• Pritem A Rajamani, Praveen Goparaju, Arvind G Kulkarni, Shekhar Y Bhojraj, S Rajasekaran, Harvinder Singh Chhabra, Shankar Acharya, Achimuthu Rajamani, Abhay Nene, Ajoy Prasad Shetty, Paresh Chandra Dey, Arun Bhanot, Pramod V Lokhande, and Priyank Patel.
• Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital & Medical Research Centre, Mumbai, India.
• World Neurosurg. 2021 Dec 1; 156: e319-e328.

ObjectivesVarious techniques of performing lumbar discectomy are prevalent, each having its rationale and claimed benefits. The authors ventured to assess the perioperative factors, outcomes, and complications of each procedure and compare among them with 946 patients contributed by 10 centers and operated by experienced surgeons.MethodsThis was a retrospective study of patients operated using open discectomy, microdiscectomy, microendoscopic discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques with a follow-up of minimum 2 years. The inclusion criteria were age >18 years, failed conservative treatment for 4-6 weeks, and the involvement of a single lumbar level.ResultsThere was a significant improvement in the visual analog scale score of back, leg, and Oswestry Disability Index scores postoperatively across the board, with no significant difference between them. Minimally invasive procedures (microendoscopic discectomy, interlaminar endoscopic lumbar discectomy, transforaminal endoscopic lumbar discectomy, and Destandau techniques) had shorter operation time, hospital stay, better cosmesis, and decreased blood loss compared with open procedures (open discectomy and microdiscectomy). The overall complication rate was 10.1%. The most common complication was recurrence (6.86%), followed by reoperation (4.3%), cerebrospinal fluid leak (2.24%), wrong level surgery (0.74%), superficial infection (0.62%), and deep infection (0.37%). There were minor differences in incidence of complications between techniques.ConclusionAlthough minimally invasive techniques have some advantages over the open techniques in the perioperative factors, all the techniques are effective and provide similar pain relief and functional outcomes at the end of 2 years. The various rates of individual complications provide a reference value for future studies.Copyright © 2021 Elsevier Inc. All rights reserved.

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