REPORT OF A CONTROLLED CLINICAL-TRIAL COMPARING AUTOMATED PERCUTANEOUS LUMBAR DISKECTOMY AND MICRODISCECTOMY IN THE TREATMENT OF CONTAINED LUMBAR DISC HERNIATION

Study Design. The results of a randomized controlled trial comparing a utomated percutaneous lumbar discectomy (APLD) with lumbar microdiscec tomy for the treatment of small contained lumbar discal herniations ar e reported. All patients gave full informed consent and were assessed by an independent observer. Seventy-one patients with radiologically c onfirmed small contained lumber disc herniations were randomly assigne d to undergo either APLD or lumbar microdiscectomy. All patients were formally assessed by the independent assessor using the Macnab outcome classification at 3 weeks, 2 months, and 6 months after the procedure with follow-up being continued for the duration of the study. Objecti ve. The objective was to complete the first randomized and blinded stu dy with sufficient numbers to provide a valid statistical evaluation o f these procedures. Summary of Background Data. No previous randomized controlled study comparing these methods has been previously reported . Methods. Each procedure was performed by the same surgeon using stan dard techniques. Statistical analysis was by the chi-square method. Re sults. In the APLD group only 9 of 31 (29%) had satisfactory outcomes as compared to 32 of 40 (80%) for the microdiscectomy group. Of those patients in the APLD group who had an unsatisfactory outcome and who t hen opted to undergo surgery (20 of 22 patients), the final success ra te was only 65%. Thus, the cumulative success rate of the group initia lly randomized to APLD including those undergoing either APLD alone or APLD and microdiscectomy after unsuccessful APLD was 22 of 31 (71%). Conclusion. In this group of patients, APLD is seen to be ineffective in the treatment of contained lumbar disc herniation.