Abstract
Introduction
Microdiscectomies and microdecompressions are traditionally defined as procedures performed with a small incision using magnification. There are no studies in the literature comparing the magnification techniques used in these operations. We compared magnifying loupes and microscopes as the senior author was trained with both instruments and was equally comfortable using both.
Materials/Methods
This is a retrospective comparative study involving 51 consecutive patients in group A (loupes) and same number in group B (microscope). The study included all patients who had single level lumbar microdiscectomy or decompression in the period from the 11th of January 2009 to the 6th of April 2010. To avoid any bias, only patients who failed to attend their follow ups were excluded from the study. The senior author operated on all patients. We noted intra-operative and post-operative complications, further interventions, length of surgery and length of hospital stay. We conducted a telephone questionnaire to collect visual analysis score for pre-op and post-op pain and functional status to calculate Macnab's functional status score. 78 patients (75.6%) answered the questionnaire, 39 patients from each group. There was 1 dural leak in group A.1 patient had discitis in the group A and 1 patient had superficial infection in group B. 4 patients in group A and 1 patient in group B had residual pain requiring intervention. The average length of surgery was one hour and five minutes and one hour and eleven minutes, respectively. Mean hospital stay was 1.43 days and 1.78 days, respectively. The data in the group B was skewed due to one patient who stayed for 9 days after surgery. 25 patients (49%) in group A and 36 patients (70.5%) in group B returned to normal pre-prolapse function and physical activity within 3 months.
Results
There were statistically significant differences found between the two groups with the rate of complications such as dural leak, deep infection and residual pain requiring intervention. Better visualization with microscope could explain the thoroughness of discectomy or decompression leading to less chance of persistent problems. The average length of surgery was slightly higher in the microscope group, as expected, due to draping and preparation time of microscope. Mean hospital stay was slightly higher in group B due to the average being skewed by one patient staying for nine days after operation. Moreover, statistically significant higher number of patients returned to pre-prolapse functional level within 3 months with the use of microscope.
