Endoscopic discectomy can be a good alternative to microdisectomy for sciatica

October 01, 2021

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GadjradjP, et al. Paper 178. Presented at: North American Spine Society Annual Meeting. September 29 – October 2, 2021; Boston (hybrid meeting).

Disclosure:
Gadjradj does not report any relevant financial information.

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Percutaneous transforaminal endoscopic discectomy may be a good alternative to open microdisectomy for treating sciatica, according to results presented at the annual meeting of the North American Spine Society.

Pravesh Gadjradj, MD, PhD, and colleagues randomly assigned 613 patients with sciatica caused by a lumbar disc herniation to either percutaneous transforaminal endoscopic discectomy (n = 304) or open microdiscectomy (n = 309). The researchers considered VAS in leg pain as the primary endpoint. During the 1 and 2 year follow-up, researchers also measured VAS for back pain, Oswestry Disability Index (ODI), cost, SF-36, and quality of life VAS.

The researchers reported 87% follow-up at 1 year and 92% follow-up at 2 years. Although the groups showed no differences in the VAS for leg pain 6 weeks after surgery, Gadjradj found that there was a statistically significant difference between the two groups at 12 months in favor of the percutaneous transforaminal endoscopic discectomy group. The two groups also had small statistically significant differences in ODI, VAS for back pain, quality of life VAS, and the summary of physical components of the SF-36 in favor of the percutaneous transforaminal endoscopic discectomy group; However, Gadjradj noted that the differences may not reach a clinically relevant threshold.

Pravesh Gadjradja

Pravesh Gadjradja

“The duration of the operation was similar. The estimated blood loss was lower in the endoscopic group, ”said Gadjradj in his presentation. “Complications were lower in the endoscopic group, mobilization was earlier in the endoscopic group, and the rate of repeated operations within one year was similar (5.3% vs. 5.6%).”

Patients in the percutaneous transforaminal endoscopic discectomy group had lower costs for primary care, secondary care, medication, informal care, absenteeism, presenterism, and unpaid loss of productivity compared to open microdiscectomy compared to open microdiscectomy, Gadjradj said. However, Gadjradj found that the percutaneous transforaminal endoscopic discectomy group had higher surgical costs.

“As [endoscopic] The operation is more effective and costs less, it is a breeze and shows a dominance in terms of cost effectiveness, ”said Gadjradj. “It has an almost 100 percent chance of being inexpensive regardless of the willingness to pay.”

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Annual meeting of the North American Spine Society

Annual meeting of the North American Spine Society