Evidence-Based Recommendations for Spine Surgery

Alexander R. Vaccaro, MD, PhD, MBA; Charles G. Fisher, MD; Srinivas K. Prasad, MD; Alpesh A. Patel, MD, FACS; John Chi, MD, MPH; Kishore Mulpuri, MBBS, MHSc; Kenneth C. Thomas, MD, MHSc; Peter G. Whang, MD, FACS


Spine. 2020;45(21):E1441-E1448. 

In This Article

Abstract and Introduction


Overdevest GM, Peul WC, Brand R, et al Tubular discectomy versus conventional microdiscectomy for the treatment of lumbar disc herniation: long-term results of a randomised controlled trial. J Neurol Neurosurg Psychiatry 2017; 88:1008–1016.

Lumbar discectomy remains one of the most commonly performed spinal operations and is recognized as being an effective treatment for radiculopathy secondary to a disc herniation that is superior to nonsurgical modalities.[1,2] The conventional technique utilizes an open incision with some form of magnification (i.e., loupes, microscope). More recently, a number of less invasive procedures have been described including a discectomy with placement of a tubular retractor which requires a smaller incision and may lead to less disruption of the surrounding soft tissues. Consequently, it has been proposed that a "tubular discectomy" may be associated with a number of potential benefits relative to open microdiscectomy such as decreased blood loss, reduced postoperative pain, shorter length of stay, and more rapid rehabilitation. While numerous comparative studies have been conducted, there continues to be a paucity of definitive evidence demonstrating the superiority of so-called "minimally invasive" strategies.[3–10] In addition, none of these series provided long-term follow-up of these cohorts. To this end, Overdevest et al[11] published the 5-year results of a clinical trial assessing the clinical and functional outcomes of patients randomized to undergo either open or tubular lumbar discectomy.