Effect of Anular Closure on Disk Height Maintenance and Reoperated Recurrent Herniation Following Lumbar Diskectomy: Two-Year Data

BackgroundLumbar disk degeneration (LDD) has been related to heavy physical loading. However, the quantification of the exposure has been controversial, and the dose-response relationship with the LDD has not been established.ObjectiveThe purpose of this study was to investigate the dose-response relationship between lifetime cumulative lifting load and LDD.DesignThis was a cross-sectional study.MethodsEvery participant received assessments with a questionnaire, magnetic resonance imaging (MRI) of the lumbar spine, and estimation of lumbar disk compression load. The MRI assessments included assessment of disk dehydration, annulus tear, disk height narrowing, bulging, protrusion, extrusion, sequestration, degenerative and spondylolytic spondylolisthesis, foramina narrowing, and nerve root compression on each lumbar disk level. The compression load was predicted using a biomechanical software system.ResultsA total of 553 participants were recruited in this study and categorized into tertiles by cumulative lifting load (ie, <4.0 × 105, 4.0 × 105 to 8.9 × 106, and ≥8.9 × 106 Nh). The risk of LDD increased with cumulative lifting load. The best dose-response relationships were found at the L5–S1 disk level, in which high cumulative lifting load was associated with elevated odds ratios of 2.5 (95% confidence interval [95% CI]=1.5, 4.1) for dehydration and 4.1 (95% CI=1.9, 10.1) for disk height narrowing compared with low lifting load. Participants exposed to intermediate lifting load had an increased odds ratio of 2.1 (95% CI=1.3, 3.3) for bulging compared with low lifting load. The tests for trend were significant.LimitationsThere is no “gold standard” assessment tool for measuring the lumbar compression load.ConclusionsThe results suggest a dose-response relationship between cumulative lifting load and LDD.

Download Full-text

Retrospective Analysis of Reoperation Rate After Standard Lumbar Discectomy and Microdiscectomy - Single Center Experience

Serbian Journal of Experimental and Clinical Research ◽

10.2478/sjecr-2019-0023 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Vojin Kovacevic ◽

Nemanja Jovanovic

Keyword(s):

Lumbar Disc ◽

Reoperation Rate ◽

Neurological Deficits ◽

Treatment Modalities ◽

Single Center Experience ◽

Group 4 ◽

Significant Difference ◽

Recurrent Herniation ◽

Clinically Significant

Abstract Discectomy is a surgical procedure in the treatment of lumbar disc herniation (LDH) if sciatica or neurological deficits occur and still persist after a course of conservative therapy. Standard discectomy (SD) and microdiscectomy (MD) are still equal in curent clinical practice. Many retrospective and prospective studies have shown that there is no clinically significant difference in the functional outcome after two treatment modalities. The aim of our study was to determine whether there are differences in the incidence of reoperation after performing SD and MD. The research included 545 patients with average period of postoperative follow-up of approximately 5.75 years. Standard discectomy was performed in 393 patients (72.11%), and micro-discectomy in 152 (27.8%) patients. The total number of reoperated patients was 37/545, or 6.78%. In the SD group, the number of reoperated patients was 33/393 (8.39%) and in the MD group 4/152 or 2.63%. Statistically significant difference (p <0.05) was recorded in favor of the MD group. Although it has been proven that both SD and MD give good endpoints of treatment and similar functional recovery, the advantage is given to microdiscectomy due to statistically significantly lower rates of recurrent herniation. This result is attributed to better visualization of neural structures and pathological substrates, as well as their mutual relationship.

Download Full-text

Outcomes of primary and recurrent inguinal hernia repair with prosthetic mesh in a single region over 15 years

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2020.7084 ◽

2021 ◽

Vol 103 (7) ◽

pp. 493-495

Author(s):

L Smith ◽

D Magowan ◽

R Singh ◽

BM Stephenson

Keyword(s):

Inguinal Hernia ◽

Mesh Repair ◽

Primary Repair ◽

Prosthetic Mesh ◽

Recurrent Inguinal Hernia ◽

Open Approach ◽

Symptomatic Recurrence ◽

Single Region ◽

Open Mesh Repair ◽

Recurrent Herniation

Background Sutured inguinal hernia repairs are now uncommon, with evidence suggesting that those augmented with mesh are associated with a lower recurrence rate. We aimed to explore the suggestion that the established use of mesh does indeed lower the rate of operation for recurrence in a single National Health Service region. Method We collected retrospective Office of Population Censuses and Surveys coded data across one region of all primary and recurrent inguinal hernia repairs over 15 years (2004–2019). Electronic records of recurrent repairs were scrutinised to identify year and type of previous primary repair. Results In total, 7,234 repairs were performed during this time, of which 289 (4%) were for symptomatic recurrence. Operations for primary repair increased year on year (111 in 2004 to 402 in 2019). Frequency of operation for recurrent herniation declined with increasing use of mesh (8.8% in 2004 to 3.5% in 2019). The majority of repairs (73%) for recurrence were by an open approach. As opposed to an open mesh repair, a primary laparoscopic repair was associated with an earlier recurrence. Conclusions Inguinal hernia repairs are increasing in frequency but operations for later symptomatic recurrence following an open primary prosthetic mesh repair are not.

Download Full-text

Revisional Percutaneous Full Endoscopic Disc Surgery for Recurrent Herniation of Previous Open Lumbar Discectomy

Asian Spine Journal ◽

10.4184/asj.2011.5.1.1 ◽

2011 ◽

Vol 5 (1) ◽

pp. 1 ◽

Cited By ~ 22

Author(s):

Kyung Hyun Shin ◽

Ho-Guen Chang ◽

Nam Kyou Rhee ◽

Kwahn Sue Lim

Keyword(s):

Lumbar Discectomy ◽

Disc Surgery ◽

Recurrent Herniation

Download Full-text

Higher risk of dural tears and recurrent herniation with lumbar micro-endoscopic discectomy. Teli M, Lovi A, Brayda-Bruno M, et al. Eur Spine J 2010;19(3):443–50. Epub 2010 Feb 3

The Spine Journal ◽

10.1016/j.spinee.2010.09.006 ◽

2010 ◽

Vol 10 (11) ◽

pp. 1033

Keyword(s):

Endoscopic Discectomy ◽

Recurrent Herniation ◽

Dural Tears

Download Full-text

Crack Growth in Twisted Rubber Disks. Part 3. Effects of Crack Depth and Location

Rubber Chemistry and Technology ◽

10.5254/1.3547802 ◽

2003 ◽

Vol 76 (5) ◽

pp. 1276-1289 ◽

Cited By ~ 11

Author(s):

A. N. Gent ◽

O. H. Yeoh

Keyword(s):

Fracture Energy ◽

Crack Depth ◽

Element Analysis ◽

Crack Location ◽

Crack Behavior ◽

Disk Size ◽

Shallow Crack ◽

Deep Crack ◽

Disk Height ◽

Long Cylinder

Abstract A simple analysis of the fracture energy for a shallow ring crack in a twisted rubber disk is presented and compared to a linear fracture mechanics solution for a similar crack in an infinitely long cylinder. The analysis predicts that the fracture energy increases linearly with crack depth. Since a previous analysis shows that the fracture energy subsequently decreases with crack depth when the crack is deep, it follows that the fracture energy passes through a peak as it transitions from shallow crack to deep crack behavior. The transition occurs when the crack depth becomes comparable to a fraction of the disk height. The analysis is supported by the results of finite element analysis. In addition, the effects of disk size, crack location (in the middle of the cylinder vs. at the bonded ends) and material properties are also considered.

Download Full-text