Three Houston Neurosurgeons have adapted miocrosurgical techniques to repairing ruptured neck discs to make it a less expensive outpatient procedure.

"It is cost-effective, and there is a great deal of patient satisfaction," said Dr. Warren D. Parker of The Neurosurgical Group of Texas. "This operation has been done since the 1940s the way we do it, but no one has done it on an outpatient basis, at least not in the international literature. That's the revolutionary thing."

This month's Journal of Neurosurgery published a study authored by Parker, Dr. J. Bob Blacklock and Dr. Richard L. Harper. The survery of 185 surgeries showed that 91 percent of the patients reported good or excellent results. The study was researched and co-authored by Dr. Christopher R. Tomaras, also of Houston.

Excellent meant being able to work with no or occasional mild pain, and good meant being able to work with mild pain.

Only seven patients reported poor results, defined as being incapable of work and suffering the same or worse pain compared with before the operation. Five of the seven had disability or personal injury claims pending.

The discs are pieces of cartilage that act as shock absorbers between the vertebrae, and the stress occasionally ruptures one, a condition often called a slipped disc or a pinched nerve.

A study on outpatient surgery on lumbar or lower back discs had already been published. The Houston study covering outpatient surgeries from 1993 to 1996 is the first on cervical or neck discs.

One common method of disc repair calls for a large incision in the front of the neck, removal of the disc and replacement with a bone graft, often from the pelvis. The bone fuses the two vertebrae, protecting the spinal cord. Since it can no longer absorb shock, the stress is distributed to all the other discs.

"The problem with the fusion is it is a spine-stiffening operation," Parker said. "When you do that, you're creating a lot of extra wear and tear on the discs above and below the fusion."

That method, called an anterior discectomy and fusion, also required wearing a brace for six weeks and a long recovery, Parker said. A second method, called a laminectomy, is to go in from the back and remove only the disc fragment, leaving the remainder to perform its function. It was this method the Houston surgeons advanced.

They make an incision less than an inch long on the back of the neck for the one and a half hour operation, and the patient can go home three to four hours later. This saves an expensive two-to three-day hospital stay for an inpatient laminectomy and costs less than half the anterior fusion method.

"It was great because it was a day surgery," said Dr. Vestal Caperton, a Conroe family practitioner who was operated on in 1995. "I went in early one morning and went home that evening at 5 o'clock, and I was at work two days later. I was fully functional really quick. It was not very painful."

In the study, the average time for return to work was just short of three weeks. Parker said patients can be running, jumping, and playing golf in three months. The method is also effective for removal of bone spurs, called osteophytes, in the foramen, the opening through which the spinal cord passes.

The surgery is limited to lateral or side ruptures of the disc, but these comprise almost all disc ruptures, Parker said, because the supporting ligament is weakest on the side.

For the rare rupture in the center of the disc, he said, the anterior method should be used because the spinal cord blocks access from the back.