Correlation Between Persistent Neurological Impairment and Clinical Outcome After Microdiscectomy for Treatment of Lumbar Disc Herniation

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 390-397 ◽  
Author(s):  
Orlando Righesso ◽  
Asdrubal Falavigna ◽  
Osmar Avanzi
Keyword(s):  
Clinical Outcome ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Neurological Examination ◽  
Lumbar Disc ◽  
Neurological Impairment ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
Operating Characteristics ◽  
Clinical Scores

Abstract BACKGROUND: Outcome of lumbar disc herniation is often based on clinical scores and less frequently on the neurological examination. However, even when clinical outcome measures are favorable, patients may still experience motor or sensory impairment. OBJECTIVE: To evaluate the percentage of patients with persistent neurological deficits after lumbar disc surgery and whether these correlate with clinical outcome. METHODS: A total of 150 patients with sciatica and lumbar disc herniation with neurological impairment underwent microdiscectomy and were prospectively followed for 24 months. Patients were assessed pre- and postoperatively with neurological examination, the Oswestry Disability Index (ODI), and the visual analog scale (VAS) for pain. RESULTS: Twenty-four months after surgery, 25% of patients who presented with motor deficits, 40% of patients with sensory deficits, and 48% of patients with reflex abnormalities remained unchanged. The VAS and the ODI showed significant improvement in both patients with and without persistent neurological impairment immediately after surgical repair of the herniated disc with progressive improvement over the follow-up period. However, when calculating the area under the receiver operating characteristics curve, no statistically significant correlation could be established between the presence and persistence of neurological impairment and the 2 clinical scores. CONCLUSION: There seems to be no correlation between clinical results and neurological impairment when assessed by the VAS and ODI.

scholarly journals Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome

2019 ◽  
Vol 35 (4) ◽  
Author(s):  
Bilge Kesikburun ◽  
Emel Eksioglu ◽  
Aynur Turan ◽  
Emre Adiguzel ◽  
Serdar Kesikburun ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Complete Resolution ◽  
Spontaneous Regression ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Partial Regression ◽  
Conservative Care ◽  
Over Time

Objective: To evaluate the natural history of lumbar extruded disc with conservative treatment on MRI and to assess relation between the radiologic changes and clinical outcome. Methods: This prospective observational study was conducted at University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital between May 2015-June 2018. It included consecutive patients who were diagnosed as having lumbar symptomatic extruded disc as shown in MRI. After an average period of 17.0±7.2 months, repeat MRI was taken in 40 patients who received only conservative care during follow-up. Changes in the volume of herniated disc was measured. The patients were assigned into 3 groups as follow: (1) non-regression, (2) partial-regression, and (3) complete resolution. Numeric Rating Scale (NRS) pain score, the Oswestry Low Back Pain Disability Index (ODI) and muscle weakness were evaluated. Results: Based on disc volume of the T2-weighted MR images; four patients (10%) did not show any regression, six patients (15%) had a partial regression, and 30 patients (75%) had a complete resolution. Patients with complete resolution showed a significant improvement in the NRS pain score and the ODI score (p<0,001) over time. In patients with partial regression, only the ODI score improved significantly (p=0,043). Non-regression group did not show any improvement in any clinical outcome measure (p>0,05). Changes in the NRS scores over time were significantly higher in complete resolution group compared to non-regression group (p=0.016). Conclusion: The majority of the patients with extruded lumbar disc herniation might have reduction in size of herniated disc in the long run along with improvement in symptoms and function with conservative care. doi: https://doi.org/10.12669/pjms.35.4.346 How to cite this:Kesikburun B, Eksioglu E, Turan A, Adiguzel E, Kesikburun S, Cakci A. Spontaneous regression of extruded lumbar disc herniation: Correlation with clinical outcome. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.346 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation

2016 ◽  
Vol 59 (2) ◽  
pp. 143 ◽  
Author(s):  
Jung Sik Bae ◽  
Kyung Hee Kang ◽  
Jeong Hyun Park ◽  
Jae Hyeon Lim ◽  
Il Tae Jang
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Poor Outcome

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

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
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.

scholarly journals Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

2016 ◽  
Vol 24 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Ulrich Hubbe ◽  
Pamela Franco-Jimenez ◽  
Jan-Helge Klingler ◽  
Ioannis Vasilikos ◽  
Christoph Scholz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operating Time ◽  
Leg Pain ◽  
P Value ◽  
Vas Scores ◽  
Recurrent Lumbar Disc Herniation

OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

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.

scholarly journals Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

2020 ◽  
Author(s):  
Seong Son ◽  
Chan Jong Yoo ◽  
Byung Rhae Yoo ◽  
Woo Seok Kim ◽  
Tae Seok Jeong
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Early Group ◽  
Significant Difference ◽  
Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

scholarly journals Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

2020 ◽  
Author(s):  
Seong Son ◽  
Chan Jong Yoo ◽  
Byung Rhae Yoo ◽  
Woo Seok Kim ◽  
Tae Seok Jeong
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Learning Curve ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Early Group ◽  
Significant Difference ◽  
Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation.However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

EVALUATION OF THE EFFECTS OF ELECTRONIC ACUPUNCTURE COMBINED WITH “THAN THONG TRUC U THANG” REMEDY IN THE TREATMENT OF SCIATICA DUE TO LUMBAR DISC HERNIATION

2019 ◽  
pp. 15-21
Author(s):  
Van Hung Nguyen ◽  
Truc Quynh Nguyen ◽  
Thi Tan Nguyen
Keyword(s):  
Traditional Medicine ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Modern Medicine ◽  
Herniated Disc ◽  
Good Level ◽  
Before And After ◽  
A Prospective Study

Background: Sciatica due to lumbar disc herniation is one of the most common diseases in the world as well as in Viet Nam, sciatica impact on patient’s quality of life, ability to work and social interaction. Currently there are many methods of treatment with modern medicine and traditional medicine. Objectives: To investigate some clinical and paraclinical characteristics of sciatica due to herniated disc without surgery and to evaluate the effects of electronic acupuncture combined of with “Than thong truc u thang” remedy in the treatment of sciatica due to lumbar disc herniation. Methods: The sample is 27 patients diagnosed sciatica due to lumbar disc herniation. We examined and treated at Traditional Medicine Department of Hue Central Hospital. A prospective study, assess the results before and after the treatment. Results: Good level occupied 44.4%; fair good level occupied 37.0%; averge good level occupied 18.5%. Conclusion: This combination is effective treatment for sciatica due to lumbar disc herniation. Key words: Sciatica, lumbar disc herniation, electronic – acupuncture, “Than thong truc u thang” remedy

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