scholarly journals Stand-Alone Open Disectomy versus Fixation in Management of Recurrent Lumbar Disc Prolapse

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
I H Sabry ◽  
M S Kabil ◽  
H N Mostafa ◽  
O E Ahmed ◽  
K M M Elshafei
Keyword(s):  
Systematic Review ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Recurrent Disc Herniation ◽  
Significant Difference ◽  
Repeated Surgery ◽  
Dural Tears ◽  
Reoperation Rates ◽  
Recurrent Lumbar Disc Herniation

Abstract Background The strict definition of recurrent disc herniation is the presence of herniated disc material at the same level, ipsi- or contralateral, in a patient who had experienced a pain-free interval of at least 6 months following discectomy. Objective The main objective of the systematic review was to compare the outcome of repeated surgery after these two techniques. Methods In the present systematic review, we evaluated 655 patients from 9 studies undergoing surgery for RLDH. Both procedures stand-alone open discectomy and discectomy with fusion were found to cause significant improvement in symptoms and disability following revision of different surgical techniques used in the primary surgery. These were open surgery. All patients showed no improvement or unsatisfactory outcome after a variable periods of proper conservative treatment. Results From the results of this systematic review concerning the recurrent lumbar disc: Recurrent lumbar disc herniation was common in males due to higher physical stress and activity. Both procedures were found to cause significant improvement in symptoms and disability following revision surgery. Fusion was found to be associated with longer operative time (70 min on average), higher intraoperative EBL (220 ml on average) and delayed hospital discharge (an average of 3 days). No significant differences were found with regards to functional outcomes, reoperation rates and dural tears between the two cohorts. Repeat discectomy alone may cause or exacerbate lumbar instability. Sciatica was the first presenting symptoms in all cases while back pain was present significantly more in patient done discectomy alone. There was no significant difference between the two approaches regarding the sensory deficit or muscle weakness. Treatment options for recurrent disc herniation include observation and aggressive medical management or operative intervention, in this systematic review all patients were managed surgically, after failure of conservative management. The optimal surgical approach for recurrent disc herniation remains a subject of controversy. Discectomy with fusion has several theoretical advantages. Dural tear was the main immediate intraoperative complication. The surgical treatment was successful with excellent or good outcome in the majority of cases with no significant difference between the two approaches and it is widely accepted that the results after repeated surgery are comparable to those of the first surgery. There was no significant factor influencing the outcome of surgery including age, sex, diabetes, duration of symptoms or pain-free interval and level or side of recurrence. Conclusion Surgery for recurrent lumbar disc herniation can be very successful and may approach the success rate for initial operations provided proper patient selection, good and thorough examination and investigations and proper surgical technique. Available evidence shows that in treating recurrent lumbar discs herniation, repeat discectomy and fusion are associated with comparable reoperation rates, incidence of dural tears, functional outcomes as well as satisfaction with surgical treatment at last follow-up. The findings should be viewed within the context of variable length of follow-up in the included studies; as such, the true long term implications of fusion as compared to repeat discectomy remain to be elucidated. Longitudinal randomized controlled trials are needed to provide firm evidence in this field.

Braking reaction time before and after surgery for patients with recurrent lumbar disc herniation

2019 ◽  
Vol 31 (1) ◽  
pp. 15-19
Author(s):  
Ricarda Lechner ◽  
David Putzer ◽  
Martin Krismer ◽  
Christian Haid ◽  
Alois Obwegeser ◽  
...  
Keyword(s):  
Reaction Time ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Positive Impact ◽  
Lumbar Disc ◽  
Control Group ◽  
Recurrent Disc Herniation ◽  
Before And After ◽  
Recurrent Lumbar Disc Herniation

OBJECTIVEThe positive effect of primary lumbar disc surgery on braking reaction time (BRT) has already been shown. The authors investigated the effect of recurrent lumbar disc herniation surgery on BRT.METHODSTwenty-four patients (mean age 49.9 years) were investigated for BRT 1 day before surgery, postoperatively before hospital discharge, and 4 to 5 weeks after surgery. Thirty-one healthy subjects served as a control group.RESULTSSignificant improvement of BRT following surgery was found in all patients (p < 0.05). For patients with right-sided recurrent disc herniation, median BRT was 736 msec before surgery, 685 msec immediately postoperatively, and 662 msec at follow-up. For patients with left-sided recurrent disc herniation, median BRT was 674 msec preoperatively, 585 msec postoperatively, and 578 msec at follow-up. Control subjects had a median BRT of 487, which differed significantly from the patient BRTs at all 3 test times (p < 0.05).CONCLUSIONSA significant reduction in BRT in patients with recurrent disc herniation was found following lumbar disc revision surgery, indicating a positive impact of surgery. Due to the improvement in BRT observed immediately after surgery, we conclude that it is appropriate to recommend that patients keep driving after being discharged from the hospital.

Comparison of Outcomes Postoperation between Straight Leg Raising Test Negative and Positive Patients Who Underwent Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation

2019 ◽  
Author(s):  
Feilong Wei ◽  
Haoran Gao ◽  
Yifang Yuan ◽  
Shu Qian ◽  
Quanyou Guo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Related Factors ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Straight Leg Raising ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Relevant Factors

Abstract Background: Percutaneous Transforaminal Endoscopic Discectomy is used increasingly in patients with Lumbar Disc Herniation. There is little knowledge on the related factors including SLR test influencing the operation. Therefore, we designed this prospective study to explore the relevant factors influencing postoperative effect of PTED surgery.Methods: Consecutive patients with LDH who came to our hospital from August 2015 to September 2016 and received PTED surgery. 4 kinds of scales including VAS (lumbar/leg), ODI and JOA were measured and reassessed at 1 day, 3 months, 6 months, 12months and 36 months after the PTED to assess their surgical outcomes. Results: All the patients had successful surgery. ODI and VAS (lumbar/leg) decreased in all patients and groups. And there was a statistically significant difference in each postoperative follow-up compared with that before surgery in every visit. In addition, the increase of JOA in postoperation was statistically significant compared with that before surgery. And, there is statistically significant difference between the three subpopulations (patients with SLR Positive (0°-30°), SLR Positive (31°-60°) and SLR Negative (61°-) in the changes of the scores of VAS(leg), ODI and JOA. However, there is no statistically significant difference between the three subpopulations (patients with SLR Positive (0°-30°), SLR Positive (31°-60°) and SLR Negative (61°--RRB- in the changes of the score of VAS(lumbar). Conclusions: PTED showed great effect on treating patients with lumbar disc herniation. And the main scale score such as VAS(leg). ODI and JOA showed that there is a statistically significant difference between the three subpopulations treated by PTED. Patients with SLR negative may get greater benefit from PTED.

A comparison between repeat discectomy versus fusion for the treatment of recurrent lumbar disc herniation: Systematic review and meta-analysis

2019 ◽  
Vol 66 ◽  
pp. 202-208
Author(s):  
Chotetawan Tanavalee ◽  
Worawat Limthongkul ◽  
Wicharn Yingsakmongkol ◽  
Panya Luksanapruksa ◽  
Weerasak Singhatanadgige
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Recurrent Lumbar Disc Herniation

Is the Effect of Intervertebral Foramen Endoscopic Surgery on Adjacent Segmental Degeneration Better Than That of Open Surgery?

2021 ◽  
Author(s):  
wang shunmin ◽  
kaiqiang sun ◽  
aigang liu ◽  
rongzi chen ◽  
xi luo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Endoscopic Surgery ◽  
Lumbar Disc ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Intervertebral Foramen ◽  
Significant Difference ◽  
Endoscopic Discectomy

Abstract Background To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) and endoscopic discectomy in the treatment of postoperative adjacent segment degeneration in patients with lumbar disc herniation. Methods From 2014 to 2017, 87 patients who were diagnosed with single-level lumbar disc herniation (LDH) and received surgery of TLIF (group X, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up. The neurological function was originally evaluated by the (JOA) score of the Japanese Orthopaedic Association. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration pfirrmann score.Results There was no significant difference in average operation age, JOA improvement rate, reoperation rate and complications between the two groups. The average blood loss, average hospital stays and average operation time in group F were lower than those in group X. During the last follow-up, HIS, CA and FA decreased in both groups, and the changes in group X were more significant than those in group X (P < 0.05). There was no significant difference in postoperative FH between the two groups, but it decreased more in group X (P < 0.05).Conclusion Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar adjacent segment degeneration after intervertebral foraminal surgery is lower.

scholarly journals Outcome analysis of patients after ligament-sparing microdiscectomy for lumbar disc herniation

2002 ◽  
Vol 13 (2) ◽  
pp. 1-4 ◽  
Author(s):  
Youn-Kwan Park ◽  
Joo-Han Kim ◽  
Heung-Seob Chung
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Successful Outcome ◽  
Outcome Analysis ◽  
Safe Procedure ◽  
Repeated Surgery ◽  
Independent Assessment

Object The authors describe a microsurgical technique for the preservation of the ligamentum flavum and the long-term surgery-related results, including an independent assessment of outcome. Methods Three hundred seventy-seven patients underwent ligament-sparing microsurgical discectomy for a previously untreated single-level lumbar disc herniation and were followed for more than 2 years. A successful outcome at 6 months was demonstrated in 93.9% of the patients. At a median follow-up period of 30 months, successful patient-assessed outcome was 84.1%. During the mean follow-up period of 4.2 years (range 2–6.5 years), recurrent disc herniation was detected in 18 patients (4.8%). These patients all underwent repeated surgery. The overall surgery-related rate of complications was 1.3%. Conclusions The authors conclude that ligament-sparing microdiscectomy is a safe procedure, with a favorable success rate and minimal morbidity. Reoperation is safer and easier when using this technique compared with traditional ones.

scholarly journals Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Binbin Wu ◽  
Gonghao Zhan ◽  
Xinyi Tian ◽  
Linyu Fan ◽  
Chenchen Jiang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Lumbar Discectomy ◽  
Low Back ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Significant Difference ◽  
Endoscopic Lumbar Discectomy

Background. Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty (TF PELD) were developed for lumbar disc herniation (LDH) patients. However, the safety and effectiveness between the TF PELF and TF PELD have not been investigated. Methods. Of the included 140 LDH patients, 62 patients received TF PELF (PELF group) and 78 patients received TF PELD (PELD group). The operation time, the duration of staying at the hospital, and complication incidences were recorded. All patients were followed up for 2 years, where low back and leg visual analogue scale (VAS) pain ratings and Oswestry Disability Index (ODI) were compared between the 2 groups before and after surgery. Modified Macnab criterion was estimated for all patients at postoperative 2 years. Results. There were no significant difference of the operation time, number of days staying at the hospital, and the incidence of complications between the 2 groups (P>0.05). Two cases in the PELF group and 1 case in the PELD group received a second surgery due to unrelieved symptoms postoperatively. Low back and leg VAS and ODI scores decreased in both groups after operation (P<0.01), respectively, but were not significant between the 2 groups over time (P>0.05). Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up; thus, only 131 patients completed Macnab evaluation. The satisfactory rate was reported as 80.4% in the PELF group and 90.7% in the PELD group (P>0.05). Conclusions. This study suggested that the safety and effectiveness of TF PELF are comparable to TF PELD for LDH patients.

Radiological predictors of recurrent lumbar disc herniation: a systematic review and meta-analysis

2020 ◽  
pp. 1-11
Author(s):  
Michael Brooks ◽  
Ashraf Dower ◽  
Muhammad Fahmi Abdul Jalil ◽  
Saeed Kohan
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Imaging Modality ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Segmental Motion ◽  
Radiological Parameters ◽  
Recurrent Lumbar Disc Herniation

OBJECTIVELumbar discectomy for the management of lumbar radiculopathy is a commonly performed procedure with generally excellent patient outcomes. However, recurrent lumbar disc herniation (rLDH) remains one of the most common complications of the procedure, often necessitating repeat surgery. rLDH is known to be influenced by a variety of factors, and in this systematic review the authors aimed to explore the radiological predictors of recurrence.METHODSA systematic review and meta-analysis was conducted to identify studies analyzing radiological predictors of recurrent herniation, both ipsilateral and contralateral. A search was conducted on Medline and EMBASE. Both retrospective and prospective comparative studies were included, measuring radiological parameters of lumbar discectomy patients. All factors were considered irrespective of imaging modality, and a meta-analysis of the data was performed in which 5 or more studies were identified analyzing the same parameter.RESULTSIn total, 1626 reported studies were screened, with 23 being included in this review, of which 13 were appropriate for meta-analysis. Three factors, namely disc height index, Modic changes, and sagittal range of motion, were determined to be significantly correlated with an increased rate of rLDH. Some variables were considered in only 1 or 2 different studies, and the authors have included a narrative review of these novel findings.CONCLUSIONSThe findings of associations between the radiological parameters and rLDH implicates the role of instability in the development of recurrence. Understanding the physiological factors associated with instability is important, because although early degenerative disc changes may predispose patients to herniation recurrence, more advanced degeneration likely reduces segmental motion and concurrently risk of recurrence.

scholarly journals Does paravertebral ozone injection have efficacy as an additional treatment for acute lumbar disc herniation? A randomized, double-blind, placebo-controlled study

2021 ◽  
pp. 1-9
Author(s):  
Hamza Sucuoğlu ◽  
Nalan Soydaş
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Additional Treatment ◽  
Controlled Study ◽  
Placebo Control ◽  
Double Blind ◽  
Significant Difference ◽  
New Treatment

OBJECTIVE: In this study we investigate the effects of paravertebral ozone injections (POI), which have been used as a new treatment approach for lower back pain in recent years, on pain and physical activity in patients with acute lumbar disc herniation (LDH) as an additional treatment. METHODS: Thirty-eight patients were assigned into the ozone therapy (OT) group (n= 20) and placebo control (PC) group (n= 18). Both groups received two sessions per week, a total of 8 sessions of lumbar POI. The ozone concentrations of 20–25 μg/ml (30 ml) and 0.1 μg/ml (30 ml) were administered to the OT and PC groups, respectively. The patients were assessed with the visual analog scale (VAS) and Oswestry Disability Index (ODI) before the treatment (V1), 15 (V2) and 30 (V3) days after the treatment started, and one month (V4) after the treatment ended. RESULTS: A significant improvement was seen in the VAS and ODI scores in the final follow-up (V4) as compared with the baselines scores (V1) in both groups (P< 0.05). The patients in the OT group had lower mean VAS and ODI scores in V2, V3, and V4 follow-ups compared with the patients in the PC group. This significant difference reached its peak in the final follow-up (V4) (P< 0.05). CONCLUSION: As an additional treatment combined with conservative treatment, lumbar POI can lessen pain and disability in patients with acute LDH.

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