Conventional Microlumbar Discectomy versus Minimally Invasive Tubular Discectomy – A Prospective Study

Abstract Background: Minimally invasive surgical procedures are fast becoming the norm and standard in all aspects of surgery. It is of utmost importance that they be critically analyzed against conventional time-tested standard procedures. Standard microscopic lumbar discectomy is the gold standard for lumbar disc herniations. It is used as a yardstick for comparison of newer procedures such as tubular discectomy (TD). Objective: The objective of our study is to compare conventional microlumbar discectomy (MLD) with minimally invasive TD. Material and Methods: The study was nonrandomized prospective study of patients who underwent either type of surgery at our institute from 2018 to 2020. Preoperative and postoperative Visual Analog Score and Oswestry Disability Questionnaire score were assessed. Furthermore, duration of surgery, blood loss, length of hospital stay, and rate of complications were compared between the two groups. Results: We observed that patients in the TD group had improved VAS and Oswestry Disability Index scores than conventional MLD group during initial postoperative period which were statistically significant. The TD group had significantly lesser blood loss ( P = 0.000) and shorter duration of hospital stay ( P = 0.000) even though the duration of surgery was longer ( P = 0.038). There was no statistically significant difference between the complication rates in both the groups. There were no recurrences in either group. Conclusions: In our study, we found that patients who underwent TD showed earlier pain relief and functional recovery as compared to conventional MLD and had lesser blood loss and shorter hospital stay. The overall long-term pain relief was similar in both the groups. However, large sample randomized trials and long-term outcome analysis would be needed to make better judgment regarding choice of one procedure over the other.