A Canadian study has found that there are no long-term beneficial outcomes between minimally invasive and open discectomies. In fact, minimally invasive surgery for discectomies may be associated with greater risks of neurologic injury and incidental damage to the covering of the spinal cord, according to a McMaster University press release.
Study Challenges Minimally Invasive Spine Surgery
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Nathan Evaniew, a research fellow in orthopedics and a Ph.D. student in health research methodologies at McMaster University’s Michael G. DeGroote School of Medicine in Hamilton, Ontario, led the study.
“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 in the press release. “We were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies.”
The study concluded 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.”
On the positive side, the researchers found that minimally invasive surgery for cervical or lumbar discectomy may speed up recovery and reduce post-operative pain. “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.
In their study Evaniew and his fellow researchers searched the MEDLINE, Embase and Cochrane Library databases 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. They noted that both forms of spinal surgery are technically difficult to master, with difficult learning curves. They urged further well-designed trials on both procedures.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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