Open discectomy versus microscopic discectomy for lumbar disc herniation

Abstract Background Discectomy for symptomatic lumbar disc herniation is the most common surgical procedure in spine surgery. Lumbar discectomy can be done by traditional open method or by varieties of minimal invasive techniques mainly microscopic or endoscopic procedures. This study evaluates the effectiveness of microdiscectomy compared with open discectomy in the treatment of lumbar disc herniation as a relation to the relief of leg pain, post-operative back pain, postoperative hospital stay and returns to daily activity. Methods Sixty patients were included in this study, 30 patients underwent an open discectomy and 30 patients underwent microdiscectomy. Those patients were followed up for 12 months after surgery. Each patient was evaluated for the postoperative back pain, leg pain, duration of hospital stay postoperatively and return to sedentary daily activity. The methods used to evaluate each patient are Visual analogue scale for back pain and leg pain and Oswestry disability index. Results Results showed that there is a significant difference in the postoperative back pain, duration of postoperative hospital stay and the time of return to sedentary daily activities between open discectomy and microdiscectomy with superiority for microdiscectomy while there is no significant difference in the relieving leg pain between the open discectomy and microdiscectomy. Conclusion Microdisctomy is effective as open discectomy in the aspect of relieving the leg pain with the advantage of less postoperative back pain, less postoperative hospital stay and early return to sedentary daily activities.

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

10.21203/rs.3.rs-16951/v2 ◽

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

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To study the effect of Triamcinolone injection for low back pain due to lumbar disc herniation

Bhutan Health Journal ◽

10.47811/bhj.58 ◽

2018 ◽

Vol 4 (1) ◽

pp. 55-59

Author(s):

Tashi Wangchuk ◽

Kunzang P. Wangmo ◽

Thinley Norbu

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Low Back ◽

Trauma History ◽

Pain Scores ◽

Significant Difference ◽

Epidural Steroid

Introduction: Low back pain is one of the most common complaints in the general population which represents a significant public health problem. Epidural Steroid Injection is being considered as a simple, effective and minimally invasive treatment modality for lumbar disc herniation. However, most studies only find a short-term benefit. In Bhutan, till date, no study has been done in Bhutan on this subject. The objective of our study was to find the effect of epidural steroid injection for low back pain due to lumbar disc herniation. Methods: An observational one-year-period study completed in Jigme Dorji Wangchuck National Referral Hospital. Symptomatic and positive Magnetic Resonance Imaging patients with lumbar disc herniation were included in our study. Pain scores were collected using Numeric Rating Scale at three different points of study. We also included patients’ age, weight and trauma history as some of the independent variables to study their associations with pain scores. The data obtained were analyzed using the Stata software program. One way repeated measures ANOVA was used to assess the significant difference in pain score. Results: Out of 100 participants recruited for the study, 91 of them completed demographic data and only 81 patients completed follow-up till 4 weeks post-treatment for demographic analysis and analytical analysis, respectively. There was a significant difference in pain scores in all three different points of study (p <0.01). No significant difference was observed in the pain scores amongst different age groups, gender, occupation and trauma history (p >0.05) at all three points of study. Conclusion: Our study observed a significant short-term benefit from epidural Triamcinolone injection for symptomatic lumbar disc herniation.

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Assessment of low back pain and leg pain using Visual Analog Scale in patients with lumbar disc herniation after microendoscopic discectomy

The Journal of Japanese Society of Lumbar Spine Disorders ◽

10.3753/yotsu.13.175 ◽

2007 ◽

Vol 13 (1) ◽

pp. 175-179 ◽

Cited By ~ 1

Author(s):

Takatoshi SHIMOMURA

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Visual Analog Scale ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Low Back ◽

Analog Scale ◽

Microendoscopic Discectomy

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Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients

Journal of Neurosurgery Spine ◽

10.3171/2020.8.spine20602 ◽

2021 ◽

pp. 1-9

Author(s):

Joel Beck ◽

Olof Westin ◽

Helena Brisby ◽

Adad Baranto

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Surgical Outcome ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Preoperative Pain ◽

Data Set ◽

Patient Reported ◽

Pain Duration

OBJECTIVESciatica is the hallmark symptom of a lumbar disc herniation (LDH). Up to 90% of LDH patients recover within 12 weeks regardless of treatment. With continued deteriorating symptoms and low patient quality of life, most surgeons recommend surgical discectomy. However, there is not yet a clear consensus regarding the proper timing of surgery. The aim of this study was to evaluate how the duration of preoperative leg pain (sciatic neuralgia) is associated with patient-reported levels of postoperative leg pain reduction and other patient-reported outcome measures (PROMs) in a prospectively collected data set from a large national cohort.METHODSAll patients aged 18–65 years undergoing a lumbar discectomy during 2013–2016 and registered in Swespine (the Swedish national spine registry) with 1 year of postoperative follow-up data were included in the study (n = 6216). The patients were stratified into 4 groups according to preoperative pain duration: < 3, 3–12, 12–24, or > 24 months. Patient results assessed with the numeric rating scale (NRS) for leg pain (rated from 0 to 10), global assessment of leg pain, EQ-5D, Oswestry Disability Index (ODI), and patient satisfaction with the final surgical outcome were analyzed and compared with preoperative values and between groups.RESULTSA significant improvement was seen 1 year postoperatively regardless of preoperative pain duration (change in NRS score: mean −4.83, 95% CI −4.73 to −4.93 in the entire cohort). The largest decrease in leg pain NRS score (mean −5.59, 95% CI −5.85 to −5.33) was seen in the operated group with the shortest sciatica duration (< 3 months). The patients with a leg pain duration in excess of 12 months had a significantly higher risk of having unchanged radiating leg pain 1 year postoperatively compared with those with < 12-month leg pain duration at the time of surgery (OR 2.41, 95% CI 1.81–3.21, p < 0.0001).CONCLUSIONSPatients with the shortest leg pain duration (< 3 months) reported superior outcomes in all measured parameters. More significantly, using a 12-month pain duration as a cutoff, patients who had a lumbar discectomy with a preoperative symptom duration < 12 months experienced a larger reduction in leg pain and were more satisfied with their surgical outcome and perception of postoperative leg pain than those with > 12 months of sciatic leg pain.

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Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

10.21203/rs.3.rs-594596/v1 ◽

2021 ◽

Author(s):

Hai-Chao He ◽

Xiao-qiang LV ◽

Yong-Jin Zhang

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Lumbar Discectomy ◽

Leg Pain ◽

Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

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Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4–12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial

Global Spine Journal ◽

10.1177/21925682211054040 ◽

2021 ◽

pp. 219256822110540

Author(s):

Christopher S. Bailey ◽

Andrew Glennie ◽

Parham Rasoulinejad ◽

Andrew Kanawati ◽

David Taylor ◽

...

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Early Surgery ◽

Adverse Event Rate ◽

Delayed Surgery ◽

Surgery Group ◽

Chronic Sciatica

Objectives To compare the effect of delaying surgery on clinical outcome in patients with chronic sciatica secondary to lumbar disc herniation. Methods Patients with sciatica lasting 4–12 months and lumbar disc herniation at the L4–L5 or L5–S1 level were randomized to undergo microdiscectomy (early surgery) or to receive 6 months of nonoperative treatment followed by surgery if needed (delayed surgery). Outcomes were leg pain, Oswestry Disability Index score (ODI), back pain, SF–36 physical component (PCS) and mental component (MCS) summary scores, employment, and satisfaction measured preoperatively and at 6 weeks, 3 months, 6 months, and 1 year after surgery. Results Of the 64 patients in the early surgery group, 56 underwent microdiscectomy an average of 3 ± 2 weeks after enrollment. Of the 64 patients randomized to nonoperative care, 22 patients underwent delayed surgery an average of 53 ± 24 weeks after enrollment. The early surgery group experienced less leg pain than the delayed surgery group, which was the primary outcome, at 6 months after surgery (early surgery 2.8 ± .4 vs delayed surgery 4.8 ± .7; difference, 2.0; 95% confidence interval, .5–3.5). The overall estimated mean difference between groups significantly favored early surgery for leg pain, ODI, SF36-PCS, and back pain. The adverse event rate was similar between groups. Conclusions Patients presenting with chronic sciatica treated with delayed surgery after prolonging standardized non-operative care have inferior outcomes compared to those that undergo expedited surgery.

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The Effect of Low Back Pain on the Daily Activities of Patients With Lumbar Disc Herniation

Journal of Neuroscience Nursing ◽

10.1097/jnn.0b013e3182478e57 ◽

2012 ◽

Vol 44 (2) ◽

pp. 98-104 ◽

Cited By ~ 8

Author(s):

Gulsah Kose ◽

Sevgi Hatipoglu

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Daily Activities ◽

Low Back

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Outcomes following discectomy for lumbar disc herniation in patients with substantial back pain

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine191382 ◽

2020 ◽

Vol 33 (5) ◽

pp. 623-626

Author(s):

Simon Thorbjørn Sørensen ◽

Rachid Bech-Azeddine ◽

Søren Fruensgaard ◽

Mikkel Østerheden Andersen ◽

Leah Carreon

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Patient Reported Outcomes ◽

Lumbar Disc ◽

Leg Pain ◽

Patient Reported ◽

Vas Scores ◽

The Mean

OBJECTIVEPatients with lumbar disc herniation (LDH) typically present with lower-extremity radiculopathy. However, there are patients who have concomitant substantial back pain (BP) and are considered candidates for fusion. The purpose of this study was to determine if patients with LDH and substantial BP improve with discectomy alone.METHODSThe DaneSpine database was used to identify 2399 patients with LDH and baseline BP visual analog scale (VAS) scores ≥ 50 who underwent a lumbar discectomy at one of 3 facilities between June 2010 and December 2017. Standard demographic and surgical variables and patient-reported outcomes, including BP and leg pain (LP) VAS scores (0–100), Oswestry Disability Index (ODI), and European Quality of Life–5 Dimensions Questionnaire (EQ-5D) at baseline and 12 months postoperatively, were collected.RESULTSA total of 1654 patients (69%) had 12-month data available, with a mean age of 48.7 years; 816 (49%) were male and the mean BMI was 27 kg/m2. At 12 months postoperatively, there were statistically significant improvements (p < 0.0001) in BP (72.6 to 36.9), LP (74.8 to 32.6), ODI (50.9 to 25.1), and EQ-5D (0.25 to 0.65) scores.CONCLUSIONSPatients with LDH and LP and concomitant substantial BP can be counseled to expect improvement in their BP 12 months after surgery after a discectomy alone, as well as improvement in their LP.

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