Objective assessment of reduced invasiveness in MED
- 31 May 2005
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 15 (5), 577-582
- https://doi.org/10.1007/s00586-005-0912-8
Abstract
Microendoscopic discectomy (MED) has been accepted as a minimally invasive procedure for lumbar discectomy because of the small skin incision and short hospital stay required for this surgery. However, there are few objective laboratory data to confirm the reduced systemic responses in the early phase after this procedure. In order to substantiate the reduced invasiveness of MED compared to microdiscectomy (MD) or procedures involved in one-level unilateral laminotomy, the invasiveness of each surgical procedure was evaluated by measuring serum levels of biochemical parameters reflective of a post-operative inflammatory reaction and damage to the paravertebral muscles. Thirty-three patients who underwent lumbar discectomy or one-level unilateral laminotomy (MED in 15 cases, MD in 11 cases and one-level unilateral laminotomy in 7 cases with lumbar spinal canal stenosis) were included in this study. The serum levels of C-reactive protein (CRP) and creatine phosphokinase (CPK) were measured at 24 h after operation. Interleukin-6 (IL-6) and Interleukin-10 (IL-10) were measured at 2, 4, 8 and -24 h following the surgery to monitor the inflammatory response to the respective surgery. The post-operative serum CRP levels from both the MD and MED groups were significantly lower than those from the open laminotomy group. However, there was no significant difference in these serum levels between the MED and MD groups. The levels of IL-6 and IL-10 in the MED group during the first post-operative day were also significantly lower than those in the laminotomy group. When the MED and MD groups were compared, the IL-6 levels in the MED group were lower than in MD group at 2, 4 and 8 h after surgery, but the differences were not statistically significant. However, the level was significantly lower in the MED group at 24 h after surgery. In terms of IL-10, no significant difference was noted between the MED and MD groups over the study period. The changes in serum levels of post-operative inflammatory: markers (CRP, IL-6 and IL-10) in the early phase indicated reduced inflammatory reactions in MED as well as in MD when compared with classical open unilateral laminotomy. These data draw a direct link between the lower level of the inflammatory response and reduced invasiveness of MED. However, an indicator for muscle damage (CPK) appeared not to be affected by the type of surgical procedure used to correct disc herniation.Keywords
This publication has 22 references indexed in Scilit:
- Video-assisted endoscopic lumbar discectomySurgical Endoscopy, 2001
- Acute-phase changes in children recovering from minor surgeryPediatric Surgery International, 1998
- Systemic stress response after laparoscopic or open cholecystectomy: A randomized trialBritish Journal of Surgery, 1997
- ▪ Focus Issue on Lumbar Disc Herniation: Macro- and MicrodiscectomySpine, 1996
- Systemic cytokine response after major surgeryBritish Journal of Surgery, 1992
- The Caspar Microsurgical Discectomy and Comparison with a Conventional Standard Lumbar Disc ProcedureNeurosurgery, 1991
- The Caspar microsurgical discectomy and comparison with a conventional standard lumbar disc procedureNeurosurgery, 1991
- Acute-phase response of human hepatocytes: Regulation of acute-phase protein synthesis by interleukin-6Hepatology, 1990
- Retrospective Analysis of Microsurgical and Standard Lumbar DiscectomySpine, 1990
- Acute phase protein response to tissue injuryCritical Care Medicine, 1987