(Press-News.org) Hamilton, ON (Nov. 26, 2014) - McMaster University researchers have found that current evidence does not support the routine use of minimally invasive surgery to remove herniated disc material pressing on the nerve root or spinal cord in the neck or lower back.
In comparing it with open surgery, they found that while minimally invasive surgery for cervical or lumbar discectomy may speed up recovery and reduce post-operative pain, it does not improve long-term function or reduce long-term extremity pain.
Minimally invasive surgery for discectomy also requires advanced technical expertise and may be associated with increased risks of neurologic injury, incidental damage to the outer covering of the brain and spinal cord, and further surgery.
The study, published today in CMAJ Open, was led by Nathan Evaniew, a physician who is a research fellow in orthopedics and a PhD student in health research methodologies at McMaster's Michael G. DeGroote School of Medicine.
"Surgeons already perform open discectomies through relatively small incisions. Selecting the right patients and providing technically adequate nerve-root decompression are probably the most important determinants of long-term outcomes," said Evaniew. "So, we were not surprised to find that outcomes are essentially the same between minimally invasive and open discectomies."
People affected by symptomatic neck and lower back spinal disc diseases make up at least five per cent of the population and they suffer with pain, disability and loss of income. For carefully selected patients who fail to improve with nonsurgical management, conventional open discectomy surgery often provides good or excellent results, said Evaniew.
Minimally invasive techniques for discectomy surgery were introduced as alternatives that are potentially less morbid, but they require specialized equipment and may involve increased risks for technical complications, he added.
Evaniew and his colleagues performed a meta-analysis of previous studies to examine the effects of minimally invasive versus open surgery on functional outcomes, pain, complications and reoperations among patients undergoing cervical or lumbar discectomy.
They searched the MEDLINE, Embase and Cochrane Library databases for reports of relevant randomized controlled trials and reviewed four trials involving 431 patients in the cervical discectomy group, and 10 trials involving 1,159 patients in the lumbar discectomy group.
"Many spinal surgery procedures are known to have difficult learning curves, and surgeons embarking on minimally invasive surgical techniques should obtain specialized training to minimize complications," the authors write. "Conventional open techniques for spinal surgery are themselves technically demanding, and minimally invasive techniques are likely even more challenging."
In addition to concluding that current research evidence does not support the routine use of minimally invasive surgery for cervical or lumbar discectomy, the researchers also found an overall lack of high-quality research, which suggests further well-designed trials are needed.
INFORMATION:
Editors:
The study may be found here: http://www.cmajopen.ca/
For more information:
Veronica McGuire
Media Relations
Faculty of Health Sciences
McMaster University
vmcguir@mcmaster.ca
905-525-9140, ext. 22169
This news release is available in German. The human brain continuously collects information. However, we have only basic knowledge of how new experiences are converted into lasting memories. Now, an international team led by researchers of the University of Magdeburg and the German Center for Neurodegenerative Diseases (DZNE) has successfully determined the location, where memories are generated with a level of precision never achieved before. The team was able to pinpoint this location down to specific circuits of the human brain. To this end the scientists used a ...
The evolution of freshwater shrimps species living in both sides of Central America, isolated by the closure of Isthmus of Panama (3 million years ago) were studied by molecular tools. Despite the small likelihood of species crossing the Isthmus from one side to the other through the channel exist, the genetic isolation of them were maintained over the time and the separation of Pacific and Atlantic sister species still unchanged. Sister species refer to pairs of species that are genetically and morphologically closely related, but reproductively isolated.
The collection ...
A new paper, by Dr Stanley Blue, lecturer in Social Sciences at The University of Manchester, claims that there needs to be a shift in public health policy, with less focus on efforts to change individual behaviour and more attention on breaking social habits and practices that are blindly leading us into bad health.
Theories of practice and public health: understanding (un)healthy practices is published in the journal, Critical Public Health, and written by Dr Stanley Blue, lecturer at the School of Social Sciences, Prof Elizabeth Shove, of Lancaster University, Prof ...
CLEVELAND, Ohio (November 26, 2014)--Removing ovaries at hysterectomy does not increase a woman's risk of pelvic organ prolapse after menopause. In fact, removing ovaries lowers the risk of prolapse. This surprising finding from a Women's Health Initiative study was published online this week in Menopause, the journal of The North American Menopause Society (NAMS).
Whether to remove ovaries at hysterectomy for reasons other than cancer is a subject of hot debate. Removing them reduces the risk of breast cancer and dramatically reduces the risk of ovarian cancer. On the ...
For several years, it has been known that superfluid helium housed in reservoirs located next to each other acts collectively, even when the channels connecting the reservoirs are too narrow and too long to allow for substantial flow. A new theoretical model reveals that the phenomenon of mysterious communication "at a distance" between fluid reservoirs is much more common than previously thought.
Liquids in containers that are at a distance from each other may behave collectively, even if the channels connecting the reservoirs are so narrow and long that they prevent ...
Enzymes are macromolecular biological catalysists that lead most of chemical reactions in living organisms. The main focus of enzymology lies on enzymes themselves, whereas the role of water motions in mediating the biological reaction is often left aside owing to the complex molecular behavior. The groups of Martina Havenith (Cluster of Excellence RESOLV - Ruhr explores Solvation) and Irit Sagi (Weizmann Institue of Science, Israel) revised the classical enzymatic steady state theory by including long-lasting protein-water coupled motions into models of functional catalysis. ...
A study reveals how little we know about the Amazonian diversity. Aiming to resolve a scientific debate about the validity of two species of freshwater shrimp described in the first half of the last century, researchers have found that not only this species is valid, but also discovered the existence of a third unknown species. The researchers concluded that these species evolved about 10 million years ago. The study was published in the open access journal ZooKeys.
The great biodiversity in Amazonia is an issue widely studied. However, the real number of species in this ...
This news release is available in Spanish.
"Let's suppose that we need a system for monitoring vital signs in a home for the elderly; preferably a wireless system. Using the deployed standard, the sensors that will be communicating via Bluetooth are connected to each other. "The elderly individuals in the home are fitted with these sensors which are used to measure their body temperature, heart rate, etc. and to forward the data to the nursing department," pointed out Josu Etxaniz-Marañón. "Time is a critical factor in a network of this type, and ...
An international team of scientists which includes researchers from the U. of Granada has demonstrated for the first time that it is possible to establish in an objective way the level of fatigue in physicians after long shifts through their eye movement.
This research reveals that the speed of saccadic movement (mostly voluntary rapid eye movements which we use to focus our gaze upon an object that attracts our attention) is an excellent index to measure objectively the level of fatigue in the medical profession.
In an article published in Annals of Surgery (the most ...
An Andalusian team of researchers led by the University of Granada has demonstrated the efficacy of a new drug against cancerogenic stem cells, which cause the onset and development of cancer, of relapse after chemotherapy and metastasis. This drug, called Bozepinib, has proved to be effective in tests with mice. The results have been published in the prestigious journal Oncotarget.
Cancerogenic stem cells appear in small quantities in tumours, and one of their important features is that they contribute to the formation of metastasis in different places within the original ...
