Comparison of the Minimally Invasive Tubular Transmuscular Approach with the Conventional Microsurgical Approach for Microsurgical Treatment of Lumbar Disk Herniation: A Prospective Randomized Study

Abstract

Background The aim of this study is to compare the outcome of the minimally invasive transmuscular approach using a tubular retractor system (Metrx) with the conventional microsurgical standard approach (CM) for microsurgical treatment of lumbar disk herniation.

Methods This is a prospective randomized controlled study with a 1:1 distribution of patients in CM and Metrx study groups. Two hundred and twenty-seven (117 CM and 110 Metrx) patients were included. The primary outcome parameters are postoperative pain intensity reduction, length of hospitalization, postoperative quality of life, and daily life performance based on the standardized questionnaires: Visual Analog Scale (VAS), 36-Item Short Form Survey (SF-36), Oswestry Disability Index (ODI), and Prolo scores. The secondary outcome parameters are intraoperative variables: surgery duration, blood loss, and fluoroscopy dose.

Results There were no significant statistical differences in the primary outcome measures between the two groups with respect to postoperative pain relief (median VAS pre-op to 3 months post-op for sciatica: 9–2 [CM] vs. 8–2 [Metrx]; for lumbago: 7–2.5 [CM] vs. 6–3 [Metrx]), the length of hospitalization (median of 5 days), or the frequency of occupational reintegration after 3 months (59.1 vs. 60.7%).

Conclusion The microsurgical therapy of lumbar disk herniation via a Metrx approach is a safe and effective treatment option and is equivalent to the CM approach.

Keywords

lumbar disk herniation - microsurgery - tubular transmuscular approach

Informed Consent

Gratitude is expressed to all patients, who gave their informed consent to participate in the trial and for publication of the data.

Availability of data and material: Data and material disclosure to third parties is not envisaged, and has to be proven by the ethics committee in detail.

Authors' Contributions

Prof. Rudolf Andreas Kristof, MD, was responsible for the study concept and design; Bogdan Pintea, MD, and Prof. Rudolf Andreas Kristof, MD, were responsible for drafting the manuscript and preparation of the final version of the manuscript. Krämer Nadine, MS (medical student), contributed substantially and gave intellectual input. Bogdan Pintea, MD, Nadine Krämer, Matthias Florian Geiger, MD, Andreas Müller, MD, PhD, and Martin Podlogar, MD, were responsible for data collection. Bogdan Pintea, MD, and Weber Patrick were responsible for data analysis.

Publikationsverlauf

Eingereicht: 13. Dezember 2019

Angenommen: 07. April 2020

Artikel online veröffentlicht:
24. Januar 2021

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