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Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

  • Park, Beom-Seok (Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kwon, Young-Joon (Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Won, Yu-Sam (Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Shin, Hyun-Chul (Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • Received : 2010.05.27
  • Accepted : 2010.09.17
  • Published : 2010.09.28

Abstract

Objective : The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. Methods : Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). Results : The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. Conclusion : Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain.

Keywords

References

  1. Anand N, Baron EM, Bray Jr RS : Benefits of the paraspinal musclesparing approach versus the conventional midline approach for posterior nonfusion stabilization : comparative analysis of clinical and functional outcomes. SAS Journal 1 : 93-99, 2007 https://doi.org/10.1016/S1935-9810(07)70053-1
  2. Anand N, Baron EM, Bray Jr RS : Modified muscle-sparing paraspinal approach for stabilization and interlaminar decompression : a minimally invasive technique for pedicle screw-based posterior nonfusion stabilization. SAS Journal 2 : 40-42, 2008 https://doi.org/10.1016/S1935-9810(08)70016-1
  3. Arts MP, Nieborg A, Brand R, Peul WC : Serum creatine phosphokinase as an indicator of muscle injury after various spinal and nonspinal surgical procedures. J Neurosurg Spine 7 : 282-286, 2007 https://doi.org/10.3171/SPI-07/09/282
  4. Brock M, Kunkel P, Papavero L : Lumbar microdiscectomy : subperiosteal versus transmuscular approach and influence on the early postoperative analgesic consumption. Eur Spine J 17 : 518-522, 2008 https://doi.org/10.1007/s00586-008-0604-2
  5. Caspar W : A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg 4 : 152, 1977
  6. Choi YY, Yoon SH, Ha Y, Kim EY, Park HC, Park CO : Posterior microscopic lesionectomy for lumbar disc herniation with tubular retraction using METRxTM system. J Korean Neurosurg Soc 40 : 406-411, 2006
  7. Dixon SH Jr, Fuchs JC, Ebert PA : Changes in serum creatine phosphokinase activity following thoracic, cardiac, and abdominal operations. Arch Surg 103 : 66-68, 1971
  8. Foley KT, Smith MM : Microendoscopic discectomy. Tech Neurosurg 3 : 301-307, 1997
  9. Katayama Y, Matsuyama Y, Yoshihara H, Sakai Y, Nakamura H, Nakashima S, et al. : Comparison of surgical outcomes between macro discectomy and micro discectomy for lumbar disc herniation : a prospective randomized study with surgery performed by the same spine surgeon. J Spinal Disord Tech 19 : 344-347, 2006 https://doi.org/10.1097/01.bsd.0000211201.93125.1c
  10. Kawaguchi Y, Matsui H, Tsuji H : Changes in serum creatine phosphokinase MM isoenzyme after lumbar spine surgery. Spine (Phila Pa 1976) 22 : 1018-1023, 1997 https://doi.org/10.1097/00007632-199705010-00015
  11. Kawaguchi Y, Yabuki S, Styf J, Olmarker K, Rydevik B, Matsui H, et al. : Back muscle injury after posterior lumbar spine surgery. Topographic evaluation of intramuscular pressure and blood flow in the porcine back muscle during surgery. Spine (Phila Pa 1976) 21 : 2683-2688, 1996 https://doi.org/10.1097/00007632-199611150-00019
  12. Kim YB, Hyun SJ : Clinical applications of the tubular retractor on spinal disorders. J Korean Neurosurg Soc 42 : 245-250, 2007 https://doi.org/10.3340/jkns.2007.42.4.245
  13. Koebbe CJ, Maroon JC, Abla A, El-Kadi H, Bost J : Lumbar microdiscectomy : a historical perspective and current technical considerations. Neurosurg Focus 13 : E3, 2002
  14. Kotil K, Tunckale T, Tatar Z, Koldas M, Kural A, Bilge T : Serum creatine phosphokinase activity and histological changes in the multifidus muscle : a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine 6 : 121-125, 2007 https://doi.org/10.3171/spi.2007.6.2.121
  15. Riesenburger RI, David CA : Lumbar microdiscectomy and microendoscopic discectomy. Minim Invasive Ther Allied Technol 15 : 267-270, 2006 https://doi.org/10.1080/13645700600958432
  16. Sasaoka R, Nakamura H, Konishi S, Nagayama R, Suzuki E, Terai H, et al. : Objective assessment of reduced invasiveness in MED. Compared with conventional one-level laminotomy. Eur Spine J 15 : 577-582, 2006 https://doi.org/10.1007/s00586-005-0912-8
  17. Schick U, Dohnert J, Richter A, König A, Vitzthum HE : Microendoscopic lumbar discectomy versus open surgery : an intraoperative EMG study. Eur Spine J 11 : 20-26, 2002 https://doi.org/10.1007/s005860100315
  18. Shin DA, Kim KN, Shin HC, Yoon DH : The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 8 : 39-43, 2008 https://doi.org/10.3171/SPI-08/01/039
  19. Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A : Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976) 18 : 575-581, 1993 https://doi.org/10.1097/00007632-199304000-00009
  20. Taylor RS : Spinal cord stimulation in complex regional pain syndrome and refractory neuropathic back and leg pain/failed back surgery syndrome : results of a systematic review and meta-analysis. J Pain Symptom Manage 31 : S13-S19, 2006 https://doi.org/10.1016/j.jpainsymman.2005.12.010
  21. Wiltse LL, Bateman JG, Hutchinson RH, Nelson WE : The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 50 : 919-926, 1968

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