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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C. y de la Sociedad Iberolatinoamericana de Columna. SILACO.

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2026, Number 2

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Cir Columna 2026; 4 (2)

Efficacy and safety of minimally invasive techniques for lumbosacral decompression in patients with radicular pain: a retrospective analysis of hemilaminectomy, discectomy, and ''over-the-top'' technique in a secondary-level hospital

Esparza PJA, Uribe LM

Language: Spanish
References: 28
Page: 102-109
PDF size: 1629.01 Kb.


ABSTRACT

Introduction: minimally invasive spine surgery (MISS) has significantly improved the surgical management of lumbosacral pathologies such as lumbar disc herniation (LDH) and spinal canal stenosis. MISS techniques enable an effective neural decompression while minimizing tissue disruption, resulting in lower morbidity and faster recovery compared to traditional open surgery. Material and methods: this retrospective study analyzed the efficacy and safety of three MISS techniques—tubular discectomy, hemilaminectomy, and bilateral decompression via a unilateral "over-the-top" approach—compared to conventional open surgery. A total of 35 patients treated at a secondary-level hospital were included. Data were collected on age, sex, surgical technique, complications, reoperations, use of biportal endoscopy, the surgical learning curve with microscope and drill, iatrogenic instability, hospital stay duration, residual pain, intraoperative bleeding, and hospital readmissions. Statistical analysis was performed to identify significant associations between surgical technique and clinical outcomes. Results: among the 35 patients, 18 underwent tubular microscopic MISS, 14 received conventional open surgery, and three underwent biportal endoscopic decompression. The average age of patients undergoing MISS was 38.7 years, significantly lower than those treated with open surgery (60.3 years). Overall complication and reoperation rates were 5.7% (two patients each), with no statistically significant association between the surgical technique and either complications (p = 0.367) or reoperations (p = 0.90). MISS approaches demonstrated observable advantages such as reduced blood loss and shorter hospital stays. Representative clinical cases and the influence of the learning curve, particularly regarding the use of the microscope and drill, were documented. Conclusion: the findings suggest that MISS techniques are both safe and effective in the management of radicular pain due to neural compression, even in non-tertiary care settings. These procedures offer clinical benefits including lower morbidity and faster recovery. The study underscores the importance of incorporating MISS training in surgical education to overcome the initial learning curve. In conclusion, MISS represents a viable, modern, and cost-effective alternative to conventional open surgery for appropriately selected patients.


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