Devices for minimally-invasive microdiscectomy: current status and future prospects

ABSTRACT

Introduction: The current gold standard technique for lumbar disc herniation (LDH) is open lumbar microdiscectomy. The use of a tubular retractor system in the microdiscectomy technique can minimize tissue trauma by muscle-splitting sequential dilation during the surgical approach. This review aimed to describe the devices and surgical procedure of this minimally invasive microdiscectomy (MI-MD) and to discuss the pros and cons of the use of tubular retractors.

Areas covered: Published medical literatures were extensively reviewed to summarize the practical devices and techniques related to the MI-MD for LDH. The placement of the tubular retractor by gradual muscle-splitting dilation technique may reduce muscle damage and postoperative wound pain. The use of flexible arm may easily change the tube direction and create a wide surgical field.

Expert opinion: With reference to published literature, the MI-MD provides comparable clinical outcomes with less tissue trauma and early recovery. Development of devices for MI-MD is still ongoing. Extensive studies, including high-quality randomized trials, are required to establish a more practical and relevant MI-MD technique.

KEYWORDS:

• Discectomy
• Lumbar
• Microscopic
• Minimally invasive
• Muscle-splitting
• Tubular retractor

Article highlights

• Minimally invasive microdiscectomy (MI-MD) is a representative minimally invasive spine surgery (MISS) technique.

• Muscle-splitting sequential dilation may reduce paraspinal muscle injury.

• Most of the standard spine surgeons are familiar with the three-dimensional microscopic visualization.

• Variable tubular retractors such as expandable tube and elliptical or rectangular tube can be useful in various surgical situations.

• Supplementary use of laser scalpel or radiofrequency may enhance the effectiveness of MI-MD.

• High-quality randomized trials are required to establish the effectiveness of MI-MD.

• Developments in optics, devices, and surgical approaches are required to make the MI-MD technique more practical and effective.

Acknowledgments

The author would like to thank Hana Kim and Jemin Son for their valuable supports.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer has received a grant for a study on endoscopic herniated disc surgery vs open microdiscectomy. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper is not funded.