scholarly journals Early Postoperative Results after Removal of Cranially Migrated Lumbar Disc Prolapse: Retrospective Comparison of Three Different Surgical Strategies

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
C. Schulz ◽  
U. Kunz ◽  
U. M. Mauer ◽  
R. Mathieu
Keyword(s):  
Lumbar Disc ◽  
Leg Pain ◽  
Surgical Approaches ◽  
Postoperative Results ◽  
Retrospective Comparison ◽  
Interlaminar Approach ◽  
Disc Material ◽  
Disc Herniations ◽  
Group A ◽  
Group B

Background. To compare the early postoperative results of three surgical approaches to lumbar disc herniations that migrated cranially. Minimally invasive techniques such as the translaminar and endoscopic transforaminal approaches are utilized in patients with lumbar disc herniations to gain access to cranially located disc material and to avoid the potentially destabilizing resection of ligament and bone tissue, which is associated with an extended interlaminar approach.Methods. This retrospective study compares the postoperative pain and functional capacity levels of 69 patients who underwent an interlaminar (Group A,n=27), a translaminar (Group B,n=22), or an endoscopic transforaminal procedure (Group C,n=20).Results. Median VAS scores for leg pain decreased significantly from before to after surgery in all groups. Surgical revisions were required in thirteen cases (five in Group A, one in Group B, and seven in Group C;P=0.031). After six weeks, there were significant differences in back pain and functional outcome scores and in the results for the MacNab criteria but not in leg pain scores.Conclusions. The interlaminar and translaminar techniques were the safest and fastest ways of gaining access to cranially migrated disc material and the most effective approaches over a period of six weeks.

scholarly journals Open Fenestration Discectomy Versus Microscopic Fenestration Discectomy for Lumbar Disc Herniation: a randomized controlled trial

2020 ◽  
Author(s):  
Sherwan Hamawandi ◽  
Injam Ibrahim Sulaiman ◽  
Ameer Kadhim Al-Humairi
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Oswestry Disability Index ◽  
Lumbar Disc ◽  
Daily Activities ◽  
Leg Pain ◽  
Group A ◽  
Group B ◽  
Type Of Surgery

Abstract Background: Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.Methods: 60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years. Results: In both groups, all patients have minimal disability by Oswestry Disability Index after surgery.There were significant differences between means of post-operative VAS for back pain between these two groups after one weeks (3.7 in group A versus 2.2 in group B) (t= 13.28, P=<0.001٭) and after 3 months (1.73 in group A versus 0.43 in group B) (t=10.54, P=<0.001٭).There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group).There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P<0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P<0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P<0.001).Conclusion: Use of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.Trial registration: NCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485

scholarly journals Lumbosacral Transitional Vertebrae in Adolescents: Effects on the Short-Term Outcomes of Percutaneous Endoscopic Lumbar Discectomy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yong Huang ◽  
Lu Mao ◽  
Hang Shi ◽  
Guanrui Ren ◽  
Lei Zhu ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Lumbar Surgery ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbosacral Transitional Vertebrae

Objective. To investigate whether lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in adolescent patients with lumbar disc herniation (LDH). Methods. This was a retrospective study with two groups. Group A was made up of 22 adolescent LDH patients with LSTV (18 males and 4 females). Group B was made up of 44 adolescent LDH patients without LSTV (36 males and 4 females), who were matched to group A for age, sex, and body mass index. All patients underwent PELD at the L4/5 or L5/S1 single level and were followed up at 18 months after surgery. We identified LSTV on radiographs and computed tomography and assessed the imaging characteristics of all patients. Outcomes were evaluated through a numerical rating scale (NRS), the Oswestry Disability Index (ODI), the modified MacNab grading system, and the incidence of additional lumbar surgery. Results. At 18 months after PELD, both groups had significant improvements in the mean NRS scores of low back pain (LBP) or leg pain and the ODI scores. In terms of the MacNab criteria, 90.9% in group A and 93.2% in group B showed excellent or good outcomes. The mean NRS scores of LBP or leg pain, ODI score, and MacNab grade after surgery were not significantly different between the 2 groups. Two patients (one patient had a recurrence; one patient had a new lumbar disc herniation) in group A and 3 patients (one patient had a recurrence; two patients had new lumbar disc herniations) in group B underwent additional lumbar surgery. Conclusions. Our study suggests that in terms of pain relief, life function improvement, and the incidence of additional lumbar surgery, LSTV has no effect on the short-term clinical outcomes of PELD in adolescents. A new lumbar disc herniation is an important reason for additional surgery in adolescents, regardless of the LSTV status.

scholarly journals Evaluation of the Efficacy of Epiduroscopic Laser Neural Discectomy in Lumbar Disc Herniations: Retrospective Analysis of 163 Cases- Evaluation of the Efficacy of ELND

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ali Metin Ülgen ◽  
Serbülent Gökhan Beyaz ◽  
Mustafa Erkan Inanmaz ◽  
Fatih Şahin
Keyword(s):  
Lumbar Disc ◽  
Leg Pain ◽  
First Year ◽  
Complication Rates ◽  
Advanced Technique ◽  
Disc Herniations ◽  
Training And Research ◽  
Fiberoptic Device ◽  
A New Technique ◽  
University Training

Background. Epiduroscopy, or spinal endoscopy, is the visualisation of the epidural space using a percutaneous and minimally invasive imaging fiberoptic device. Recently, as a result of some studies, it has been reported that laser therapy with epiduroscopic laser neural discectomy (ELND) was applied during multiple lesions. Methods. In this study, ELND performed between January 2012 and July 2016 at the Algology Clinic of the Department of Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, was examined retrospectively. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores were recorded preoperatively, as well as after 2 weeks and 2, 6, and 12 months after the ELND. Results. According to the preoperative VAS and ODI scores, the decrease in postoperative 2nd week, 2nd, 6th, and 12th month VAS and ODI scores was significant p = 0.001 . Similarly, according to the postoperative 2nd week VAS and ODI scores, decrease in postoperative 6th and 12th VAS and ODI scores was significant p = 0.001 . Conclusions. As a result, ELND with Holmium: YAG laser, which is a new technique in patients with lumbar disc herniated low back and/or leg pain, can reduce VAS and ODI scores from 2 weeks without any complications that open surgery can bring with it. We believe that it is a useful and advanced technique in treatment of lumbar disc herniation and has low complication rates that provides maximum efficacy from the first year.

scholarly journals Comparison of conventional fenestration discectomy with Transforaminal endoscopic lumbar discectomy for treating lumbar disc herniation:minimum 2-year long-term follow-up in 1100 patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Quanyi Li ◽  
Yongchun Zhou
Keyword(s):  
Hospital Stay ◽  
Lumbar Disc ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Intraoperative Blood Loss ◽  
Postoperative Length ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Abstract Purpose To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods The clinical data of 1100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.

scholarly journals Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Xinbo Wu ◽  
Guoxin Fan ◽  
Shisheng He ◽  
Xin Gu ◽  
Yunfeng Yang
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Nucleus Pulposus ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Satisfaction Rate ◽  
Disc Herniations

Objective. The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods. Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results. Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P<0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions. Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.

scholarly journals Standard Surgical Approaches to Primary Choledocholithiasis — Definitive Versus Temporary Decompression

HPB Surgery ◽  
1992 ◽  
Vol 6 (1) ◽  
pp. 35-49
Author(s):  
António Castro Mendes de Almeida ◽  
Fernando José Aldeia ◽  
Noel Medina dos Santos ◽  
Caetano Winston Gracias
Keyword(s):  
Revisional Surgery ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Anastomotic Complications ◽  
T Tube ◽  
Group A ◽  
Group B

The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T-tube decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction, due to dysmotility of the SO, lies behind most stone-containing ducts. Thus it seems logical to us that a permanent “fenestration” should be the management of most such ducts.We prospectively followed-up, for one to 10 years, two groups of patients submitted to primary CBDE aiming to assess the short and long-term results of two different surgical approaches to duct lithiasis. In one (Group A) 162 CBDE's were performed, out of 680 CHE's (24%), with a “positivity” of 68% and in the other (Group B) 80 CBDE's, out of 438 CHE's (18%), with a “positivity” of 70%. In Group A a T-tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T-tube was employed in only 3(4%) and some form of permanent “fenestration” in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T-tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long-term results, though, were significantly worse among patients of Group A whose ducts were temporarily decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for bilio-digestive anastomotic complications with cholangitis.It is concluded that it is against the long-term efficiency of the approach utilized in Group B that the new laparoscopic techniques should be compared.

scholarly journals Comparison of Conventional Fenestration Discectomy Versus Percutaneous Transforaminal Endoscopic Discectomy for Treating Lumbar Disc Herniation

2020 ◽  
Author(s):  
Quanyi Li ◽  
yongchun zhou
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Intraoperative Blood Loss ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Group A ◽  
Group B

Abstract Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) versus percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH from January 2012 to December 2017 were retrospectively analysed. IFD was performed on the 605 patients in Group A, while PTED was performed on the 505 patients in Group B. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for pain, and modified Macnab criteria were adopted to evaluate the outcomes. Moreover, the surgery durations, intraoperative blood loss, postoperative off-bed activities, and postoperative lengths of hospital stay for the two groups were observed. Results: The follow-up period ranged from 24 months to 60 months, with an average duration of 43 months. As the excellent and good outcome rate was 93.5% in Group A and 92.6% in Group B, there were no significant differences in efficacy between the two groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest durations and postoperative lengths of hospital stay than did Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and PTED had similar levels of efficacy in treating LDH, transforaminal endoscopic discectomy exhibited several advantages, such as less trauma, less bleeding, and a shorter length of hospital stay, and it can be considered an ideal surgical option for treating LDH.Save and Continue

Sudden bilateral foot drop due to dorsally unilateral migration of the herniated lumbar disc: A case report

2021 ◽  
pp. 1-5
Author(s):  
Hoon Seok ◽  
Seung Yeol Lee ◽  
Dong Seong Shin ◽  
Jung Hoon Kang ◽  
Soo Bin Im ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Emergency Operation ◽  
Sudden Onset ◽  
Foot Drop ◽  
Leg Pain ◽  
Resonance Imaging ◽  
Dural Sac ◽  
Disc Material ◽  
Herniated Lumbar Disc ◽  
Extradural Space

BACKGROUND: Due to the anatomical characteristics of the anterior epidural space, dorsal migration of material from herniated lumbar disc is quite rare. Also, bilateral foot drop due to unilateral dorsal migration of disc herniation is extremely rare. This report presents a case of sudden bilateral foot drop caused by the unilateral dorsal migration of material from a herniated lumbar disc. CASE DESCRIPTION: A 51-year-old male presented with sudden onset severe leg pain with bilateral foot drop. The patient was referred to our emergency department by a local clinic. Neurological examination showed bilateral ankle and big toe dorsiflexion weakness grade 1. There was no perianal anesthesia, anal sphincter weaknesses, or voiding difficulty. Apart from essential hypertension, this patient’s medical history was unremarkable. Magnetic resonance imaging showed that intervertebral disc material in the dorsal extradural space at the L3-4 level had compressed the dural sac from the left side to the center. We performed an emergency operation. The pathologic result revealed fibrous cartilaginous materials. After the operation, the leg pain was markedly resolved. At postoperative three months, the patient showed improvement of foot drop. CONCLUSION: We recommended emergent mass removal, which produced a favorable outcome.

Outcomes of Thoracolumbar Burst Fracture in Patients With Osteoporosis Without Neurologic Symptoms: Analysis of Three Different Surgical Approaches

2019 ◽  
Vol 9 (8) ◽  
pp. 1052-1057
Author(s):  
Tao Li ◽  
Yonghong Zheng ◽  
Zhengwei Xu ◽  
Dingjun Hao ◽  
Lixiong Qian
Keyword(s):  
Blood Loss ◽  
Internal Fixation ◽  
Hospital Stay ◽  
Burst Fracture ◽  
Surgical Approaches ◽  
Intraoperative Blood Loss ◽  
Thoracolumbar Burst Fracture ◽  
Neurologic Symptoms ◽  
Group A ◽  
Group B

This study aimed to compare the outcomes of thoracolumbar burst fractures in patients with osteoporosis without neurologic symptoms according to the surgical approach. The patients in group A underwent percutaneous balloon kyphoplasty, those in group B underwent minimally invasive percutaneous reduction and internal fixation, and those in group C underwent open reduction with bone graft fusion and internal fixation. Fracture reduction was assessed by X-ray. The operative time in group A was shorter than that in groups B and C, with less intraoperative blood loss and shorter hospital stay. The intraoperative blood loss was less in group B than in group C, with shorter hospital stay. The postoperative visual analog scale scores were lower than the preoperative scores in each group. Cobb's angle of the injured vertebra in the last follow-up was larger in group A than in groups B and C. Regarding complications, in group A, nine patients developed postoperative bone cement leakage that required no specific treatment. In group B, one patient developed subcutaneous hematoma that healed well after treatment. The screw channel was loosened in two patients without symptoms; the screws were removed 1 year later. In group C, delayed incision healing was found in five patients. All three surgical approaches safely and effectively relieved the lower back pain in patients with thoracolumbar burst fracture with osteoporosis but without neurologic symptoms.

Pelvic vein incompetence influences pain levels in patients with lower limb varicosity

2010 ◽  
Vol 25 (4) ◽  
pp. 179-183 ◽  
Author(s):  
G Asciutto ◽  
A Mumme ◽  
K C Asciutto ◽  
B Geier
Keyword(s):  
Pelvic Pain ◽  
Lower Limb ◽  
Standing Position ◽  
Leg Pain ◽  
Control Group ◽  
Pain Level ◽  
Pelvic Vein ◽  
Median Level ◽  
Group A ◽  
Group B

Purpose To detect the influence of pelvic vein incompetence (PVI) on pain levels in patients with varicosity of the lower limb. Materials and methods Women of child-bearing age with symptomatic primary or recurrent varicosity of the greater saphenous vein (GSV) were prospectively included in two groups depending on the presence or absence of phlebographic signs of PVI. Pain assessment was carried out with the help of a visual analogue scale (VAS). Results Forty women were included in the study. Nineteen of them had phlebographic evidence of PVI (group A), whereas 21 were included in the control group (group B). Patients of group A reported a higher median total pain level than patients of group B (group A median 62, range 25–100; group B median 32, range 0–100; P = 0.001). In group A, patients experienced a median level of pain of 67.2 at the lower limb in the standing position (range 40–100) versus a median of 50.3 (range 36–81) in patients of group B ( P = NS). The median level of leg pain in the sitting position was 41.2 (range 0–67) in patients of group A and 38.1 (range 0–46) in women of group B ( P = NS). Pelvic pain level in the standing position was higher ( P = NS) in patients of group A (median 72.2, range 50–91), than in women of group B (median 20.1, range 0–41). In patients of group A, statistically significant ( P = 0.0001) higher VAS scores for pelvic pain level in sitting (group = A median 67.2, range 59–71; group B median 18.1 range 0–35) were reported. Conclusions In a small population of patients with GSV varicosity, overall pain levels were significantly higher in a subgroup of patients with phlebographic signs of PVI. This finding suggests that the presence of PVI might influence the intensity of varicosity symptoms.

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