Microsurgical techniques for the lumbar spine

With the increasing trend toward ambulatory surgery, many ideas are being tried to facilitate this advance. One such idea is the use of the operating microscope to reduce wound size. There is a tug-of-war between the Orthopedic and Neurosurgical disciplines as to whether the microscope is a useful adjunct to surgery for degenerative lumbar spine problems. Although numerous studies show no difference in the outcomes between standard diskectomy and microsurgical diskectomy, these authors are firmly in the camp of using the operating microscope. A recent study has shown that the operating microscope leads to safer and faster diskectomy on an outpatient basis. In addition, the use of the operating microscope has been extended to many other procedures for the degenerative lumbar spine. The open diskectomy, whether microscope-assisted or not, remains the 'gold-standard' for treatment of the lumbar disk herniation. Barriers to lessen scar tissue need further study before the technique is universally accepted. (C) 2000 Lippincott Williams and Wilkins, Inc.