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 What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Hazel J. Jenkins ◽  
Alice Kongsted ◽  
Simon D. French ◽  
Tue Secher Jensen ◽  
Klaus Doktor ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Observational Study ◽  
Diagnostic Imaging ◽  
Pain Intensity ◽  
Clinical Outcomes ◽  
Chiropractic Care ◽  
Leg Pain ◽  
Low Back ◽  
One Year

Abstract Background Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care. Methods A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. Data was collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks. Results 2162 patients were included, with 24.1% referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two-weeks (0.4, 95%CI: 0.1, 0.8) and one-year (0.4, 95%CI: 0.0, 0.7), and disability at two-weeks (5.7, 95%CI: 1.4, 10.0), but the changes are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed. Conclusions Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.

scholarly journals Alternative strategies for lumbar discectomy: intradiscal electrothermy and nucleoplasty

2002 ◽  
Vol 13 (2) ◽  
pp. 1-6 ◽  
Author(s):  
William C. Welch ◽  
Peter C. Gerszten
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Lessons Learned ◽  
Leg Pain ◽  
Low Back ◽  
Disc Disease ◽  
Discogenic Pain ◽  
Discogenic Low Back Pain ◽  
Disc Material

In recent years the general trend in spinal surgery has been one of reductionism and minimalization. A number of techniques have recently been developed that are applicable in the treatment of lumbar disc herniation and discogenic pain due to degenerative disc disease. The purpose of this manuscript is to examine two newer percutaneous disc treatment techniques, intradiscal electrothermal therapy (IDET) anuloplasty and nucleoplasty. The authors review the appropriate clinical treatment criteria, techniques, and lessons learned after performing these procedures in more than 100 patients. The IDET involves the percutaneous insertion of a specially designed thermal resistance probe followed by controlled heating of the intervertebral disc. This may result in disc shrinkage and reduction in pain. The nucleoplasty procedure involves the percutaneous removal of disc material by using a low-temperature resister probe to disintegrate and evacuate disc material, followed by thermal treatment of adjacent residual disc material. To date, no study has been published in which investigators examine the outcomes of this procedure for the treatment of radicular leg pain and low-back pain. Both IDET and nucleoplasty appear to be safe procedures. The IDET procedure may be an alternative to lumbar interbody fusion. Although its long-term role is being defined, this technique appears to provide intermediate-term relief of pain in a population of patients with discogenic low-back pain. Nucleoplasty may provide a percutaneous alternative to microdiscectomy in selected cases.

Clinical Outcomes Among Low Back Pain Consulters With Referred Leg Pain in Primary Care

Spine ◽  
2011 ◽  
Vol 36 (25) ◽  
pp. 2168-2175 ◽  
Author(s):  
Jonathan C. Hill ◽  
Kika Konstantinou ◽  
Bolaji E. Egbewale ◽  
Kate M. Dunn ◽  
Martyn Lewis ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Leg Pain ◽  
Low Back ◽  
Referred Leg Pain

scholarly journals Posterior epidural migration of a lumbar disc herniation

2020 ◽  
Vol 11 ◽  
pp. 4
Author(s):  
Meryem Himmiche ◽  
Khalid Chakour ◽  
Mohammed El Faiz Chaoui ◽  
Mohammed Benzagmout
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Low Back ◽  
Case Description ◽  
Disc Material ◽  
Disc Herniations ◽  
History Of

Background: Posterior epidural migration of a lumbar disc fragment (PEMLDF) refers to the dorsal migration of disc material around the thecal sac that can lead to radiculopathy and/or cause a cauda equina syndrome. It is rare and the diagnosis is often just established intraoperatively. Case Description: A 50-year-old male with a chronic history of low back pain and psychosis presented with PEMLDF originating at the L4–L5 level. Conclusion: Lumbar disc herniations rarely present as PEMLDF resulting in symptoms varying from radiculopathy to cauda equina syndrome. These should be included among the differential diagnostic considerations for dorsolateral epidural lesions.

scholarly journals Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

2019 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
Godson E. Anyanwu ◽  
Remigius T. Ekwunife ◽  
Emmanuel C. Iyidobi ◽  
Cajetan U. Nwadinigwe ◽  
Henry C. Ekwedigwe ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Low Back ◽  
Inclusion Criteria ◽  
Laptop Computer ◽  
Disc Herniations

<p class="abstract"><strong>Background:</strong> Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.</p><p class="abstract"><strong>Methods:</strong> The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).</p><p class="abstract"><strong>Conclusions:</strong> That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age.</p>

Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy

1993 ◽  
Vol 78 (2) ◽  
pp. 216-225 ◽  
Author(s):  
H. Michael Mayer ◽  
Mario Brock
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Motor Deficits ◽  
Low Back ◽  
Content Type ◽  
Sensory Deficits ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Fine Print

✓ Percutaneous endoscopic discectomy is a new technique for removing “contained” lumbar disc herniations (those in which the outer border of the anulus fibrosus is intact) and small “noncontained” lumbar disc herniations (those at the level of the disc space and occupying less than one-third of the sagittal diameter of the spinal canal) through a posterolateral approach with the aid of specially developed instruments. The technique combines rigid straight, angled, and flexible forceps with automated high-power suction shaver and cutter systems. Access can thus be gained to the dorsal parts of the intervertebral space where the disc herniation is located. Percutaneous endoscopic discectomy is monitored using an endoscope angled to 70° coupled with a television and video unit and is performed with the patient under local anesthesia and an anesthesiologist available if needed. Its indication is restricted to discogenic root compression with a minor neurological deficit. Two groups of patients with contained or small noncontained disc herniations were treated by either percutaneous endoscopic discectomy (20 cases) or microdiscectomy (20 cases). Both groups were investigated in a prospective randomized study in order to compare the efficacy of the two methods. The disc herniations were located at L2–3 (one patient), L3–4 (two patients), or L4–5 (37 patients). There were no significant differences between the two groups concerning age and sex distribution, preoperative evolution of complaints, prior conservative therapy, patient's occupation, preoperative disability, and clinical symptomatology. Two years after percutaneous endoscopic discectomy, sciatica had disappeared in 80% (16 of 20 patients), low-back pain in 47% (nine of 19 patients), sensory deficits in 92.3% (12 of 13 patients), and motor deficits in the one patient affected. Two years after microdiscectomy, sciatica had disappeared in 65% (13 of 20 patients), low-back pain in 25% (five of 20 patients), sensory deficits in 68.8% (11 of 16 patients), and motor deficits in all patients so affected. Only 72.2% of the patients in the microdiscectomy group had returned to their previous occupation versus 95% in the percutaneous endoscopic discectomy group. Percutaneous endoscopic discectomy appears to offer an alternative to microdiscectomy for patients with “contained” and small subligamentous lumbar disc herniations.

scholarly journals Is Open Lumbar Micro- Discectomy Safe at Periphery of Nepal?

2016 ◽  
Vol 13 (1) ◽  
pp. 30-34
Author(s):  
Bal K Thapa
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Disc Herniation ◽  
Economic Status ◽  
Lumbar Disc ◽  
Low Back ◽  
Indications For Surgery ◽  
Nerve Roots ◽  
Disc Herniations

Lumbar disc surgery is performed exclusively for disc herniation. Either low back pain, or sciatica or both are common presentations depending upon the levels of compressed nerve roots. Indications for surgery and MRI needs to be carefully judged upon keeping the economic status of our patients into consideration. Open lumbar (micro) discectomy is safe and successful method for lumbar disc herniations at periphery. Results in these hundred thirteen initial cases with minimum follow up of 5 years indicate that this is not only feasible but safe in these 57 males and 56 female patients aged between 12 and 93. Redo surgeries were not that difficult in this series and were safe. There were 18 cases with Multiple and 95 single levels. Of the single levels it gradually increased as the level gradually decreased in terms of the vertebral counts. L3/4: 3 cases, L4/5: 28 cases and L5/S1 : 64 cases . There were 18 cases of more than one level discs. There were 96 (Micro) discectomies, 11 Laminotomies and 6 Laminectomies.Nepal Journal of Neuroscience 13:30-34, 2016

scholarly journals Chemonucleolysis with Chondroitin Sulfate ABC Endolyase for Treating Lumbar Disc Herniation: Exploration of Prognostic Factors for Good or Poor Clinical Outcomes

2020 ◽  
Author(s):  
Katsuhiko Ishibashi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chondroitin Sulfate ◽  
Clinical Outcomes ◽  
High Intensity ◽  
Disease Duration ◽  
Leg Pain ◽  
Intensity Change ◽  
Low Back ◽  
Score Improvement

Background and Objectives: Chondroitin sulfate ABC endolyase (condoliase) was launched as a new drug for chemonucleolysis in 2018. There are few Few studies assessed regarding its clinical outcomes, and many important factors matters still remain unclear. The purpose of this This study aimed is to clarify clarify the preoperative conditionsfactors for in which condoliase could beis highly effective. Materials and Methods: Of the 47 patients who received condoliase, 34 patients were enrolled in this study. The mean age of the patients was 33 years. The average disease duration since the onset of the disease was 8.6 months. We evaluated the patients&rsquo;patient&rsquo;s low back and leg painpains using a numericalNumerical rating scale (NRS) score at two time points (before therapy and 3 months after therapyadministration). We divided the patients into two groups ([good group [(G]:): NRS score improvement &ge; 50%, poor group (P): NRS score improvement &amp;lt; 50%]. The parameters evaluatedSurvey items were age, disease disease duration, body mass index (BMI), and the presence or absence of positive or negative straight leg raising (SLR) test results. In additionMoreover, the loss of disc height loss and participation of preoperative radiological findings were also evaluated. Results: In terms of low back and leg pain, the G group were in 9/34 (26.5%) and 21/34 (61.8%) patients, respectively. Patients&rsquo;. Patient&rsquo;s age (low back pain G/P, 21.0/36.5 years)), was significantly loweryounger in the G group of low back pain (p = 0.001). High intensity change inof the protruded nucleus pulposus (NP) and the spinal canal occupancy by theof NP &ge; 40% were significantly highhighly observed in those withthe leg pain in the G groups (14/21,: p = 0.04; and 13/21,: p = 0.03, respectively). Conclusions: The efficacy of improvement inof leg pain was significantlyhighly correlated with high intensity change and size of the protruded NP. Condoliase was not significantly effective forto low back pain, but could might be expected have anthe effect onto younger patients.

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