scholarly journals Lumbar discectomy with annulus fibrosus closure: a retrospective series of 53 consecutive patients

2022 ◽  
Author(s):  
Arthur R. Kurzbuch ◽  
Constantin Tuleasca ◽  
Jean-Yves Fournier
Keyword(s):  
Annulus Fibrosus ◽  
Lumbar Discectomy

scholarly journals Three-year results from a randomized trial of lumbar discectomy with annulus fibrosus occlusion in patients at high risk for reherniation

2019 ◽  
Vol 161 (7) ◽  
pp. 1389-1396 ◽  
Author(s):  
Jenny C. Kienzler ◽  
◽  
Peter Douglas Klassen ◽  
Larry E. Miller ◽  
Richard Assaker ◽  
...  
Keyword(s):  
High Risk ◽  
Randomized Trial ◽  
Annulus Fibrosus ◽  
Lumbar Discectomy

scholarly journals A Pilot Study of Full-Endoscopic Annulus Fibrosus Suture Following Lumbar Discectomy: Technique Notes and One-Year Follow-Up

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E497-E505
Author(s):  
Zhen-zhou Li
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Annulus Fibrosus ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Group I ◽  
Interlaminar Approach ◽  
One Year ◽  
Endoscopic Lumbar Discectomy

Background: An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation. Objective: The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture. Study Design: This study used a prospective cohort design. Setting: The research was conducted in a hospital and outpatient surgery center. Methods: A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded. Results: All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P < .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P > .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the oneyear follow-up (P < .01), but the tendon reflex did not recover significantly (P > .05). Limitations: This is an observational cohort study with relatively small sample sizes and short-term follow-up. Conclusions: Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy. Keywords: Annulus fibrosus suture; full-endoscope; lumbar disc herniation; lumbar discectomy; minimally invasive spinal surgery

scholarly journals Pain Variability of Tissues Under Endoscope in Percutaneous Endoscopic Lumbar Discectomy and Its Significance: A Retrospective Study

2021 ◽  
Vol 24 (6) ◽  
pp. E877-E882
Keyword(s):  
Nerve Root ◽  
Annulus Fibrosus ◽  
Ligamentum Flavum ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Dural Sac ◽  
Vas Scores ◽  
Endoscopic Lumbar Discectomy

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD), as a representative minimally invasive spine surgery technique for lumbar disc herniation (LDH), has been standardized. In PELD, tissues such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate were exposed, removed, and decompressed. However, during PELD, whether there is pain or not in the tissues under endoscope in LDH patients has never been thoroughly discussed in the previous research. OBJECTIVES: The purpose of the study is to evaluate tissue pain variability during PELD as for the treatment of LDH, to provide references and guideline for the operation, and to give humanistic care for patients. STUDY DESIGN: A retrospective analysis. SETTING: All data were collected from Shandong Provincial Hospital Affiliated to Shandong First Medical University. METHODS: From January 2008 to December 2020, 3,600 patients with LDH were enrolled in this retrospective study. All patients suffered from low back and leg pain because of LDH and underwent PELD. The pain of these tissues under endoscope was assessed according to the Visual Analog Scale (VAS) scores for the back and legs (VAS-B and VAS-L, respectively). RESULTS: For VAS-B, the tissues were ranked from the highest VAS scores to the lowest in the following order: posterior longitudinal ligament; next, dural sac/nerve root; then, endplate/annulus fibrosus/ligamentum flavum. For VAS-L, they were in the following order: dural sac/nerve root; next, posterior longitudinal ligament; then, endplate/annulus fibrosus/ligamentum flavum. LIMITATIONS: Retrospective nature of data collection. CONCLUSIONS: Tissues, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, have different kinds of pain in PELD for LDH. KEY WORDS: Percutaneous endoscopic lumbar discectomy, visual analog scale, lumbar disc herniation, pain

PEID (Percutaneous Endoscopic Interlaminar Discectomy): Cautionary Points Based on the Evidence

2018 ◽  
Vol 1 (2) ◽  
pp. 7
Author(s):  
Jun Ho Lee
Keyword(s):  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Radiographic Evaluation ◽  
Operative Indication ◽  
Endoscopic Techniques ◽  
Bone Removal ◽  
Iatrogenic Trauma ◽  
Minimal Damage ◽  
Surgical Modality ◽  
Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) is one of the most sophisticated operative procedures for the treatment of lumbar disc herniation (LDH). Endoscopic techniques are now becoming standard in many areas due to expanded technical possibilities of full-endoscopic transforaminal or interlaminar resection of herniated lumbar discs as well as stenosis. However conventional percutaneous endoscopic interlaminar discectomy (PEID) disc operations may sometimes result in subsequent untoward complications due to unnoticed iatrogenic trauma to neural structures, which is mostly related to an anatomical limitation during endoscope insertion.Methods: An appropriate operative indication of the PEID without bone removal or laminectomy can be used to treat LDH cases with an enough interlaminar space (at least ≥ 20 mm by bi-facetal distance) from the reported evidences. Otherwise, there might be several indications for requirement of bone removal; a narrow interlaminar space, disappearance of the concave shape of the upper vertebral laminae, high-grade migration of LDH, recurrent LDH, obesity, or an immobile nerve root.Conclusion: The significance of PEID lies also in its minimal damage to surrounding structures such as muscle, bone, and ligaments. A discrete radiographic evaluation from the patient preoperatively is mandatory before choosing a proper endoscopic surgical modality for the sake of optimal clinical outcome after PEID. 

Association of time to surgery with leg pain after lumbar discectomy: is delayed surgery detrimental?

2020 ◽  
Vol 32 (2) ◽  
pp. 160-167 ◽  
Author(s):  
Alessandro Siccoli ◽  
Victor E. Staartjes ◽  
Marlies P. de Wispelaere ◽  
Marc L. Schröder
Keyword(s):  
Rating Scale ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Lumbar Discectomy ◽  
Cox Proportional Hazards Model ◽  
Neurological Deficits ◽  
Leg Pain ◽  
Specific Method ◽  
Time To Surgery ◽  
Patient Reported

OBJECTIVEWhile it has been established that lumbar discectomy should only be performed after a certain waiting period unless neurological deficits are present, little is known about the association of late surgery with outcome. Using data from a prospective registry, the authors aimed to quantify the association of time to surgery (TTS) with leg pain outcome after lumbar discectomy and to identify a maximum TTS cutoff anchored to the minimum clinically important difference (MCID).METHODSTTS was defined as the time from the onset of leg pain caused by radiculopathy to the time of surgery in weeks. MCID was defined as a minimum 30% reduction in the numeric rating scale score for leg pain from baseline to 12 months. A Cox proportional hazards model was utilized to quantify the association of TTS with MCID. Maximum TTS cutoffs were derived both quantitatively, anchored to the area under the curve (AUC), and qualitatively, based on cutoff-specific MCID rates.RESULTSFrom a prospective registry, 372 patients who had undergone first-time tubular microdiscectomy were identified; 308 of these patients (83%) obtained an MCID. Attaining an MCID was associated with a shorter TTS (HR 0.718, 95% CI 0.546–0.945, p = 0.018). Effect size was preserved after adjustment for potential confounders. The optimal maximum TTS was estimated at 23.5 weeks based on the AUC, while the cutoff-specific method suggested 24 weeks. Discectomy after this cutoff starts to yield MCID rates under 80%. The 24-week cutoff also coincided with the time point after which the specificity for MCID first drops below 50% and after which the negative predictive value for nonattainment of MCID first surpasses ≥ 20%.CONCLUSIONSThe study findings suggest that late lumbar discectomy is linked with poorer patient-reported outcomes and that—in accordance with the literature—a maximum TTS of 6 months should be aimed for.

EFFICACY OF ANTIBIOTICS PROPHYLAXIS IN PATIENTS WITH LUMBAR DISC HERNIATION UNDERGOING LUMBAR DISCETOMY

2018 ◽  
Vol 8 (5) ◽  
pp. 14-19
Author(s):  
Tri Truong Van ◽  
Tri Tran Duc Duy ◽  
Khai Vo Le Quang
Keyword(s):  
Surgical Site Infection ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
University Hospital ◽  
Site Infection ◽  
Surgical Wound ◽  
A Prospective Study ◽  
Length Of Hospitalization

Introduction: Surgical wound infection in developing coutries is about 3%. Antibiotics prophylaxis may help to reduce the surgical site infection. The objective of this study was to evaluate the efficacy of antibiotics prophylaxis in patients with lumbar disc herniation who were treated with lumbar discectomy at Hue University hospital. Materials and Methods: A prospective study was conducted at Hue University hospital from March 2015 to May 2018 on 54 patients with lumbar disc herniation who were used antibiotics prophylaxis when undergoing discectomy. Results: The infection rate in our study was 0%. Antibiotics prophylaxis reduced the length of hospitalization as well as the medical cost. Conclusion: Antibiotics prophylaxis was effective in preventing surgical site infection despite the fact that the condition of operating rooms did not meet the standard rules. Key words: prophylaxis antibiotics, lumbar disc herniation

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