Beginner's Consecutive Series of Lumbar Microdiscectomy during Neurosurgical Training—5 year Outcome of Beginner's Pitfalls and Comparison with the Other Series

There is no study that compares the beginner with the more experiences about the postoperative results of lumbar microdiscectomy. The object of this study is to investigate the outcome after lumbar microdiscectomy performanced by a beginner in spinal surgery, compared to the other series. A consecutive series of 86 patients were followed for a mean of 57 months in the 83 of them. We used both axial and sagittal direction for classifying the herniation according to computerized tomography and/or magnetic resonance image. Preoperatively, we identified several special conditions, as recurrent disc herniation at the same level and on the same side, lateral recess stenosis, axillar or extraforaminal types of herniations and congenital lumbosacral anomaly. In the axillar type, the fragment of disc was removed through the axilla. Medial type was performed by the hemilateral approach on the dominant symptom side. Extraforaminal disc herniations were approached from the midline via submuscular dissection going laterally to the intertransverse window. Recurrent herniation at the same level and on the same side was approached via an extended approach from the scarfree dura. Outcomes were assessed using Oswestry Disability Index(ODI). At final follow-up, the mean ODI was 11.4. Eighty one percent had minimal disability and 8% had moderate disability. The success rate was 89%. The recurrence rate and reoperation rate were 3.6% respectively. Even the beginner in spinal neurosurgery can perform safe microdiscectomy under appropriate supervision for every type of herniation. The precise analysis and planning of the operation yields good results. (Received August 5, 2009;accepted November 13, 2009)