Minimally invasive disc surgery is a pain in the neck

November 26, 2014

Hamilton, ON (Nov. 26, 2014) - McMaster University researchers 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.

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.

The study, published today in CMAJ Open, was led by Nathan Evaniew, a physician who is a research fellow in orthopedics and a PhD student in health research methodologies at McMaster's Michael G. DeGroote School of Medicine.

"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," said Evaniew. "So, we were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies."

People affected by symptomatic neck and lower back spinal disc diseases make up at least five per cent of the population and they suffer with pain, disability and loss of income. For carefully selected patients who fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results, said Evaniew.

Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less morbid, but they require specialized equipment and may involve increased risks for technical complications, he added.

Evaniew and his colleagues performed a meta-analysis of previous studies to examine the effects of minimally invasive versus open surgery on functional outcomes, pain, complications and reoperations among patients undergoing cervical or lumbar discectomy.

They searched the MEDLINE, Embase and Cochrane Library databases for reports of relevant randomized controlled trials and reviewed four trials involving 431 patients in the cervical discectomy group, and 10 trials involving 1,159 patients in the lumbar discectomy group.

"Many spinal surgery procedures are known to have difficult learning curves, and surgeons embarking on minimally invasive surgical techniques should obtain specialized training to minimize complications," the authors write. "Conventional open techniques for spinal surgery are themselves technically demanding, and minimally invasive techniques are likely even more challenging."

In addition to concluding that current research evidence does not support the routine use of minimally invasive surgery for cervical or lumbar discectomy, the researchers also found an overall lack of high-quality research, which suggests further well-designed trials are needed.
-end-
Editors:

The study may be found here: http://www.cmajopen.ca/

For more information:

Veronica McGuire
Media Relations
Faculty of Health Sciences
McMaster University
vmcguir@mcmaster.ca
905-525-9140, ext. 22169

McMaster University

Related Spinal Cord Articles from Brightsurf:

Stem cells can help repair spinal cord after injury
Spinal cord injury often leads to permanent functional impairment. In a new study published in the journal Science researchers at Karolinska Institutet in Sweden show that it is possible to stimulate stem cells in the mouse spinal cord to form large amounts of new oligodendrocytes, cells that are essential to the ability of neurons to transmit signals, and thus to help repair the spinal cord after injury.

Improving treatment of spinal cord injuries
A group led by UC Riverside bioengineering professor Victor G.

Spinal cord gives bio-bots walking rhythm
Miniature biological robots are making greater strides than ever, thanks to the spinal cord directing their steps.

Co-delivery of IL-10 and NT-3 to enhance spinal cord injury repair
Spinal cord injury (SCI) creates a complex microenvironment that is not conducive to repair; growth factors are in short supply, whereas factors that inhibit regeneration are plentiful.

Locomotor engine in the spinal cord revealed
Researchers at Karolinska Institutet in Sweden have revealed a new principle of organization which explains how locomotion is coordinated in vertebrates akin to an engine with three gears.

Neurological signals from the spinal cord surprise scientists
With a study of the network between nerve and muscle cells in turtles, researchers from the University of Copenhagen have gained new insight into the way in which movements are generated and maintained.

An 'EpiPen' for spinal cord injuries
An injection of nanoparticles can prevent the body's immune system from overreacting to trauma, potentially preventing some spinal cord injuries from resulting in paralysis.

From spinal cord injury to recovery
Spinal cord injury disconnects communication between the brain and the spinal cord, disrupting control over part of the body.

Transplanting adult spinal cord tissues: A new strategy of repair spinal cord injury
Spinal cord injury repair is one of the most challenging medical problems, and no effective therapeutic methods has been developed.

Gene medication to help treat spinal cord injuries
The two-gene medication has been proven to recover motor functions in rats.

Read More: Spinal Cord News and Spinal Cord Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.