Clark Aaron J, Safaee Michael M, Khan Nickalus R, Brown Matthew T, Foley Kevin T
Department of Neurological Surgery, University of California, San Francisco, California.
Department of Neurosurgery, University of Tennessee Health Science Center; and.
Neurosurg Focus. 2017 Aug;43(2):E7. doi: 10.3171/2017.5.FOCUS17202.
OBJECTIVE Microendoscopic 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. METHODS The 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. RESULTS Similar 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. CONCLUSIONS Prospective 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.
目的 显微内镜下椎间盘切除术是一种微创手术技术，最初于1997年被描述。它使外科医生能够通过安装在手术台上的小直径管状牵开器用双手操作，并应用标准的显微外科技术，即采用小切口和最小限度的肌肉分离。无论外科医生选择使用内镜还是显微镜进行可视化操作，该技术都使用相同类型的牵开器，因此被称为管状显微椎间盘切除术。本研究的目的是回顾当前文献，审视支持管状显微椎间盘切除术的证据水平，并描述避免并发症的手术技术。方法 作者使用“显微椎间盘切除术试验”“管状与开放式显微椎间盘切除术”“显微内镜下开放式椎间盘切除术”以及“微创开放式显微椎间盘切除术或显微髓核摘除术”等术语在PubMed上进行了系统检索。在317篇参考文献中，基于研究设计、相关性以及开放式与管状椎间盘切除术的适当比较，纳入了10篇手稿进行分析。结果 管状和标准显微椎间盘切除术可预期获得相似且非常良好的临床结果。研究表明两种手术的手术时间相当，管状显微椎间盘切除术的失血量更少，住院时间更短。此外，已证明管状显微椎间盘切除术后的术后镇痛药物使用量显著更低。管状和标准显微椎间盘切除术的总体并发症发生率没有差异。结论 前瞻性随机试验已被用于评估常见的微创腰椎手术的结果。对于腰椎间盘切除术，一级证据支持管状显微椎间盘切除术与标准显微椎间盘切除术的效果同样良好。同样，一级数据表明两者的安全性相似，并且可能表明管状显微椎间盘切除术的失血量更低。未来的研究应考察这些手术的相对价值。
