27 Nov Minimally Invasive Surgery May Not Be Best For Disc Removal

MedicalResearch.com Interview with:
Nathan Evaniew MD
Division of Orthopaedics
McMaster University

Medical Research: What is the background for this study?

Dr. Evaniew: Symptomatic cervical and lumbar spinal disc diseases affect at least 5% of the population and they cause a great deal of pain, disability, social burden, and economic impact. For carefully selected patients that fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results.

Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less destructive, but they require specialized equipment and expertise, and they may involve increased risks for technical complications.

Medical Research: What are the main findings?

Dr. Evaniew: In this study, we found that the current evidence from research does not support the routine use of minimally invasive surgery for cervical or lumbar discectomy. We also found an overall lack of high-quality evidence, which suggests that further research is warranted.

Medical Research: What should clinicians and patients take away from your report?

Dr. Evaniew: The current evidence suggests a risk–benefit ratio that does not support the routine use of minimally invasive surgery for cervical and lumbar discectomy. Appropriate patient selection and technically adequate nerve-root decompression may be the most important determinants of long-term outcomes, and surgeons embarking on minimally invasive surgical techniques should consider obtaining specialized training.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Evaniew: Given the lack of high-quality evidence, well-designed randomized trials are needed, as are large observational studies and economic evaluations. Future studies should also further examine and clearly report the influence of surgeon expertise on patient-important outcomes.

Citation:

Nathan Evaniew, Moin Khan, Brian Drew, Desmond Kwok, Mohit Bhandari, and Michelle Ghert. Minimally invasive versus open surgery for cervical and lumbar discectomy: a systematic review and meta-analysis. CMAJ Open, November 2014 DOI: 10.9778/cmajo.20140048

Last Updated on November 27, 2014 by Marie Benz MD FAAD