Tubular discectomy for the treatment of lumbar disc herniation : new standard or transient fashion? : Results of a double-blind randomised controlled trial

Arts, M.P. (2010)

Doctoral Thesis

Unilateral transflaval microdiscectomy is the golden standard for surgical treatment of lumbar disc related sciatica to which all new techniques should be compared. Minimally invasive tubular discectomy has been popularised aiming at reduced muscle trauma, less postoperative low-back pain, shorter hospitalisation and faster resumption of work and daily activities. This thesis outlines the results of a double-blind multicentre trial in which tubular discectomy (166 patients) was compared with unilateral transflaval microdiscectomy (159 patients). Use of tubular discectomy compared with conventional microdiscectomy did not result in a statistically significant functional improvement as measured by the Roland Disability Questionnaire for Sciatica. The median time until complete recovery was 2 weeks, irrespective of the allocated surgical treatment. Both groups reported relief of leg pain and low-back pain, although the differences favoured the conventional microsurgery group. However, these differences were small and not clinically relevant. At 2 years after surgery, 71% of patients who underwent tubular discectomy versus 77% of those treated with conventional surgery reported complete recovery. Cost-utility analysis showed no significant difference between tubular discectomy and conventional microdiscectomy. In conclusion, the data of this trial did not support a superior outcome of tubular discectomy compared with conventional microdiscectomy.

• Hernia
• Lumbar disc
• Minimal invasive surgery
• Randomised controlled trial
• Spine
• Tubular discectomy

• All authors: Arts, M.P.
• Supervisor: Peul, W.C.; Brand, R.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2010-09-23
• ISBN (print): 9789090256252