scholarly journals Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chi Heon Kim ◽  
Yunhee Choi ◽  
Chun Kee Chung ◽  
Ki-Jeong Kim ◽  
Dong Ah Shin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Short Form ◽  
Lumbar Disc ◽  
Nonsurgical Treatment ◽  
Nonsurgical Management ◽  
Sf 36 ◽  
Patient Reported ◽  
Short Form Health

AbstractPhysicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.

scholarly journals Predictive outcome factors in the young patient treated with lumbar disc herniation surgery

2016 ◽  
Vol 25 (4) ◽  
pp. 448-455 ◽  
Author(s):  
Fredrik Strömqvist ◽  
Björn Strömqvist ◽  
Bo Jönsson ◽  
Paul Gerdhem ◽  
Magnus K. Karlsson
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Short Form ◽  
Lumbar Disc ◽  
Young Patients ◽  
Leg Pain ◽  
Short Form Health

OBJECTIVE The aim of this study was to evaluate predictive factors for outcome after lumbar disc herniation surgery in young patients. METHODS In the national Swedish spine register, the authors identified 180 patients age 20 years or younger, in whom preoperative and 1-year postoperative data were available. The cohort was treated with primary open surgery due to lumbar disc herniation between 2000 and 2010. Before and 1 year after surgery, the patients graded their back and leg pain on a visual analog scale, quality of life by the 36-Item Short-Form Health Survey and EuroQol–5 Dimensions, and disability by the Oswestry Disability Index. Subjective satisfaction rate was registered on a Likert scale (satisfied, undecided, or dissatisfied). The authors evaluated if age, sex, preoperative level of leg and back pain, duration of leg pain, pain distribution, quality of life, mental status, and/or disability were associated with the outcome. The primary end point variable was the grade of patient satisfaction. RESULTS Lumbar disc herniation surgery in young patients normalizes quality of life according to the 36-Item Short-Form Health Survey, and only 4.5% of the patients were unsatisfied with the surgical outcome. Predictive factors for inferior postoperative patient-reported outcome measures (PROM) scores were severe preoperative leg or back pain, low preoperative mental health, and pronounced preoperative disability, but only low preoperative mental health was associated with inferiority in the subjective grade of satisfaction. No associations were found between preoperative duration of leg pain, distribution of pain, or health-related quality of life and the postoperative PROM scores or the subjective grade of satisfaction. CONCLUSIONS Lumbar disc herniation surgery in young patients generally yields a satisfactory outcome. Severe preoperative pain, low mental health, and severe disability increase the risk of reaching low postoperative PROM scores, but are only of relevance clinically (low subjective satisfaction) for patients with low preoperative mental health.

scholarly journals Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring: a technique note report

2019 ◽  
Author(s):  
Tong Yu ◽  
Jiu-Ping Wu ◽  
Jun Zhang ◽  
Hai-Chi Yu ◽  
Tian-Yang Yuan ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Screw Fixation ◽  
Short Form ◽  
Lumbar Disc ◽  
Intraoperative Neuromonitoring ◽  
Percutaneous Screw Fixation ◽  
Intervertebral Fusion ◽  
Sf 36

Abstract Abstract Background: Open discectomy and intervertebral fusion surgery, including posterior lumbar intervertebral fusion (PLIF), anterior lumbar intervertebral fusion (ALIF), oblique lateral lumbar intervertebral fusion (OLIF), transforaminal lumbar intervertebral fusion (TLIF), and direct lateral lumbar intervertebral fusion (DLIF), are the common strategies for lumbar disc herniation (LDH), but they require quite a long recovery period. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF) has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays, and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. Methods: a 51-year-old male with left lower extremity pain and numbness for 1 year was diagnosed with lumbar disc herniation (LDH). This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin’s triangle. Each step of the operation was performed under INM. Results: The follow-up period lasted 1 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 minutes. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, nonunion, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. Conclusion: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar’s exiting nerve root directly with minimal invasion in selected patients.

scholarly journals Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

2018 ◽  
Vol 21 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Julio D. Montejo ◽  
Joaquin Q. Camara-Quintana ◽  
Daniel Duran ◽  
Jeannine M. Rockefeller ◽  
Sierra B. Conine ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pediatric Patients ◽  
Lumbar Disc ◽  
Low Back ◽  
Duration Of Symptoms ◽  
Patient Reported ◽  
The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

scholarly journals Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients

2021 ◽  
pp. 1-9
Author(s):  
Joel Beck ◽  
Olof Westin ◽  
Helena Brisby ◽  
Adad Baranto
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Outcome ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Preoperative Pain ◽  
Data Set ◽  
Patient Reported ◽  
Pain Duration

OBJECTIVESciatica is the hallmark symptom of a lumbar disc herniation (LDH). Up to 90% of LDH patients recover within 12 weeks regardless of treatment. With continued deteriorating symptoms and low patient quality of life, most surgeons recommend surgical discectomy. However, there is not yet a clear consensus regarding the proper timing of surgery. The aim of this study was to evaluate how the duration of preoperative leg pain (sciatic neuralgia) is associated with patient-reported levels of postoperative leg pain reduction and other patient-reported outcome measures (PROMs) in a prospectively collected data set from a large national cohort.METHODSAll patients aged 18–65 years undergoing a lumbar discectomy during 2013–2016 and registered in Swespine (the Swedish national spine registry) with 1 year of postoperative follow-up data were included in the study (n = 6216). The patients were stratified into 4 groups according to preoperative pain duration: < 3, 3–12, 12–24, or > 24 months. Patient results assessed with the numeric rating scale (NRS) for leg pain (rated from 0 to 10), global assessment of leg pain, EQ-5D, Oswestry Disability Index (ODI), and patient satisfaction with the final surgical outcome were analyzed and compared with preoperative values and between groups.RESULTSA significant improvement was seen 1 year postoperatively regardless of preoperative pain duration (change in NRS score: mean −4.83, 95% CI −4.73 to −4.93 in the entire cohort). The largest decrease in leg pain NRS score (mean −5.59, 95% CI −5.85 to −5.33) was seen in the operated group with the shortest sciatica duration (< 3 months). The patients with a leg pain duration in excess of 12 months had a significantly higher risk of having unchanged radiating leg pain 1 year postoperatively compared with those with < 12-month leg pain duration at the time of surgery (OR 2.41, 95% CI 1.81–3.21, p < 0.0001).CONCLUSIONSPatients with the shortest leg pain duration (< 3 months) reported superior outcomes in all measured parameters. More significantly, using a 12-month pain duration as a cutoff, patients who had a lumbar discectomy with a preoperative symptom duration < 12 months experienced a larger reduction in leg pain and were more satisfied with their surgical outcome and perception of postoperative leg pain than those with > 12 months of sciatic leg pain.

scholarly journals Patient Reported Outcomes Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Oliver G S Ayling ◽  
Tamir T Ailon ◽  
Nicolas Dea ◽  
Charles Fisher
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Outcome Research ◽  
Patient Reported Outcomes ◽  
Lumbar Disc ◽  
The United States ◽  
Patient Reported

Abstract INTRODUCTION Canada has a universal health care system that is government funded and access to specialist care requires a referral by general practitioners. The United States utilizes a blended public and private payer system where insured patients can directly access specialists. The purpose of this study is to investigate whether there are differences in outcomes in the two systems. METHODS Surgical lumbar disc herniation patients treated between 2013 and 2016 in Canada that were enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry. The Canadian cohort was compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Baseline demographics and spine-related patient reported outcomes (PROs) were compared at 3 mo and 1 yr postoperatively. RESULTS The CSORN cohort consisted of 703 patients and the SPORT cohort was made up of 573 patients. The rate of females in each cohort was similar (47.2% vs 46.4%, P = .78), however, patients in the CSORN cohort were older (46.2 13.2 vs 41.6 10.9, P < .001), had a higher rate of smoking (32.0% vs 22.8%, P < .001), and were more likely to be employed (66.9% vs 61.3%, P = .034). The CSORN cohort had a slightly lower Owestry Disability score at baseline (50.515.1 vs 55.7 19.6, P < .01) but had a higher proportion of patients with a symptom duration greater than 6 mo (44.5% vs 21.1%, P < .0001). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 mo (74.8% vs 65.3%, P = .003) and 1 yr (81.4% vs 68.7%, P < .001). Improvements in back and leg pain followed similar trajectories. CONCLUSION Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) reported higher rates of satisfaction at 3 mo and 1 yr postoperatively compared to the United States cohort (SPORT) despite having longer durations of symptoms prior to surgery.

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