Is a Microscope Necessary in Cervical Discectomy to Reduce Neurological Injury?: A Prospective Randomized Control Trial.

Abstract

Objective: This study aimed to compare the complications and outcomes of macroscopic and microscopic anterior cervical discectomy.

Methods: In this single-blind randomized clinical trial, 47 patients referred for anterior cervical discectomy and fusion were randomly assigned to two groups: microscopic (n=23) and macroscopic (n=24). Both groups were evaluated and compared regarding 1) complications, including neurological deficits, dural damage, and dysphagia; 2) the amount of intra- and postoperative bleeding; 3) the amount of analgesic administered; 4) length of hospitalization; 5) quality of life before and one month after surgery, using the 12-item short form questionnaire; and 6) time required to return to daily activities.

Results: Complications and neurological deficits were not significantly different between the two groups. Although the preoperative quality of life was not significantly different between the two groups (p=0.458), the microscopic groups had a greater improvement in quality of life after surgery than the macroscopic group (43.04±3.67 vs. 37.84±2.30; p<0.001). However, the microscopic group had a longer surgical duration than the macroscopic group (75.86±9.78 vs. 57.12±2.81 minutes; p<0.001).

Conclusion: Anterior cervical discectomy with an intraoperative microscope increases the surgical duration but is not significantly different from the macroscopic method in terms of neurological deficits and complications. However, the microscopic method may improve the quality of life of patients compared to the macroscopic method during the short-term follow-up.