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J Neurol Surg A Cent Eur Neurosurg 2024; 85(06): 561-569
DOI: 10.1055/s-0043-1775760
Original Article

Transforaminal Endoscopic Lumbar Diskectomy versus Open Microdiskectomy for Symptomatic Lumbar Disk Herniation: A Comparative Cohort Study on Costs and Long-Term Outcomes

Sajjad Saghebdoust
1   Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
2   Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
3   Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
,
Farshid Khadivar
4   Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
,
Mehran Ekrami
3   Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
,
Mohammad Ali Abouei Mehrizi
3   Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
,
Amir Valinezhad Lajimi
3   Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
,
Mohammad Reza Rouhbakhsh Zahmatkesh
1   Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
3   Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
,
Neda Pak
5   Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
,
Morteza Faghih Jouibari
2   Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
,
Seyed Shahab Ghazi Mirsaeed
6   Department of Neurosurgery, Golestan Hospital, Tehran, Iran
,
Mohammad Reza Boustani 
2   Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
6   Department of Neurosurgery, Golestan Hospital, Tehran, Iran
› Author Affiliations Funding None.
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Abstract

Background Transforaminal endoscopic lumbar diskectomy (TELD) is considered an effective treatment for lumbar disk herniation (LDH). There is a paucity of studies comparing in detail the costs and long-term clinical outcomes of TELD and open microdiskectomy (MD), especially in developing countries. Thus, we sought to provide a multidimensional insight into this matter by comparing the direct costs and long-term outcomes of TELD with those of MD.

Methods The electronic health records of 434 patients with LDH who underwent either TELD or MD were collected from February 2011 to October 2014. Within a 7-year follow-up period, 412 patients, comprising 203 patients treated with TELD and 209 patients treated with MD, were fully evaluated. Patient characteristics, operative time, intraoperative blood loss (IBL), postoperative hospital stay, time to return to work (RTW), perioperative complications, and direct costs were collected. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria.

Results The postoperative ODI and VAS scores improved significantly in both groups (p < 0.001). In accordance with the modified MacNab criteria, the rate of excellent and good outcomes was 88.67 and 88.03% in the TELD and MD groups, respectively. There were no significant differences between the groups in the clinical outcomes and perioperative complications. However, IBL, hospital stay, and RTW were significantly reduced in the TELD group (p < 0.05). Twenty-one cases in the TELD group and nine in the MD group underwent reoperation due to recurrence (p < 0.05). Total inpatient cost per patient was $1,596 in the TELD group and $1,990 in the MD group (p < 0.05).

Conclusion TELD for the treatment of symptomatic LDH could be an affordable strategy, providing certain advantages of minimally invasive procedures such as shorter hospital stay and earlier recovery along with comparable clinical outcomes to the conventional surgical method.

Keywords

lumbar disk herniation - transforaminal endoscopic lumbar diskectomy - microdiskectomy - long-term outcomes - costs


Publication History

Received: 17 February 2023

Accepted: 14 August 2023

Article published online:
25 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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