scholarly journals A comparison of long-term efficacy of K-rod-assisted non-fusion operation and posterior lumbar interbody fusion for single-segmental lumbar disc herniation

2021 ◽  
Author(s):  
Xueliang Cheng ◽  
Yang Qu ◽  
Rongpeng Dong ◽  
Mingyang Kang ◽  
Jianwu Zhao
Keyword(s):  
Clinical Outcomes ◽  
Clinical Efficacy ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Fusion Operation

Abstract BACKGROUND Since the development of internal fixation, posterior lumbar interbody fusion (PLIF) surgery has become the gold standard for the treatment of lumbar disc herniation. Although it has good short-term clinical efficacy, it can result in problems such as postoperative intractable lower back pain and degeneration of adjacent segments. K-rod-assisted non-fusion surgery for the treatment of lumbar disc herniation has also been proven to have clinical efficacy; however, its long-term effects have not been examined.AIMTo compare the long-term clinical efficacy of K-rod-assisted non-fusion operation to the clinical efficacy of PLIF in the management of single-segment lumbar disc herniation.METHODSThis study retrospectively analyzed 22 patients with lumbar disc (L4/5) herniation who underwent K-rod-assisted non-fusion operation (n=13) or PLIF (n=9) between December 2010 and December 2013 and were followed-up for more than 5 years. Clinical outcomes were evaluated by the Oswestry Disability Index (ODI), pain Visual Analogue Score (VAS), and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Imaging evaluations included adjacent segmental intervertebral height, range of motion (ROM) of the vertebrae, incidence of lumbar instability, spino-pelvic parameters, Pfirrmann grading, Modic changes, and University of California Los Angeles (UCLA) grading.RESULTS Clinical outcomes, namely operation times (110.5±11.15 min vs. 134.44±12.36 min, P <0.05) and blood loss (59.2±7.03 ml vs. 80.0±8.66 ml, P <0.05), were significantly reduced in the K-rod group compared to the PLIF group. At the last follow-up, the clinical outcomes of the K-rod group were improved compared to those of the PLIF group as observed by the VAS score (2.1±0.9 vs. 3.0±0.7, P <0.05), JOABPEQ (26.7±1.1 vs. 25.2±1.5, P <0.05), and ODI (21.0±3.7 vs. 28.4±6.9, P <0.05). Imaging outcomes at the last follow-up indicated that the loss of height in the L3/4 intervertebral space (0.4±0.9 mm vs. 1.5±0.7 mm, P <0.05) and L5/S1 intervertebral space (0.2±0.5 mm vs. 1.8±1.7 mm, P <0.05), the ROM of L3/4 (4.9±2.0 vs. 8.8±2.4, P <0.05), the ROM of L5/S1 (5.7±1.7 vs. 8.6±1.2, P <0.05), and the incidence of adjacent segment degeneration (7.7% vs. 38.9%, P <0.05) in the PLIF group were significantly higher than those in the K-rod group. According to Pfirrmann grading, Modic changes, and UCLA grading, the incidence of adjacent segment degeneration was 55.6% in the PLIF group and 15.4% in the K-rod group. Changes in spino-pelvic parameters between the two groups were as follows: pelvic index remained unchanged, pelvic tilt angle increased, and lumbar lordosis and sacral slope decreased.CONCLUSIONCompared to PLIF, single-segment lumbar disc herniation using K-rod-assisted non-fusion surgery resulted in better long-term clinical efficacy. Our results demonstrate that this procedure can delay adjacent segment degeneration after lumbar surgery.

scholarly journals Minimum of Two-Year Follow-up After Percutaneous Endoscopic Transforaminal Discectomy on Lumbar Disc Herniation: Clinical and Radiographic Outcomes

2021 ◽  
Author(s):  
Lei Yue ◽  
Hao Chen ◽  
Guanzhang Mu ◽  
Bingxu Li ◽  
Haoyong Fu ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Intervertebral Disc ◽  
Clinical Outcomes ◽  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc

Abstract Background Percutaneous endoscopic transforaminal discectomy (PETD) is a widely-used minimally invasive technique in treating lumbar disc herniation (LDH), our aim was to investigate the long-term effect of PETD on clinical outcomes and magnetic resonance imaging (MRI) characteristics of LDH patients.Methods This is a retrospective case series to assess patients who underwent single level PETD from January 2015 to June 2019 with a minimum follow-up of 2 years. Clinical outcomes included numeric rating scale (NRS), Oswestry Disability Index (ODI) and adverse events. Radiographic parameters included sagittal spine geometry, characteristics of protrusion, and degeneration grading of intervertebral disc and facet joint. Sensitivity analysis and risk factor analysis were also performed.Results Thirty-eight patients (43.16 ± 13.32 years; M: F = 20: 18) were assessed. During the follow-up period (33.47±12.53 months), the mean disc height decreased from 10.27 ± 1.92 mm to 8.95 ± 1.74 mm (P=0.000), and lumbar lordosis increased from 31.31 ± 8.63° to 35.07 ± 8.07° (P=0.002). The size of protrusion significantly decreased after PETD (P=0.000). Disc degeneration grading was generally higher at last follow-up compared with baseline (p=0.002). Compared with baseline, significant improvements were observed on NRS and ODI at 3-months follow-up and the last follow-up. On risk factor analysis, facet tropism was correlated with radiographic recurrence of disc herniation (OR=6.00 [95% confidential interval (CI)1.176-30.624], p=0.031).Conclusions This study demonstrates that at long-term follow-up, despite the good clinical results, the PETD resulted in significant aggravation of intervertebral disc degeneration.

Is the Effect of Intervertebral Foramen Endoscopic Surgery on Adjacent Segmental Degeneration Better Than That of Open Surgery?

2021 ◽  
Author(s):  
wang shunmin ◽  
kaiqiang sun ◽  
aigang liu ◽  
rongzi chen ◽  
xi luo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Endoscopic Surgery ◽  
Lumbar Disc ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Intervertebral Foramen ◽  
Significant Difference ◽  
Endoscopic Discectomy

Abstract Background To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) and endoscopic discectomy in the treatment of postoperative adjacent segment degeneration in patients with lumbar disc herniation. Methods From 2014 to 2017, 87 patients who were diagnosed with single-level lumbar disc herniation (LDH) and received surgery of TLIF (group X, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up. The neurological function was originally evaluated by the (JOA) score of the Japanese Orthopaedic Association. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration pfirrmann score.Results There was no significant difference in average operation age, JOA improvement rate, reoperation rate and complications between the two groups. The average blood loss, average hospital stays and average operation time in group F were lower than those in group X. During the last follow-up, HIS, CA and FA decreased in both groups, and the changes in group X were more significant than those in group X (P < 0.05). There was no significant difference in postoperative FH between the two groups, but it decreased more in group X (P < 0.05).Conclusion Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar adjacent segment degeneration after intervertebral foraminal surgery is lower.

Clinical Outcome of Full-endoscopic Interlaminar Discectomy for Single-level Lumbar Disc Herniation: A Minimum of 5-year Follow-up

2017 ◽  
Vol 3 (20;3) ◽  
pp. E425-E430 ◽  
Author(s):  
Bing Wang
Keyword(s):  
Retrospective Study ◽  
Clinical Outcome ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Single Level

Background: Full-endoscopic interlaminar discectomy (FEID) is widely applied for the treatment of lumbar disc herniation (LDH) and satisfactory short-term outcomes have been achieved. However, the long-term evaluation for this technique is still lacking, especially the comparison between FEID and microendoscopic discectomy (MED). Objective: To evaluate the clinical outcome of FEID technique in comparison with MED for singlelevel LDH with a minimum of 5-year follow-up. Study Design: Retrospective study. Setting: Inpatient surgery center. Methods: A total of 152 patients with single-level LDH located at either L4-L5 or L5-S1 who underwent either FEID or MED from August 2008 to April 2011 at our hospital were enrolled in this study. General parameters including operative time, length of hospital stay, mean time to return to work, complications, and recurrences were recorded. Clinical outcomes were evaluated using visual analog scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI) for functional assessment, and modified MacNab criteria for patient satisfaction. Results: At the final follow-up, the VAS of leg and back pain decreased from 7.6 ± 1.6 and 3.1 ± 2.2 points preoperatively to 1.6 ± 1.2 and 1.7 ± 0.9 at the final follow-up, respectively (P < 0.05). The ODI score was 69.5% ± 10.5% preoperatively, and declined to 21.8% ± 7.0% at the final follow-up (P < 0.05). VAS, ODI, and modified MacNab criteria of the FEID group were improved compared to the control group though there were no statistically significant differences between the 2 groups. Limitations: This was a retrospective study with a relatively small sample size. Additionally, this study contained only clinical outcomes, without long-term radiological outcomes. Conclusions: The application of FEID achieved similar satisfactory long-term clinical outcomes for the surgical treatment of LDH as MED. However, compared with MED, FEID exhibits advantages including less operation time, shorter hospital stay, and faster postoperative recovery. Key words: Lumbar disc herniation, full-endoscopic interlaminar discectomy, microendoscopic disectomy, long-term Pain Physician 2017

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.

Sign in / Sign up

Export Citation Format

Share Document