Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes

Study Design: Systematic review and meta-analysis. Objective: To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4. Methods: A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), P = .66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), P = .08. Conclusion: Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.

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COMPARATIVE STUDY OF EFFICIENCY OF DESTANDAU ENDOSCOPIC DISCECTOMY AND OPEN MICROSURGICAL DISCECTOMY FOR LUMBAR DISC HERNIATION

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.1.63-68 ◽

2005 ◽

pp. 063-068 ◽

Cited By ~ 3

Author(s):

Aleksandr Evgenyevich Simonovich ◽

Sergey Petrovich Markin

Keyword(s):

Surgical Treatment ◽

Surgical Complications ◽

Lumbar Disc ◽

Analog Scale ◽

Endoscopic Intervention ◽

Endoscopic Discectomy ◽

Disc Herniations ◽

Invasive Method ◽

Hospital Stays ◽

Operation Results

Objectives. To estimate efficiency, safety and traumatizing impact of endoscopic discectomy in comparison with traditional microsurgical discectomy. Material and methods. A total of 330 patients underwent Destandau endoscopic discectomy and 964 – open microsurgical discectomy. The operative times, terms of patient postoperative bed and hospital stays, postoperative dynamics of neurologic deficiency, surgical complications and frequency of herniation recurrences were estimated in both groups. Pain intensity was assessed with the 10-score Visual Analog Scale (VAS), and functional activity – with the Oswestry Disability Index (ODI). Results of surgical treatment were estimated in 8–10 days, 6 and 12 months after operation. Results. VAS and ODI data have not revealed essential distinctions in pain regression dynamics after endoscopic and open surgeries. Surgical complications after endoscopic intervention were not more often, than after microsurgical discectomy. Damage of dura mater occurred in 2.4 % of cases, and increase in neurologic deficiency (hypoesthesia) – in 0.6 %. Herniation recurrences have evolved in 3.0 % of cases after endoscopic discectomy and in 4.7 % – after open microsurgical one. Conclusion. Destandau endoscopic surgery is a low invasive method of effective treatment for lumbar disc herniations, which by its technical opportunities and results is competitive with classical open microsurgical discectomy.

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The Surgical Treatment of Single Level Multi-Focal Subarticular and Paracentral and/or Far-Lateral Lumbar Disc Herniations: The Single Incision Full Endoscopic Approach

The International Journal of Spine Surgery ◽

10.14444/1016 ◽

2014 ◽

Vol 8 ◽

pp. 16 ◽

Cited By ~ 9

Author(s):

James J. Yue ◽

David L. Scott ◽

Xiao Han ◽

Alem Yacob

Keyword(s):

Surgical Treatment ◽

Single Incision ◽

Lumbar Disc ◽

Endoscopic Approach ◽

Single Level ◽

Disc Herniations ◽

Far Lateral

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Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

Ideggyógyászati Szemle ◽

10.18071/isz.74.0027 ◽

2021 ◽

Vol 74 (1-2) ◽

pp. 27-32

Author(s):

Sevket Evran ◽

Salim Katar

Keyword(s):

Surgical Treatment ◽

Functional Capacity ◽

Pain Control ◽

Steroid Injection ◽

Lumbar Disc ◽

Radicular Pain ◽

Disc Herniations ◽

Transforaminal Epidural Steroid Injection ◽

Far Lateral ◽

Epidural Steroid

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of patient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

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Outcome after Surgical Treatment for Late Recurrent Lumbar Disc Herniations in Standard Open Microsurgery

World Neurosurgery ◽

10.1016/j.wneu.2016.02.028 ◽

2016 ◽

Vol 89 ◽

pp. 382-386 ◽

Cited By ~ 4

Author(s):

Niels Buchmann ◽

Alexander Preuß ◽

Jens Gempt ◽

Yu-Mi Ryang ◽

Martin Vazan ◽

...

Keyword(s):

Surgical Treatment ◽

Lumbar Disc ◽

Disc Herniations

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A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification

Advances in Orthopedics ◽

10.1155/2013/270565 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

A. F. Ozer ◽

F. Keskin ◽

T. Oktenoglu ◽

T. Suzer ◽

Y. Ataker ◽

...

Keyword(s):

Surgical Treatment ◽

Disc Herniation ◽

Lumbar Disc ◽

Dynamic Stabilization ◽

Great Effort ◽

Type I ◽

Invasive Approach ◽

Segmental Instability ◽

Recurrent Disc Herniation ◽

Disc Herniations

Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations.

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