MONDAY, April 24, 2006 (HealthDay News) -- In a study touted as the most extensive of its kind, a team of surgeons reports that a minimally invasive surgery for herniated spinal discs appears to be better for patients than the traditional approach.
But debate over the best treatment may continue, with one specialist saying the new technique can be "gimmicky" and not always the right choice.
At issue is how to treat herniated discs, which occur when the nucleus of a spinal disc -- the cushioned part of the spine -- pushes into the spinal canal due to a tear or rupture.
"It's sort of a wear-and-tear phenomenon, a degenerative process," said study co-author Dr. Richard G. Fessler, chief of neurosurgery at the University of Chicago. "It's probably one of the most common problems that people will see in their lifetime, particularly up to age 55."
Many people recover from herniated disc on their own, but some require operations. According to estimates, more than one million Americans undergo disc surgery each year to repair the breaches. In the traditional procedure, doctors make an opening 1.5-2 inches long, cut through muscles, push nerves aside and take out the herniated disk, Fessler said.
The surgery has a high rate of success, but the recovery period can be long. Fessler said a newer technique, called microendoscopic discectomy, requires a much smaller incision -- about 2 centimeters -- and doesn't require cutting through muscles.
While surgeons have been using the newer technique for years, there hasn't been good data about the long-term effects of the surgery, Fessler said. So he and colleagues launched the new study.
They tracked outcomes for 114 patients who underwent microendoscopic discectomy treatment between 2002 and 2005. Of the patients, 87 were followed for as long as 18 months to track their recovery.
The findings of the study, funded by Fessler's clinic, were to be reported Monday at the annual meeting of the American Association of Neurological Surgeons in San Francisco.
The Chicago team found that the average operation took nearly two hours and required a hospital stay of 10.2 hours. In comparison to the traditional procedure, the subjects had "less pain, less blood loss, less infection," Fessler said. "They returned to normal faster."
But Dr. A. N. Shamie, director of the Comprehensive Spine Center at the University of California at Los Angeles, was skeptical of the study. He said it only examined patients who received the newer approach and didn't compare them directly to a group of patients who received the traditional technique.
Other approaches can still be better for certain patients, he said. " 'Minimally invasive' is a good technology, which I have adopted in my practice, but it tends to be gimmicky a little bit," he said. "Surgeons use it as an advertising tool to attract patients. But there are a lot of nuances in various diseases that are not clearly apparent to the layperson, and you may do a disservice to the patient by not doing the adequate surgery that's required."
In related research, two other studies presented Monday at the San Francisco meeting found that patients who received artificial discs had speedier recoveries after surgery than patients who underwent an alternate procedure, spinal fusion.
In spinal fusion, surgeons use screws or plates to fuse together two or more vertebrae to create a more stable spine.
The two new studies involved a total of 972 patients. In both cases, researchers found that patients receiving the artificial discs returned to work sooner compared to those undergoing fusion. For example, in one study, patients receiving the Bryan disc returned to work 50 days after the procedure, vs. 74 days for those who underwent spinal fusion surgeries.
More information
To learn more about herniated discs, head to the North American Spine Society.
