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Clin Neurol Neurosurg. 2016 Jun;145:74-8. doi: 10.1016/j.clineuro.2016.04.004. Epub 2016 Apr 9.

Serum creatine phosphokinase levels as an indicator of muscle injury following lumbar disc surgery: Comparison of fully endoscopic discectomy and microdiscectomy.

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Department of Neurosurgery, Liv Hospital, Istanbul, Turkey. Electronic address:
Department of Neurosurgery, Private Asia Hospital, Istanbul, Turkey.
Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.
Department of Neurosurgery, Liv Hospital, Istanbul, Turkey.
Department of Anethesiology and Reanimation, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey.



The aim of this study is to make a comparison between fully endoscopic lumbar discectomy (FELD) and conventional microdiscectomy (MD) by using pre- and postoperative serum creatine phosphokinase (CPK) levels in correlation with postoperative low-back pain.


Fortyfive consecutive patients who underwent surgery for lumbar disc herniation were allocated into three groups with 15 patients on each: (1) FELD with interlaminar approach (IL), (2) FELD with transforaminal approach (TF), (3) Conventional MD. Serum CPK levels pre- and 1, 6, 12 and 24h postoperatively, patients' body mass index (BMI), operation duration and hospital stays were recorded. The low-back pain pre- and postoperatively was assessed with the use of the 100mm visual analog scale (VAS) and the "Oswestry Disability Index" (ODI).


There were 16 female (35.5%) and 29 male (64.5%) patients with a mean age of 44.1 years. CPK levels at 6th, 12th and 24th hours postoperatively were found significantly lower in TF and IL groups compared to MD group (p<0.004). Mean operation duration was significantly shorter in MD group (p: 0.014). There was a significant decrease in both the VAS and ODI scores after the surgery in all patient groups (p<0.001). Postoperative VAS scores were found significantly higher in MD group (p: 0.04).


Minimal invasive nature of FELD procedures compared to the MD was substantiated by serum CPK levels in this study. To draw definitive conclusions regarding pain relief, larger patient samples should be evaluated, although postoperative VAS scores were found in favor of FELD.


Creatine phosphokinase; Fully endoscopic; Interlaminar; Microdiscectomy; Minimally invasive; Muscle injury; Transforaminal

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