scholarly journals A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

2021 ◽  
Author(s):  
David A. T. Werner ◽  
Margreth Grotle ◽  
Milada Cvancarova Småstuen ◽  
Sasha Gulati ◽  
Øystein P. Nygaard ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Lumbar Disc Herniation ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Prognostic Model ◽  
Clinical Decision Making ◽  
Lumbar Disc ◽  
Multicenter Cohort Study ◽  
Lumbar Microdiscectomy ◽  
Validation Set

Abstract Objective To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. Methods This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. Results The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. Conclusion We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery.

scholarly journals A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Manyoung Kim ◽  
Sol Lee ◽  
Hyeun-Sung Kim ◽  
Sangyoon Park ◽  
Sang-Yeup Shim ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Surgical Methods ◽  
Endoscopic Lumbar Discectomy

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.

Lumbar microdiscectomy in pediatric patients: a large single-institution series

2010 ◽  
Vol 12 (2) ◽  
pp. 165-170 ◽  
Author(s):  
Kevin S. Cahill ◽  
Ian Dunn ◽  
Thorsteinn Gunnarsson ◽  
Mark R. Proctor
Keyword(s):  
Length Of Stay ◽  
Physical Examination ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pediatric Population ◽  
Lumbar Disc ◽  
Csf Leak ◽  
Safe Procedure ◽  
Lumbar Microdiscectomy ◽  
The Mean

Object Lumbar disc herniation is a rare but significant cause of pain and disability in the pediatric population. Lumbar microdiscectomy, although routinely performed in adults, has not been described in the pediatric population. The objective of this study was to determine the surgical results of lumbar microdiscectomy in the pediatric population by analyzing the experiences at Children's Hospital Boston over the past decade. Methods A series of 87 consecutive cases of lumbar microdiscectomy performed by the senior author (M.R.P.) from 1999 to 2008 were reviewed. Presenting symptoms, physical examination findings, and preoperative MR imaging findings were obtained from medical records. Immediate operative results were assessed including operative duration, blood loss, length of stay, and complications, along with long-term outcome and need for repeat surgery. Results This series represents the first surgical series of pediatric microdiscectomies. The mean patient age was 16.6 years (range 12–18 years) and 60% were female. The preoperative physical examination results were notable for motor deficits in 26% of patients, sensory changes in 41%, loss of deep tendon reflex in 22%, and a positive straight leg raise in 95%. Conservative management was the first line of treatment in all patients and the mean duration of symptoms until surgical treatment was 12.2 months. The mean operative time was 110 minutes and the mean postoperative length of stay was 1.3 days. Complications were rare: postoperative infection occurred in 1%, postoperative CSF leak in 1%, and new postoperative neurological deficits in 1%. Only 6% of patients needed repeat lumbar surgery and 1 patient ultimately required lumbar fusion. Conclusions The treatment of pediatric lumbar disc herniation with microdiscectomy is a safe procedure with low operative complications. Nuances of the presentation, treatment options, and surgery in the pediatric population are discussed.

scholarly journals Application of Nomogram Based on Radiomics Label in Prediction of Treatment Scheme for Lumbar Disc Herniation

2021 ◽  
Author(s):  
Gang Yu ◽  
Wenlong Yang ◽  
Jingkun Zhang ◽  
Qi Zhang ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Calibration Curve ◽  
Clinical Decision Making ◽  
Sagittal Plane ◽  
Treatment Plan ◽  
Lumbar Disc ◽  
Characteristic Curve ◽  
Test Group ◽  
Multivariate Logistic Regression Model

Abstract Objective: To investigate and verify the efficiency and effectiveness the the value of nomogram based on radiomics label in predicting the treatment of lumbar disc herniation (LDH). Methods: The clinical medical records and imaging data of 200 patients with LDH diagnosed in the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine in the past 3 years have been analyzed retrospectively. The collected cases are randomly divided into a training group (n=140) and a test group (n=60) with ratio of 7:3. Two radiologists with experience in reading orthopaedics images are independently segmented ROI, the whole intervertebral disc with the most obvious protrusion in the sagittal plane T2WI of lumbar MRI as a mask (ROI) are sketched. The LASSO algorithm is used to filter the features after extracting the radiomics features. The multivariate Logistic regression model is used to construct a quantitative imaging Rad‑Score for the selected features with non-zero coefficients. The radiomics labels and nomogram were evaluated using the receiver operating characteristic curve (ROC) and the area under the curve (AUC). The calibration curve is used to evaluate the consistency between the nomogram prediction and the actual treatment plan. The DCA decision curve is used to evaluate the clinical applicability of nomogram. Result: Following the feature extraction, 11 radiomics features are used to construct the radiomics label for predicting the treatment plan of LDH, The nomogram was then constructed. The AUC was 0.930 (95%CI:0.865-0.995) with a sensitivity of 96.8% and a specificity of 90%. The calibration curve shows that there is a good consistency between the prediction and the actual observation. The DCA decision curve analysis shows that the nomogram of imaging group has a great potential for clinical application when the risk threshold is over 10%. Conclusion: The nomogram based on radiomics label has a good predictive value for the treatment of LDH and therefore can be used as a reference for clinical decision-making.

Analysis of Prognostic Factors in Surgical Treatment for Lumbar Disc Herniation

1997 ◽  
Vol 32 (4) ◽  
pp. 1090 ◽  
Author(s):  
Chung Nam Kang ◽  
Jong Ho Kim ◽  
Dong Wook Kim ◽  
Young Do Koh ◽  
Sang Hoon Go ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc

scholarly journals Evaluation of the Clinical Curative Effect of an O2-O3 mixture to Treat Lumbar Disc Herniation with Different Treatment Sessions

2009 ◽  
Vol 15 (2) ◽  
pp. 159-163 ◽  
Author(s):  
L. Xu ◽  
Z-L. Li ◽  
X-F. He ◽  
D-C. Xiang ◽  
J. Ma ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Clinical Decision Making ◽  
Lumbar Disc ◽  
Clinical Decision ◽  
Effective Rate ◽  
Ozone Therapy ◽  
Curative Effect ◽  
Significant Difference ◽  
The Cost

To compare the effective rates among one week, two week and four week treatment sessions of ozone therapy for lumbar disc herniation to provide a foundation for clinical decision-making. One hundred and eighty-seven lumbar disc herniation patients were divided into three groups, 103 cases for one week, 61 cases for two week and 23 cases for four week treatment sessions. The clinical curative effective rates in the three groups were 82.52%, 85.24% and 95.65% respectively. The effective rate among the three groups showed no significant difference at statistical analysis. Considering the cost-effectiveness of ozone therapy, increasing the treatment course does not enhance the curative effect.

scholarly journals Criteria for failure and worsening after surgery for lumbar disc herniation: a multicenter observational study based on data from the Norwegian Registry for Spine Surgery

2017 ◽  
Vol 26 (10) ◽  
pp. 2650-2659 ◽  
Author(s):  
David A. T. Werner ◽  
Margreth Grotle ◽  
Sasha Gulati ◽  
Ivar M. Austevoll ◽  
Greger Lønne ◽  
...  
Keyword(s):  
Observational Study ◽  
Lumbar Disc Herniation ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Multicenter Observational Study

scholarly journals Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us?

2017 ◽  
Vol 08 (02) ◽  
pp. 194-198 ◽  
Author(s):  
Shearwood McClelland ◽  
Jeffrey A. Goldstein
Keyword(s):  
Pain Relief ◽  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Systematic Reviews ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Cervical Disc ◽  
Readmission Rates

ABSTRACT Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined. Methods: A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion. Results: A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy. Conclusion: The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery, particularly in the current advertising climate greatly favoring MIS.

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