caa a22 4500 445831170 CHVBK 20180317145315.0 cr unu---uuuuu 170323e20110101xx s 000 0 eng 10.1007/s00586-010-1482-y doi (NATIONALLICENCE)springer-10.1007/s00586-010-1482-y Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial [Elektronische Daten] [Mark Arts, Ronald Brand, Bas van der Kallen, Geert Lycklama à Nijeholt, Wilco Peul] The concept of minimally invasive lumbar disc surgery comprises reduced muscle injury. The aim of this study was to evaluate creatine phosphokinase (CPK) in serum and the cross-sectional area (CSA) of the multifidus muscle on magnetic resonance imaging as indicators of muscle injury. We present the results of a double-blind randomized trial on patients with lumbar disc herniation, in which tubular discectomy and conventional microdiscectomy were compared. In 216 patients, CPK was measured before surgery and at day 1 after surgery. In 140 patients, the CSA of the multifidus muscle was measured at the affected disc level before surgery and at 1year after surgery. The ratios (i.e. post surgery/pre surgery) of CPK and CSA were used as outcome measures. The multifidus atrophy was classified into three grades ranging from 0 (normal) to 3 (severe atrophy), and the difference between post and pre surgery was used as an outcome. Patients' low-back pain scores on the visual analogue scale (VAS) were documented before surgery and at various moments during follow-up. Tubular discectomy compared with conventional microdiscectomy resulted in a nonsignificant difference in CPK ratio, although the CSA ratio was significantly lower in tubular discectomy. At 1year, there was no difference in atrophy grade between both groups nor in the percentage of patients showing an increased atrophy grade (14% tubular vs. 18% conventional). The postoperative low-back pain scores on the VAS improved in both groups, although the 1-year between-group mean difference of improvement was 3.5mm (95% CI; 1.4-5.7mm) in favour of conventional microdiscectomy. In conclusion, tubular discectomy compared with conventional microdiscectomy did not result in reduced muscle injury. Postoperative evaluation of CPK and the multifidus muscle showed similar results in both groups, although patients who underwent tubular discectomy reported more low-back pain during the first year after surgery. The Author(s), 2010 Creatine phosphokinase nationallicence Muscle injury nationallicence Atrophy nationallicence Microdiscectomy nationallicence Herniated disc nationallicence Low-back pain nationallicence Arts Mark Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK, The Hague, The Netherlands aut Brand Ronald Department of Medical Statistics and BioInformatics, Leiden University Medical Center, Leiden, The Netherlands aut van der Kallen Bas Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands aut Lycklama à Nijeholt Geert Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands aut Peul Wilco Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK, The Hague, The Netherlands aut European Spine Journal Springer-Verlag 20/1(2011-01-01), 51-57 0940-6719 20:1<51 2011 20 586 https://doi.org/10.1007/s00586-010-1482-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-010-1482-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Arts Mark Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Brand Ronald Department of Medical Statistics and BioInformatics, Leiden University Medical Center, Leiden, The Netherlands aut NATIONALLICENCE 700 1- van der Kallen Bas Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Lycklama à Nijeholt Geert Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands aut NATIONALLICENCE 700 1- Peul Wilco Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK, The Hague, The Netherlands aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/1(2011-01-01), 51-57 0940-6719 20:1<51 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer