A Novel Approach to the Surgical Treatment of Lumbar Disc Herniations: Indications of Simple Discectomy and Posterior Transpedicular Dynamic Stabilization Based on Carragee Classification

Surgery of lumbar disc herniation is still a problem since Mixter and Barr. Main trouble is dissatisfaction after the operation. Today there is a debate on surgical or conservative treatment despite spending great effort to provide patients with satisfaction. The main problem is segmental instability, and the minimally invasive approach via microscope or endoscope is not necessarily appropriate solution for all cases. Microsurgery or endoscopy would be appropriate for the treatment of Carragee type I and type III herniations. On the other hand in Carragee type II and type IV herniations that are prone to develop recurrent disc herniation and segmental instability, the minimal invasive techniques might be insufficient to achieve satisfactory results. The posterior transpedicular dynamic stabilization method might be a good solution to prevent or diminish the recurrent disc herniation and development of segmental instability. In this study we present our experience in the surgical treatment of disc herniations.

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Microendoscopic discectomy for recurrent disc herniations

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.3.11 ◽

2003 ◽

Vol 15 (3) ◽

pp. 1-4 ◽

Cited By ~ 28

Author(s):

Robert E. Isaacs ◽

Vinod Podichetty ◽

Richard G. Fessler

Keyword(s):

Disc Herniation ◽

Nerve Root ◽

Lumbar Disc ◽

Cerebrospinal Fluid Leak ◽

Open Approach ◽

Recurrent Disc Herniation ◽

Previous Operation ◽

Endoscopic Discectomy ◽

Disc Herniations ◽

Microendoscopic Discectomy

Object The use of microendoscopic discectomy (MED) for the treatment of primary lumbar disc herniations has become fairly well accepted; its role in recurrent disc herniations is less clear. The reluctance of many surgeons to use this technique stems, in part, from the concern of undertaking an endoscopic discectomy in a patient in whom the anatomy is distorted from a previous operation. It appears counterintuitive to operate through a limited working area when the traditional open approach for recurrence favors wider exposure of the surgical field. Given that operating on previously exposed tissue can be associated with even greater morbidity than on virginal tissue, the authors describe their experience with performing MED for recurrent disc herniation. Methods Unilateral MED was performed in patients with classic symptoms of lumbar radiculopathy, a previous operation at that level, and findings of recurrent disc herniation on magnetic resonance imaging. The approach was similar to a standard MED. Aided by fluoroscopic guidance, a working cannula was docked on the laminofacet junction at the level of the nerve root, with care taken to ensure a slightly more lateral initial trajectory. A good decompression of the nerve root could then be achieved through the use of the endoscope with preservation of the paraspinous musculature and much of the remaining facet capsule. Ten consecutive patients undergoing the procedure were analyzed prospectively and compared with the previous 25 who underwent routine single-level MED. Use of the MED technique provided excellent visualization and decompression of the nerve root; no conversions to open procedures were necessary in either group. The average operative time in the experimental group was 98.5 minutes, with a mean blood loss of 33 ml and an approximate hospital stay of 7.3 hours. In this respect, there was no statistical difference between the two groups (analysis of variance, p = 0.39, 0.68, and 0.51, respectively). There was one cerebrospinal fluid leak in each group. Conclusions Microendoscopic discectomy for recurrent disc herniation can be safely performed without an increase in surgery related morbidity.

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A Transforaminal Endoscopic Surgical Technique for Treating Lumbar Disc Herniation in the Setting of Spina Bifida

Case Reports in Neurological Medicine ◽

10.1155/2020/1076847 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Albert E. Telfeian ◽

Adetokunbo Oyelese ◽

Jared Fridley ◽

Rohaid Ali ◽

Deus Cielo ◽

...

Keyword(s):

Spina Bifida ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Recent Literature ◽

Lumbar Disc ◽

Surgical Techniques ◽

Surgical Decompression ◽

Minimally Invasive Approach ◽

Disc Disease ◽

Invasive Approach

Recent literature suggests that adult patients with spina bifida receive surgery for degenerative disc disease at higher rates than the general population. However, sometimes the complex anatomic features of co-occurring spina bifida and lumbar disc herniation can significantly challenge standard surgical techniques. Here, the technical steps are presented for treating a foraminal lumbar 4-5-disc herniation in the setting of a patient with multifaceted degenerative and spina bifida occulta anatomy. Utilized is a minimally invasive approach that does not require general anesthesia or fusion and allows the patient to leave the same day. To the best of our knowledge, this is the first-reported case of endoscopic surgical decompression of a lumbar disc in a patient with spina bifida.

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Surgical treatment of intraforaminal/extraforaminal lumbar disc herniations: Many approaches for few surgical routes

Acta Neurochirurgica ◽

10.1007/s00701-017-3198-9 ◽

2017 ◽

Vol 159 (7) ◽

pp. 1273-1281 ◽

Cited By ~ 3

Author(s):

Giorgio Lofrese ◽

Lorenzo Mongardi ◽

Francesco Cultrera ◽

Giorgio Trapella ◽

Pasquale De Bonis

Keyword(s):

Surgical Treatment ◽

Lumbar Disc ◽

Disc Herniations

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SwissDisc Registry (SDR) – The Register of Patients undergoing Surgical Treatment of lumbar Disc Herniation in Switzerland

10.1055/s-0037-1603878 ◽

2017 ◽

Author(s):

O. Wetzel ◽

S. Rey ◽

C. Perren ◽

J. Fandino ◽

J.C. Kienzler

Keyword(s):

Surgical Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc

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Surgical treatment of the lumbar disc herniation complicated by lumbar spinal stenosis

Ukrainian Neurosurgical Journal ◽

10.25305/unj.182625 ◽

2020 ◽

Vol 26 (1) ◽

pp. 5-12 ◽

Cited By ~ 1

Author(s):

Mykhaylo V. Khyzhnyak ◽

Artur Yu. Ksenzov ◽

Tymur A. Ksenzov

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Spinal

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Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: a new guidance is coming? [abstract]

Journal of Ozone Therapy ◽

10.7203/jo3t.3.4.2019.15506 ◽

2019 ◽

Vol 3 (4) ◽

Author(s):

Kenan Hao ◽

Huan Liu ◽

Yang Yang ◽

Qingle Zeng ◽

Xiaofeng He

Keyword(s):

Nucleus Pulposus ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Ozone Treatment ◽

Type I ◽

Type Ii ◽

Ring Type ◽

Type Iv ◽

Fibre Ring

PURPOSE: To investigate the sub-types of lumbar disc herniation, compare efficacies of ozone treatment in various types of lumbar disc herniation and analyze the mechanisms. MATERIAL AND METHODS: A total of 250 patients (159 males, 91 females; age range: 14 - 85 years) diagnosed of lumbar disc herniation from January 2009 to Jun 2014 in Nanfang Hospital were enrolled. Disc Lesions, classified by Magnetic Resonance examinations and images when injecting ozone under Digital Subtraction Angiography, were divided into four types: type I: Non-prominent nucleus pulposus with ruptured fibre ring; type II: Prominent nucleus pulposus with ruptured fibre ring; type III: Non-prominent nucleus pulposus with Non-ruptured fibre ring; type IV: Prominent nucleus pulposus with Non-ruptured fibre ring. All patients underwent intradiscal and paravertebral injection of oxygen-ozone. Visual Analogue Scale (VAS) weighted score was administered for the measurement of low back pain before treatment, and the evaluation of efficacy respectively at 1 week, 1 month, 6 month and 12 month follow-up period. RESULTS: Most of the patients (about 4/5) showed better response to ozone treatment. Herniated disc shrinkage was obtained among type II and IV. The type II had the most reduction of average score while the type III had the least. The proportion of patients who had once experienced pain relief at the follow up interval, namely the curative efficacy, showed significant difference: type I occupied the most, type IV occupied the least. CONCLUSION: Ozone treatment is effective and safe for all types of lumbar disc herniation, but efficacy varies according the types, of which type I has the best results and type IV has the worst ones.

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A Study of Lumbar Disc Herniation and Facet Joint Asymmetry

International Surgery ◽

10.9738/intsurg-d-16-00119.1 ◽

2019 ◽

Vol 103 (1-2) ◽

pp. 87-94

Author(s):

Qi Lai ◽

Yuan Liu ◽

Runsheng Guo ◽

Xin Lv ◽

Qiang Wang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Facet Joint ◽

Lumbar Disc ◽

Patients Âgés ◽

Lower Lumbar Spine ◽

Significant Difference ◽

Facet Joint Degeneration ◽

Disc Herniations ◽

Lumbar Facet

Purpose: To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine. Methods: A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type. Results: At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P > 0.05). Conclusion: Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.

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Genotypic and Antimicrobial Characterisation ofPropionibacterium acnesIsolates from Surgically Excised Lumbar Disc Herniations

BioMed Research International ◽

10.1155/2013/530382 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 37

Author(s):

Jess Rollason ◽

Andrew McDowell ◽

Hanne B. Albert ◽

Emma Barnard ◽

Tony Worthington ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Herniated Disc ◽

Type Ii ◽

Type Ia ◽

Disc Herniations ◽

Typing Methods ◽

Human Infections ◽

Clinical Conditions

The anaerobic skin commensalPropionibacterium acnesis an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation.P. acnesand other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence ofP. acnesin their excised herniated disc tissue. UsingrecAand mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role ofP. acnesin lumbar disc herniation should not be readily dismissed.

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