Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period.

Park, Beom Seok; Kwon, Young Joon; Won, Yu Sam; Shin, Hyun Chul

doi:2010.48.3.225

Original Article

Journal of Korean Neurosurgical Society 2010;48(3): 225-229.
doi: https://doi.org/10.3340/jkns.2010.48.3.225

Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period.

Beom Seok Park, Young Joon Kwon, Yu Sam Won, Hyun Chul Shin

Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. neuriac@skku.edu

ABSTRACT

OBJECTIVE
The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness.
METHODS
Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients).
RESULTS
The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period.
CONCLUSION
Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain.

Key Words: Lumbar spine; Muscle sparing technique; Microdiscectomy; Minimally invasive surgery