Endoscopic discectomy may be good alternative to microdiscectomy for sciatica
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Percutaneous transforaminal endoscopic discectomy may be a good alternative to open microdiscectomy for treatment of sciatica, according to results presented at the North American Spine Society Annual Meeting.
Pravesh Gadjradj, MD, PhD, and colleagues randomly assigned 613 patients with sciatica caused by lumbar disc herniation to undergo either percutaneous transforaminal endoscopic discectomy (n=304) or open microdiscectomy (n=309). Researchers considered VAS for leg pain as the primary outcome measure. During 1- and 2-year follow-up, researchers also measured VAS for back pain, Oswestry Disability Index (ODI), cost, SF-36 and quality of life VAS.
Researchers reported an 87% follow-up at 1 year and a 92% follow-up at 2 years. Although the groups had no differences in VAS for leg pain 6 weeks after surgery, Gadjradj noted there was a statistically significant difference between the two groups by 12 months in favor of the percutaneous transforaminal endoscopic discectomy group. The two groups also had small statistically significant differences in the ODI, VAS for back pain, quality of life VAS and the physical component summary of the SF-36 in favor of the percutaneous transforaminal endoscopic discectomy group; however, Gadjradj noted the differences may not reach a clinically relevant threshold.
“Duration of surgery was similar. Estimated blood loss was less in the endoscopic group,” Gadjradj said in his presentation. “Complications were less in the endoscopic group, mobilization was earlier in the endoscopic group and the rate of repeated surgery within 1 year was similar (5.3% vs. 5.6%).”
Patients in the percutaneous transforaminal endoscopic discectomy group had lower cost of primary care, secondary care, medication, informal care, absenteeism, presenteeism and unpaid productivity loss compared with open microdiscectomy, according to Gadjradj. However, Gadjradj noted the percutaneous transforaminal endoscopic discectomy group had higher surgical costs.
“As [endoscopic] surgery is more effective and has less costs, it’s a no brainer and it shows dominance in cost-effectiveness,” Gadjradj said. “It has almost 100% chance of being cost effective at whatever willingness to pay.”
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Gadjradj P, et al. Paper 178. Presented at: North American Spine Society Annual Meeting. Sept. 29 - Oct. 2, 2021; Boston (hybrid meeting).
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