scholarly journals Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Min-Seok Kang ◽  
Jin-Ho Hwang ◽  
Dae-Jung Choi ◽  
Hoon-Jae Chung ◽  
Jong-Hwa Lee ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Scar Tissue ◽  
Lumbar Discectomy ◽  
Disc Material ◽  
Recurrent Lumbar Disc Herniation

Abstract Background Although literature provides evidence regarding the superiority of surgery over conservative treatment in patients with lumbar disc herniation, recurrent lumbar disc herniation (RLDH) was the indication for reoperation in 62% of the cases. The major problem with revisional lumbar discectomy (RLD) is that the epidural scar tissue is not clearly isolated from the boundaries of the dura matter and nerve roots; therefore, unintended durotomy and nerve root injury may occur. The biportal endoscopic (BE) technique is a newly emerging minimally invasive spine surgical modality. However, clinical evidence regarding BE-RLD remains limited. We aimed to compare the clinical outcomes after performing open microscopic (OM)-RLD and BE-RLD to evaluate the feasibility of BE-RLD. Methods This retrospective study included 36 patients who were diagnosed with RLDH and underwent OM-RLD and BE-RLD. RLDH is defined as the presence of herniated disc material at the level previously operated upon in patients who have experienced a pain-free phase for more than 6 months. BE-RLD was performed as follows: two independent surgical ports were made inside the medial pedicular line of the target segment and on the intact upper and lower laminas. Peeling off the soft tissue from the vertebral lamina helps to easily identify the traversing nerve root and the recurrent disc material without dealing with the fibrotic scar tissue. Clinical outcomes were obtained using a visual analog scale (VAS) and the modified Macnab criteria before and at 2 days, 2 and 6 weeks, and 3, 6, and 12 months after surgery. Results The data of 20 and 16 patients who underwent OM-RLD and BE-RLD, respectively, were evaluated. The demographic and perioperative data were comparable between the groups. During the year following the surgery, in the BE-RLD group, the VAS scores at each point were significantly improved over the baseline and remained improved up to 2 weeks after surgery (p < 0.05); however, no statistical difference between the two groups was observed after 6 weeks of surgery (p > 0.05). According to the modified Macnab criteria on the follow-up, the excellent or good satisfaction rates reported at 2 weeks, 6 weeks, 6 months, and 12 months after surgery were 81.25%, 81.25%, 75%, and 81.25%, respectively, in the BE-RLD group, and 50%, 75%, 75%, and 80%, respectively, in the OM-RLD group. Conclusion BE-RLD yielded similar outcomes to OM-RLD, including pain improvement, functional improvement, and patient satisfaction, at 1 year after surgery. However, faster pain relief, earlier functional recovery, and better patient satisfaction were observed when applying BE-LRD. Trial registration Retrospectively registered

scholarly journals Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

2021 ◽  
pp. 219256822097608
Author(s):  
Dinesh Kumarasamy ◽  
Shanmuganathan Rajasekaran ◽  
Sri Vijay Anand K. S ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty T ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Rating Scale ◽  
Lumbar Disc ◽  
Modic Changes ◽  
P Value ◽  
Functional Scores

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

scholarly journals Comparison of Percutaneous Endoscopic Lumbar Discectomy and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Revision Surgery for the Recurrent Lumbar Disc Herniation After Percutaneous Endoscopic Lumbar Discectomy

2020 ◽  
Author(s):  
Anqi Wang ◽  
Zhengrong Yu
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Revision Surgery ◽  
Lumbar Disc ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Surgical Methods ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Percutaneous endoscopic lumbar discectomy (PELD) has become a feasible alternative to the conventional open surgery for the treatment of lumbar disc herniation (LDH), but PELD is associated with a certain rate of recurrence. Therefore, a good choice of surgical approach for recurrent lumbar disc herniation (rLDH) is important. The purpose of this study was to compare the outcomes between PELD and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for revision surgery for the rLDH after primary PELD surgery.Methods: This study retrospectively assessed 46 patients who suffered from rLDH after PELD surgery in Peking University First Hospital from January 2015 to June 2019, and patients were divided into two groups, PELD group (n=24) and MIS-TLIF group (n=22), according to different revision surgical methods. Preoperative data, perioperative conditions, complications, recurrence condition, and clinical outcomes were compared between these two groups.Results: Compared with the MIS-TLIF group, the PELD group was associated with shorter operative time, less intraoperative hemorrhage, and shorter post-operative hospitalization, but higher recurrence rate. Complication rates were comparable between two groups. Both the two groups could provide patients with satisfactory clinical outcomes at the 12-month follow-up after revision surgery. Compared with MIS-TLIF, PELD was associated with visual Analog Scale (VAS) scores of back pain, and Oswestry disability index (ODI) at the 1-month follow-up, whereas this effect was equalized after 6 months postoperatively.Conclusions: Either PELD or MIS-TLIF surgery could provide satisfactory clinical outcomes for revision surgery for the rLDH after primary PELD. PELD brought advantages in shorter operative time, less intraoperative hemorrhage, and shorter post-operative hospitalization over MIS-TLIF, however, higher postoperative recurrence rate of PELD couldn’t be ignored. Surgeons must weigh advantages against disadvantages of these surgical methods and fully informed patients preoperatively.

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 Clinical outcomes after minimal-access surgery for recurrent lumbar disc herniation

2003 ◽  
Vol 15 (3) ◽  
pp. 1-4 ◽  
Author(s):  
Hoang Le ◽  
Faheem A. Sandhu ◽  
Richard G. Fessler
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Length Of Hospital Stay ◽  
Surgical Approaches ◽  
Published Data ◽  
Minimal Access ◽  
Disc Herniations ◽  
Recurrent Lumbar Disc Herniation

Object Experience with minimal-access surgical approaches for revision lumbar surgery has not been previously reported. Methods During a 7-month period, 10 consecutive patients with recurrent disc herniations underwent revision operations in which microendoscopic discectomy (MED) was performed. Perioperative data and clinical outcomes (according to Macnab criteria) were compared with those obtained in 25 consecutive patients who underwent routine single-level MED as well as with previously published data. Overall, outcome of the MED-treated revision group was excellent or good in 90% during a mean follow-up period of 18.5 months (minimum 12 months). Operative blood loss, duration, complications, and length of hospital stay were not significantly different between the revision and primary MED-treated groups. Conclusions Analysis of these early data suggests equivalent or superior results are obtained when performing MED compared with historical controls in which conventional surgery was conducted for recurrent disc surgery. The procedure appears to be a safe and effective alternative in cases in which recurrent lumbar disc herniation causes radiculopathy.

RECURRENT LUMBAR DISC HERNIATION AFTER SINGLE-LEVEL LUMBAR DISCECTOMY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 574-578 ◽  
Author(s):  
Giannina L. Garcés Ambrossi ◽  
Matthew J. McGirt ◽  
Daniel M. Sciubba ◽  
Timothy F. Witham ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Single Level ◽  
Recurrent Disc Herniation ◽  
Care Costs ◽  
Recurrent Lumbar Disc Herniation

Abstract OBJECTIVE Same-level recurrent lumbar disc herniation complicates outcomes after primary discectomy in a subset of patients. The health care costs associated with the management of this complication are currently unknown. We set out to identify the incidence and health care cost of same-level recurrent disc herniation after single-level lumbar discectomy at our institution. METHODS We retrospectively reviewed 156 consecutive patients undergoing primary single-level lumbar discectomy at one institution. The incidence of symptomatic same-level recurrent disc herniation either responding to conservative therapy or requiring revision discectomy was assessed. Institutional billing and accounting records were reviewed to determine the billing costs of all diagnostic and therapeutic measures used for patients experiencing recurrent disc herniation. RESULTS Twelve months after surgery, 141 patients were available for follow-up. Of these patients, 124 (88%) were symptom free or had minimal symptoms not affecting their daily activity. Radiographically proven symptomatic same-level recurrent disc herniation developed in 17 patients (12%) a median of 8 months after primary discectomy. Eleven patients (7%) required revision surgery, whereas 6 (3.9%) responded to conservative therapy alone. Diagnosis and management of recurrent disc herniation were associated with a mean cost of $26 593 per patient, and the mean cost was markedly less for patients responding to conservative treatment ($2315) compared with those requiring revision surgery ($39 836) (P &lt; 0.001). Of 141 primary lumbar discectomies performed at our institution with the patients followed for 1 year, the total cost associated with the management of subsequent recurrent disc herniation was $452 083 ($289 797 per 100 primary discectomies). CONCLUSION In our experience, recurrent lumbar disc herniation occurred in more than 10% of patients and was associated with substantial health care costs. Development of novel techniques to prevent recurrent lumbar disc herniation is warranted to decrease the health care costs and morbidity associated with this complication. Prolonged conservative management should be attempted when possible to reduce the health care costs of this complication.

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