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KMID : 0382619870070020813
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Hanyang Journal of Medicine
1987 Volume.7 No. 2 p.813 ~ p.829
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A Comparative Study on Standard Discectomy, Microsurgical Discectomy and Chemonucleolysis for Herniated Lumbar Disc
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Abstract
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A comparative study was presented on three different therapeutic methods for her-niated lumbar discs, i.e., standard discectomy, microsurgical discectomy and chem-onucleolysis. For seven year period from 1980 to 1987, 3000 patients with her-niated lumbar disc were selected for comprison. Each thousand patients received one of the above three methods. Not only the overall success rate but also various clinical characteristics were compared and analysed with chi-square tests.
Microsurgical discectomy according to Chung´s modified method brought the best results in not only success rate but also in failure and complication rates. The efficacy of chemonucleolysis was relatively low in this comparison, but in selected cases, it was as effective as microsurgical discectomy. Along with its strong advantages in hospital stay, time to return to work and operating time, chemonucleolysis. was the least invasive one: Thus chemonucleolysis could be performed with better expected success rate and the following situations. 1)The age of the patient was less. than 50, 2) radiating pain was a dominant syinptom, 3) the symptom lasted shorter than 1 year, 4) lesions were not in L5-S1 level, 5) the patient had more than 3 abnormal findings in 5 physical and neurological signs, i.e., motor weakness, dermatomal sensory loss, reflex change, positive straight leg raising test and crossed straight leg raising test, and 6) no severe compression in myelograms. In the other two situations, chemonucleolysis could be indicated as an initial treatment. There are 7) patients of over 70-year-old and 8) lesions in more than 3 levels. No serious complications were not found in chemonucleolysis. Meanwhile in the following cases, microsugical discec-tomy should be considered as the first therapeutic method. 1) Patient in the 6th and 7th decades, 2) low back pain as a dominant symptom, 3) duration of symptoms more than 1 year, 4) lesions in L5-S1, 5) only 2 abnormal findings in 5 signs decribed above, and 6) severe compression in myelograms. Standard discectomy did not show any significant Advantages over the two methods in this comparative analysis.
Any single. therapeutic method could not be the best way in the treatment of patients with the herniated lumbar disc. It is desirable to choose the most suitable method for each patient according to not only the success rate of an individual method but also his clinical characteristics, radiological features, surgeon´s experience and preference, and the choice of the patient himself.
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