Microscope-Assisted Tubular Lumbar Discectomy vs Open Microdiscectomy: A Prospective Comparative Study

Background Lumbar disc herniation (LDH) is a leading cause of radiculopathy and disability worldwide. Open microdiscectomy remains the criterion standard, but it requires paraspinal muscle stripping, which may delay recovery. Microscope-assisted tubular discectomy, which combines reusable tubular retractors with a standard operating microscope, is useful in resource-limited settings where endoscopic platforms are unavailable, yet prospective data from such settings are scarce. Objective To determine whether microscope-assisted tubular discectomy is associated with a more favorable perioperative and early recovery profile, with no statistically significant difference in long-term clinical outcomes, compared with open microdiscectomy for single-level LDH. Methods In this prospective comparative study, 150 patients with single-level LDH were enrolled at a tertiary care neurosurgical center (January 2020 to December 2024) and allocated on a nonrandomized basis, determined by operative list scheduling and surgeon availability, to tubular (n = 75) or open microdiscectomy (n = 75). After loss to follow-up, 71 and 72 patients, respectively, were analyzed. All procedures in both arms were performed or directly supervised by a single senior neurosurgeon. Primary outcomes were visual analog scale leg and back pain and Oswestry Disability Index at baseline, 2 weeks, and 3, 6, and 12 months. Secondary outcomes included operative time, blood loss, hospital stay, time to ambulation, and return to work among employed patients. Longitudinal primary outcomes were analyzed with linear mixed-effects models (patient as random intercept; group, time, and group by time as fixed effects). Multivariable regression was adjusted for baseline covariates, and a propensity-score-matched sensitivity analysis was performed to further address confounding from nonrandomized allocation. Results Tubular discectomy was associated with shorter operative time (48.5 vs 72.3 minutes), less blood loss (32.4 vs 78.6 mL), shorter hospital stay (1.2 vs 1.8 days), earlier ambulation (0.8 vs 1.2 days), and faster return to work among employed patients (18.0 vs 28.0 days; n = 60 vs 57; all P < 0.001). Linear mixed-effects models showed significantly lower visual analog scale and Oswestry Disability Index scores in the tubular group at 2 weeks and at 3 and 6 months; between-group differences did not exceed established minimum clinically important difference thresholds, and the difference was not statistically significant at 12 months. Complication (11.3% vs 16.7%, P = 0.39) and recurrence rates were comparable; dural tears occurred in 9.9% vs 4.2% (P = 0.19). A propensity-score-matched sensitivity analysis (58 pairs) reproduced the direction and approximate magnitude of these findings. Conclusions Microscope-assisted tubular discectomy offered meaningful perioperative advantages and faster early recovery, with long-term outcomes not significantly different from open microdiscectomy at 12 months. Given the nonrandomized design and the observational nature of the comparison, these findings should be interpreted as evidence of a favorable perioperative profile rather than a demonstration of long-term superiority. Clinical Relevance Microscope-assisted tubular discectomy using reusable retractors and a standard operating microscope is a safe and efficient alternative to open microdiscectomy, particularly in resource-constrained environments where endoscopic infrastructure is unavailable. Level of Evidence 2.