Lumbar Microdiscectomy: Historical Perspective and Techniques
Lumbar Microdiscectomy: Historical Perspective and Techniques
A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome. A modification of the lumbar microdiscectomy technique is described including patient positioning in the lateral position as well as minimal disc space and nerve root manipulation. In their experience performing more than 3000 microdiscectomies, the authors have produced good-to-excellent clinical results in nearly 90% of patients, with the majority returning to work within 1 month. The complication rate of dural tears, discitis, or root injury has been less than 2%, with a reoperation rate of 5%. The authors believe that lumbar microdiscectomy remains the gold standard with which all other discectomy techniques must be compared.
Lumbar discectomy has become the most common neurosurgical procedure in the US, with nearly 300,000 procedures performed each year because of the epidemic problem of low-back pain, which leads to 15 million physician visits per year and has created a tremendous financial burden on society exceeding $50 billion annually. A retrospective analysis of Workers' Compensation claims at a large industrial manufacturer within the US found 19% of claims were related to back injuries, and these claims were responsible for a disproportionate 41% of total injury costs. Low-back pain causes nearly 80% of injured workers to miss at least 8 weeks of work following a back injury. In persons younger than 45 years old, low-back pain is the most frequent cause of activity limitation. Although only 2% of patients with low-back pain have an acute disc herniation, a disproportionate 30% of US annual costs for the treatment of low-back pain are spent on this relatively small percentage of patients. We review of the history of lumbar disc disease with a focus on the evolution of surgical treatment leading toward microdiscectomy and then present lessons learned from more than 2500 lumbar microdiscectomies performed by the senior author.
A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome. A modification of the lumbar microdiscectomy technique is described including patient positioning in the lateral position as well as minimal disc space and nerve root manipulation. In their experience performing more than 3000 microdiscectomies, the authors have produced good-to-excellent clinical results in nearly 90% of patients, with the majority returning to work within 1 month. The complication rate of dural tears, discitis, or root injury has been less than 2%, with a reoperation rate of 5%. The authors believe that lumbar microdiscectomy remains the gold standard with which all other discectomy techniques must be compared.
Lumbar discectomy has become the most common neurosurgical procedure in the US, with nearly 300,000 procedures performed each year because of the epidemic problem of low-back pain, which leads to 15 million physician visits per year and has created a tremendous financial burden on society exceeding $50 billion annually. A retrospective analysis of Workers' Compensation claims at a large industrial manufacturer within the US found 19% of claims were related to back injuries, and these claims were responsible for a disproportionate 41% of total injury costs. Low-back pain causes nearly 80% of injured workers to miss at least 8 weeks of work following a back injury. In persons younger than 45 years old, low-back pain is the most frequent cause of activity limitation. Although only 2% of patients with low-back pain have an acute disc herniation, a disproportionate 30% of US annual costs for the treatment of low-back pain are spent on this relatively small percentage of patients. We review of the history of lumbar disc disease with a focus on the evolution of surgical treatment leading toward microdiscectomy and then present lessons learned from more than 2500 lumbar microdiscectomies performed by the senior author.
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