Researchers at McMaster University have found 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.
The study, published in CMAJ Open, was led by Nathan Evaniew, research fellow in orthopedics and a PhD student in health research methodologies at McMaster’s Michael G DeGroote School of Medicine.
In comparing it with open surgery, they found that while minimally invasive surgery for cervical or lumbar discectomy may speed up recovery and reduce post-operative pain, it does not improve long-term function or reduce long-term extremity pain. Minimally invasive surgery for discectomy also requires advanced technical expertise and may be associated with increased risks of neurologic injury, incidental damage to the outer covering of the brain and spinal cord, and further surgery.
“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,” says Evaniew. “We were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies.” For carefully selected patients who fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results, indicated the authors.
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