Computed Tomography of the Postoperative Intervertebral Disc and Lumbar Spinal Canal: Serial Long-Term Investigation in 19 Patients after Successful Operation for Lumbar Disc Herniation

Neurosurgery ◽  
1991 ◽  
Vol 29 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Raoul Heilbronner ◽  
Heinz Fankhauser ◽  
Pierre Schnyder ◽  
Nicolas de Tribolet
Keyword(s):  
Contrast Enhancement ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Signs And Symptoms ◽  
Failed Back Surgery Syndrome ◽  
Ct Scans ◽  
X Rays ◽  
Successful Operation ◽  
Failed Back Surgery

Abstract The first part of this work, published in 1988, included 25 patients who had computed tomographic (CT) scans without contrast enhancement and plain x-rays of the lumbar spine before, 1 week after, and 6 to 7 weeks after a successful operation for lumbar disc herniation. The present study extends the follow-up period to 3 years in 19 of the 25 original patients. Clinical examinations, lateral plain x-rays, and CT scans without contrast enhancement of the operated disc were repeated. The results indicate a decrease or even a disappearance of the hyperdense extradural material thought to represent fibrosis. An image suggestive of persistent disc herniation was still present in 5 of 8 patients with this finding on early postoperative CT scans. Persistent intradiscal gas was seen in nearly half of the patients. Total normalization of the posterior extraspinal structures was the rule. There was no correlation between CT appearance and residual complaints of the patients. CT scans without contrast enhancement may be sufficient to guide the surgeon in postoperative patients with massive signs and symptoms of recurrent root compression in whom a second operation is indicated on clinical grounds. In all other cases, myelography followed by CT scans is considered appropriate to investigate failed back surgery syndrome. (Neurosurgery 29:1-7, 1991)

Computed Tomography of the Postoperative Intervertebral Disc and Lumbar Spinal Canal : Investigation of Twenty - five Patients after Successful Operation for Lumbar Disc Herniation

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 1014-1022 ◽  
Author(s):  
Stefano Montaldi ◽  
Heinz Fankhauser ◽  
Pierre Schnyder ◽  
Nicolas de Tribolet
Keyword(s):  
Computed Tomography ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Spinal Canal ◽  
Lumbar Disc ◽  
Heterogeneous Material ◽  
Failed Back Surgery Syndrome ◽  
Successful Operation ◽  
Dural Sac ◽  
Failed Back Surgery

Abstract Twenty-five patients with good outcome after operation for lumbar disc herniation underwent unenhanced computed tomography (CT) and plain radiography of the lumbar spine before, 5 to 7 days after, and 6 lo 7 weeks after the operation to define the radiological features ofthe postoperative disc and spinal canal. After operation, the center of the disc appears hypodense. The anterior and lateral borders remain sharply delimited, but in 44% of the cases the posterior border shows an image suggesting the persistence of disc herniation. In 84% of the cases, there are major changes in the spinal canal with complete occlusion of the extradural space on the operated side by a heterogeneous material the attenuation value of which ranged between those of cerebrospinal fluid and disc. The outline of the dural sac and of the nerve root is lost. This aspect did not significantly change between the 1st and the 6 th postoperative week, except for the disappearance of any air within the canal and a slight movement on the dural sac toward the operated side. From these major radiological modifications found in asymptomatic postoperative patients, it is concluded that positive CT in patients with the failed back surgery syndrome has limited value. Myelography is preferred as the primary neuroradiological investigation.

scholarly journals A Rare Case of Spinal Subdural Hematoma Complicating Minimally Invasive Lumbar Micro Discectomy and Decompression for Recurrent Lumbar Disc Herniation

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Failed Back Surgery Syndrome ◽  
Neurological Deficits ◽  
Unusual Complication ◽  
Lumbar Region ◽  
Failed Back Surgery ◽  
Spinal Subdural Hematoma ◽  
Recurrent Lumbar Disc Herniation

Spinal subdural hematomas is a very rare and unusual complication of spinal interventions. We present a case of subacute SSDH in the lumbar region of a 60 year-old woman following microdiscectomy for recurrent lumbar disc herniation. By presenting this rarely seen case of postoperative subacute SSDH, we want to bring attention to the possible postoperative complications like spinal hematomas in the differential diagnosis of failed back surgery syndrome in patients who do not respond to conservative treatment or develop neurological deficits and to the importance of radiological imaging in such cases.

Long-term Outcome of 104 Patients after Lumbar Sequestrectomy According to Williams

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Markus Wenger ◽  
Luigi Mariani ◽  
Andreas Kalbarczyk ◽  
Uli Gröger
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Failed Back Surgery Syndrome ◽  
Neurological Dysfunction ◽  
Long Term Outcome ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Clinical Records

Abstract OBJECTIVE The authors report the late outcome of 104 consecutive patients after Williams' sequestrectomy for virgin lumbar disc herniation. METHODS The clinical records and the mailed questionnaires of 38 women and 66 men operated consecutively between March 1991 and November 1993 were analyzed retrospectively. In these 104 patients, 105 Williams' sequestrectomies were performed. RESULTS The mean age at operation was 50.5 years (range, 23.2–86.7 yr), and follow-up ranged from 4.1 to 6.9 years (mean, 5.3 yr). Success rates, including excellent, good, and fair results, were 92.5%, 94.7%, and 93.3% for lumbalgia, radicular pain, and neurological dysfunction, respectively. Only a few patients did not improve or presented with worsened symptoms. Three of four patients with cauda equina syndrome recovered immediately after the intervention. There were eight (7.7%) minor postoperative complications, which were treated conservatively. Three women and three men (5.8%) underwent a revision procedure for a recurrent lumbar disc herniation at the same level after 0.4 to 3.1 years (mean, 1.8 yr). Two (1.9%) of these patients underwent further operations because of reherniation, and they required internal instrumentation eventually because of failed back surgery syndrome. CONCLUSION Williams' conservative approach with sequestrectomy alone is a safe operative modality. It should be used whenever possible. As demonstrated in our series with a long follow-up time, the results are as favorable as or better than results after standard microsurgical lumbar discectomy with curettement of the interspace. Whether the incidence of failed back surgery syndrome can be reduced by this approach remains to be proved.

scholarly journals Bilateral post-injection fibrosis of the gluteal region mimicking lumbar disc herniation: a case report

2009 ◽  
Vol 1 (1) ◽  
pp. 25 ◽  
Author(s):  
Kamil Cagri Kose ◽  
Levent Altinel ◽  
Cengiz Isik ◽  
Erkam Komurcu ◽  
Serhat Mutlu ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Excision ◽  
Gluteal Region ◽  
Injection Pain ◽  
Clinical Feature ◽  
Post Injection ◽  
X Rays ◽  
Gluteal Fibrosis

Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4-5 level twice but his complaints had not resolved. A third operation including L4-5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal region is not a frequently described clinical feature of this condition. Many reports in the literature emphasize a contracture rather than pain. Post-injection fibrosis in the gluteal region may mimic lumbar disc herniation and a detailed physical examination is the key for correct differential diagnosis. In refractory cases not responding to conservative treatment, surgical excision of the nodules may lead to a complete clinical recovery of the patient.

scholarly journals Association of facet orientation and tropism with lumbar disc herniation

2020 ◽  
Vol 6 (2) ◽  
pp. 296
Author(s):  
Deepak H. R. ◽  
Karan Shetty ◽  
Lakshmi Narayana Reddy G.
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Control Level ◽  
Signs And Symptoms ◽  
Intervertebral Disc Herniation ◽  
Degenerative Lumbar Disease ◽  
Magnetic Resonance Imaging Mri ◽  
Facet Tropism

<p class="abstract"><strong>Background:</strong> Intervertebral disc herniation is a degenerative lumbar disease and a common pathology of skeletal system. Currently, most experts assume that facet tropism may affect lumbar degenerative diseases. Considering the previous inconsistent findings on the relationship of facet tropism, the present study was aimed to find the association between facet tropism and lumbar disc herniation.</p><p class="abstract"><strong>Methods:</strong> Patients with low back pain attending the OPD of orthopaedics department, with signs and symptoms of disc herniation were sent for magnetic resonance imaging (MRI). 72 patients with single level disc herniation were included in the study. Facet angles were measured using MRI of 1.5 T using the method described by Karacan et al. Facet tropism was defined as difference of 100 or more in facet joint angles between right and left sides.<strong></strong></p><p class="abstract"><strong>Results:</strong> 45 of the 72 cases (50%) who presented with lumbar disc herniation (LDH) had tropism while none (0%) at the control level did. This association was not statistically significant (p=0.983). Significant association was found between the side of disc herniation and the distribution of the more coronal or sagittal facing facet (p=0.024).</p><p class="abstract"><strong>Conclusions:</strong> Despite the presence of tropism only in the intervertebral segments affected with LDH in our study, the association between tropism and LDH was not statistically significant.</p>

scholarly journals Relevance of Signs and Symptoms in the Prognosis of Patients with Lumbar Disc Herniation

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554544-s-0035-1554544
Author(s):  
Asdrubal Falavigna ◽  
Orlando Righesso ◽  
Alisson Roberto Teles ◽  
Pedro Guarise da Silva ◽  
Suelen Cardoso ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Signs And Symptoms

Postoperative radicular neuroma

2001 ◽  
Vol 11 (5) ◽  
pp. 1-3 ◽  
Author(s):  
Tahsin Erman ◽  
Metin Tuna ◽  
A. İskender Göçer ◽  
Faruk İdan ◽  
Erol Akgül ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Lumbar Disc ◽  
Failed Back Surgery Syndrome ◽  
Lumbar Discectomy ◽  
Intervertebral Disc Herniation ◽  
Intractable Pain ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Failed Back Surgery ◽  
Back Surgery

Lumbar discectomy is the most common surgical procedure performed in neurosurgery clinics. Such a large number of procedures underscore not only the prevalence of conditions such as intervertebral disc herniation, but also the strong belief of surgeons that the operation does provide benefits to patients suffering from sciatica. In spite of this belief, sciatic pain may continue after the surgery. The recurrence of sciatic and/or back pain after primary discectomy is called the “failed back surgery syndrome.” The rate of the complications involved in standard lumbar discectomy ranges from 5.4 to 14%. One of the complications of the lumbar disc surgery is nerve root injury. The complication rate of this injury ranges from 0.7 to 2.2%. Postoperative radicular neuroma must be considered in differential diagnosis for the patient who has failed back surgery syndrome. In this study the authors evaluate a patient who had undergone surgery for lumbar disc herniation and suffered intractable pain. A traumatic radicular neuroma is demonstrated and the pertinent literature is presented.

Recurrence Rate of Lumbar Disc Herniation After Standard Discectomy and Microdiscectomy: A 5-Year Study

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

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