmentectomy." Clinical Orthopaedics and Related Research 347 (February 1998): 150???167. http://dx.doi.org/10.1097/00003086-199802000-00018.

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Aslanukov, M. N., S. A. Vasilyev, R. S. Levin, and E. P. Fisenko. "Lumbar microdiscectomy using intraoperative ultrasound." Khirurgiya. Zhurnal im. N.I. Pirogova, no. 2 (2020): 21. http://dx.doi.org/10.17116/hirurgia202002121.

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KAHANOVITZ, NEIL, KATHLEEN VIOLA, and JOHN MUCULLOCH. "Limited Surgical Discectomy and Microdiscectomy." Spine 14, no. 1 (January 1989): 79–81. http://dx.doi.org/10.1097/00007632-198901000-00016.

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Silvers, H. Roy, P. Jeffrey Lewis, Loubert S. Suddaby, Harold L. Asch, David E. Clabeaux, and Leslie E. Blumenson. "Day Surgery for Cervical Microdiscectomy." Journal of Spinal Disorders 9, no. 4 (August 1996): 287???293. http://dx.doi.org/10.1097/00002517-199608000-00003.

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Badlani, Neil, Elizabeth Yu, Junyoung Ahn, Mark F. Kurd, and Safdar N. Khan. "Minimally Invasive/Less Invasive Microdiscectomy." Clinical Spine Surgery 29, no. 3 (April 2016): 108–10. http://dx.doi.org/10.1097/bsd.0000000000000369.

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Broc, Guy G., Neil R. Crawford, Volker K. H. Sonntag, and Curtis A. Dickman. "Biomechanical Effects of Transthoracic Microdiscectomy." Spine 22, no. 6 (March 1997): 605–12. http://dx.doi.org/10.1097/00007632-199703150-00005.

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