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Research article
Sherwan Hamawandi
Hawler Medical University College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6521-1840
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.
Methods: 60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years.
Results: In both groups, all patients have minimal disability by Oswestry Disability Index after surgery.
There were significant differences between means of post-operative VAS for back pain between these two groups after one weeks (3.7 in group A versus 2.2 in group B) (t= 13.28, P=<0.001٭) and after 3 months (1.73 in group A versus 0.43 in group B) (t=10.54, P=<0.001٭).
There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group).
There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P<0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P<0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P<0.001).
Conclusion: Use of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.
Trial registration: NCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485
Keywords
Back pain, leg pain, lumbar disc herniation, open fenestration discectomy, microdiscectomy,Oswestry disability index, visual analogue scale.
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CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 04 Jun, 2020
No community comments so far
Editorial decision: Accept
On 02 Jun, 2020
Editor assigned
On 27 May, 2020
Submission checks complete
On 26 May, 2020
Editor invited
On 26 May, 2020
No comments provided
Editorial decision: Major revision
On 05 May, 2020
Review #1 received
Received 10 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Reviewers invited
Invitations sent on 16 Mar, 2020
Editor assigned
On 05 Mar, 2020
First submitted
On 04 Mar, 2020
Submission checks complete
On 04 Mar, 2020
Editor invited
On 04 Mar, 2020
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Subject Areas
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A new preprint design is coming!
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See the published version of this preprint at BMC Musculoskeletal Disorders.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Sherwan Hamawandi
Hawler Medical University College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-6521-1840
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Musculoskeletal Disorders.
Version 2
Posted 04 Jun, 2020
No community comments so far
Editorial decision: Accept
On 02 Jun, 2020
Editor assigned
On 27 May, 2020
Submission checks complete
On 26 May, 2020
Editor invited
On 26 May, 2020
No comments provided
Editorial decision: Major revision
On 05 May, 2020
Review #1 received
Received 10 Apr, 2020
Reviewer #1 agreed
On 06 Apr, 2020
Reviewers invited
Invitations sent on 16 Mar, 2020
Editor assigned
On 05 Mar, 2020
First submitted
On 04 Mar, 2020
Submission checks complete
On 04 Mar, 2020
Editor invited
On 04 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Musculoskeletal Disorders.
Background: Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.
Methods: 60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years.
Results: In both groups, all patients have minimal disability by Oswestry Disability Index after surgery.
There were significant differences between means of post-operative VAS for back pain between these two groups after one weeks (3.7 in group A versus 2.2 in group B) (t= 13.28, P=<0.001٭) and after 3 months (1.73 in group A versus 0.43 in group B) (t=10.54, P=<0.001٭).
There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group).
There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P<0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P<0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P<0.001).
Conclusion: Use of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.
Trial registration: NCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
This is a list of supplementary files associated with this preprint. Click to download.
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