A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy

Background: The usefulness of video-assisted arthroscopic microdiscectomy f or the treatment of a herniated lumbar disc has been studied previously. In the current prospective, randomized study the results of this procedure we re compared with those of conventional open laminotomy and discectomy. Methods: Sixty patients who had objective evidence of a single intracanalic ular herniation of a lumbar disc caudad to the first lumbar vertebra mere r andomized into two groups consisting of thirty patients each; Group 1 was m anaged with open laminotomy and discectomy, and Group 2 was managed with vi deo-assisted arthroscopic microdiscectomy, None of the patients had had a p revious operation on the low back, and all had failed to respond to nonoper ative measures. Analysis of the outcomes of both procedures was based on th e patient's self-evaluation before and after the operation, the preoperativ e and postoperative clinical findings, and the patient's ability to return to a functional status. The patients were followed for nineteen to forty-tw o months postoperatively. Results: On the basis of the patient's preoperative and postoperative self- evaluation, the findings on physical examination, and the patient's ability to return to work or to normal activity, twenty-eight patients (93 percent ) in Group 1 and twenty-nine patients (97 percent) in Group 2 mere consider ed to have had a satisfactory outcome. The mean duration of postoperative d isability before the patients were able to return to work was considerably longer in Group 1 than in Group 2 (forty-nine compared with twenty-seven da ys). The patients in Group 1 used narcotics for a longer duration postopera tively, No neurovascular complications or infections were encountered in ei ther group. Conclusions: Although the rate of satisfactory outcomes was approximately t he same in both groups, the patients who had had an arthroscopic microdisce ctomy had a shorter duration of postoperative disability and used narcotics for a shorter period. These findings suggest that arthroscopic microdiscec tomy may be useful for the operative treatment of specific symptoms includi ng radiculopathy; that are caused by lumbar disc herniation, provided that patients are properly selected - that is, they must have a herniated disc a t a single level as confirmed on imaging studies, have failed to respond to nonoperative management, have no evidence of spinal stenosis, and have a h erniation not exceeding one-half of the anteroposterior diameter of the spi nal canal. Moreover, the surgeon must be familiar with this technique and m ust have received training in its use.