Clinical Outcome of Minimally Invasive Spine Surgery (MIS) Discectomy Using a Tubular Retractor System
Keywords:
Minimally invasive spine surgery, tubular system, discectomy, clinical outcomeAbstract
Background: Lumbar disc herniation is one of the most common conditions affecting the lumbar spine, often causing severe radicular pain and neurological deficits. Traditional open discectomy involves significant paraspinal muscle disruption, leading to postoperative pain and prolonged recovery. Minimally invasive spine surgery (MIS) with a tubular retractor system offers a muscle-splitting “key-hole” approach, potentially reducing soft-tissue trauma, blood loss, and hospital stay.
Aim: To evaluate the clinical outcomes of MIS discectomy using a tubular system in patients presenting to our tertiary care centre.
Methodology: This retrospective study included all patients who underwent tubular-system MIS discectomy between January 2023 and March 2024. Thirty-one patients (any age, socioeconomic status, or symptom duration) with single-level disc prolapse confirmed on MRI were enrolled. Exclusion criteria were prior lumbar surgery, scoliosis, multilevel herniation, canal stenosis, or spondylolisthesis. Outcomes were assessed by pre- and postoperative Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and modified Macnab score, with follow-up ranging from 6 to 12 months. Intraoperative metrics (blood loss, operative time), hospital stay, analgesic use, and complications were recorded. Statistical analysis used paired t-tests (SPSS v27.0), with p < 0.05 considered significant.
Results: Mean age group of patients in our study was 53 with male preponderance. Clinical outcome was determined by VAS, ODI, and Modified Macnab Score. Mean pre-operative VAS score was 8.5 which reduced to 2.03 postoperatively (p value < 0.001, t = 47.17). Mean pre-operative and post-operative ODI scores were 77 and 11.8 respectively (p value < 0.001, t = 27.752). Post-operative Modified Macnab Score was excellent in 51.6%, good in 45%, and poor in 1 (3%). Mean blood loss was 40 ml. The mean operative time was 210 mins. We had an overall complication rate of 6.5%, with a durotomy rate of 6.5% seen in two patients. Re-operation rate was 3.2% [1].
Conclusion: Tubular-system MIS discectomy yields excellent to good clinical outcomes in 97% of cases, with significant pain and disability reduction, minimal blood loss, and early return to work. Although operative times are longer—reflecting the learning curve—MIS provides a muscle-sparing, infection-reducing approach that matches conventional outcomes and enhances patient satisfaction.
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