Private and Non-Private Disc Herniation Patients: Do they Differ?

Objectives : In the 2006 yearly report from the Swedish National Register for Lumbar Spine Surgery it was claimed that international studies show obvious differences between private and non-private patients with regard to results from back surgery. Therefore our aim was to reveal such possible differences by comparing the two categories of patients at a private clinic. Material and Methods : The material comprises 1184 patients operated on for lumbar disc herniation during the period of 1987 to 2007. Basic pre-operative data were obtained from the medical records and follow-up was performed by a questionnaire around 5 years post-operatively. Results : Small but statistically significant differences between private and non-private patients were seen pre-operatively regarding the proportions of a/ men and women in the samples, b/ those with physically demanding jobs, c/ those on sick leave and d/ those with lumbar pain. Over the years the admitted private patients had a decreasing mean duration of symptoms which was not seen in the non-private patients. No apparent differences (n.s.) were seen between the two categories of patients pre-operatively regarding age, presence and level of leg pain or the proportion who smoked. Post-operative improvement in leg and lumbar pain was very similar in private and non-private patients as was satisfaction with the results and the proportion of patients returning to work. Conclusion : Despite small pre-operative differences concerning some variables and a significant difference in symptom duration between private and non-private disc herniation patients, the final clinical results were very similar.

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Clinical Outcomes After Standard Discectomy and Microdiscectomy for Lumbar Disc Herniation: A Single-Center Study

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2020-0006 ◽

2020 ◽

Vol 13 (1) ◽

pp. 41-47

Author(s):

Mladen E. Ovcharov

Keyword(s):

Surgical Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Surgical Techniques ◽

Postoperative Outcome ◽

Clinical Results ◽

Leg Pain ◽

Clinical Aspects ◽

Duration Of Symptoms

Summary Unsatisfactory results from lumbar disc herniation (LDH) conservative treatment suggest referral of patients for neurosurgical treatment. The time required for such a decision is considered to be about 4-6 weeks. In most cases, surgery quickly relieves pain symptoms, all along with the restoration of patient functions. The optimal surgical technique for LDH is theoretically controversial. We consider two discectomy methods as quite effective in our clinic: standard open discectomy (SD) and microdiscectomy (MD). Many retrospective studies have demonstrated the superiority of one of these techniques. Most studies describe microdiscectomy as a golden standard for surgical treatment of symptomatic disc herniation. We focused on the clinical aspects and correlations in the surgical treatment of LDH, as presented in the literature. The patients we present were divided by type of surgical procedure (SD or MD), and other parameters: sex, age, duration of symptoms, blood loss, duration of the operation, reoperation rate, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). We used chi-square tests (ANOVA analysis) and directional measures to determine statistically significant data. Five hundred eighty-nine single-level lumbar discectomies were performed for five years (2012-2017), and all the patients presented with classical signs of the condition, i.e., vertebral and radicular syndromes. SD was performed on 498 patients, and MD – on 91 patients. Analyses of the parameters mean VAS values of lumbar and leg pain postoperatively, and within one month after surgery demonstrated statistically significant differences between standard and microdiscectomy (p<0.05). LDH surgical techniques have become more and more sophisticated over the last 40 years, but without substantial improvement in the functional and clinical results. Appropriate patient selection is a crucial factor for the postoperative outcome. Neurosurgeons should fully master the chosen technique for satisfactory postoperative results.

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Open discectomy versus microscopic discectomy for lumbar disc herniation

10.21203/rs.3.rs-16951/v1 ◽

2020 ◽

Author(s):

Sherwan Hamawandi ◽

Injam Ibrahim Sulaiman ◽

Ameer Kadhim Al-Humairi

Keyword(s):

Back Pain ◽

Hospital Stay ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Postoperative Hospital Stay ◽

Daily Activities ◽

Leg Pain ◽

Significant Difference ◽

Pain Duration

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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Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000500005 ◽

2007 ◽

Vol 65 (3b) ◽

pp. 758-763 ◽

Cited By ~ 5

Author(s):

Daniel Benzecry Almeida ◽

Paola Hesse Poletto ◽

Jerônimo Buzetti Milano ◽

André Giacomelli Leal ◽

Ricardo Ramina

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Lumbar Pain ◽

Long Term Follow Up ◽

Degree Of Satisfaction ◽

First Time

Lumbar disc herniation (LDH) is a common cause of back and sciatic pain. When clinical treatment fails, surgery may be indicated in selected patients. Although surgery is effective in most cases, some of these patients may have a poor outcome. Different factors may influence these results and poor adaptation at work is one well-known cause of treatment failure. This study examines 350 patients on long-term follow-up after surgery for first-time LDH. The relationship was analyzed between occupation before surgery and outcome (maintenance of lumbar and leg pain, satisfaction with the surgical treatment and return to work). The preoperative occupation (employed in public or private services, autonomous, unemployed, housewife, retired or student) and the exertion at work were analyzed as prognostic factors for different clinical outcomes. Although unemployed people had higher numerical analog scale for lumbar pain and retired patients had a higher leg pain, this difference was not statistically significant. Retired people were significantly less satisfied with the surgical result. Higher exertion at work showed a statistically insignificant higher level of pain and lower degree of satisfaction. The authors conclude that preoperative occupation was not a statistically significant factor in this series of patients.

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Clinical Efficacy and Safety of Trans-Sacral Epiduroscopic Laser Decompression Compared to Percutaneous Epidural Neuroplasty

Pain Research and Management ◽

10.1155/2019/2893460 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Bong Ju Moon ◽

Seong Yi ◽

Yoon Ha ◽

Keung Nyun Kim ◽

Do Heum Yoon ◽

...

Keyword(s):

Clinical Efficacy ◽

Functional Outcomes ◽

Short Form ◽

Lumbar Disc ◽

Leg Pain ◽

Safe Procedure ◽

Efficacy And Safety ◽

Duration Of Symptoms ◽

Promising Alternative ◽

Significant Difference

Percutaneous epidural neuroplasty (PEN) is an effective and safe procedure for herniated lumbar disc (HLD). Although PEN has an advantage of adhesiolysis, this procedure cannot decompress the protruded disc. Recently, trans-sacral epiduroscopic laser decompression (SELD) for HLD has been introduced as a promising alternative methodology. This study evaluated the clinical efficacy and safety of SELD compared to PEN, as well as the change in protruded disc volume after SELD through pre- and postoperative magnetic resonance imaging (MRI), in patients with HLD. Thirty consecutive patients underwent SELD (SELD group), and 45 patients underwent PEN (PEN group). The Visual Analog Scale (VAS) for leg pain; Oswestry Disability Index (ODI); 12-Item Short-Form Health Survey (SF-12); preoperative and postoperative 4-, 12-, and 24-week Macnab criteria; and preoperative and 24-week postoperative lumbar spinal MRIs after SELD were obtained. There was no significant difference in age, sex, duration of symptoms, and the distributions of disc level between the two groups (all P>0.05). Between the SELD and PEN groups, preoperative VAS, ODI, and SF-12 scores had no significant differences. However, the VAS, ODI, and SF-12 scores improved significantly after the procedures by postoperative week 24 in each group (all P<0.05). Furthermore, improvements of VAS, ODI, SF-12, and success rate of Macnab criteria in the SELD group were better than those in the PEN group (all P<0.05). The protruded disc volume after SELD decreased significantly (P=0.034). All clinical and functional outcomes of patients undergoing SELD and PEN for HLD improved following the procedures. Notably, SELD was superior to PEN regarding the degree of improvement in clinical and functional outcomes. Therefore, we suggest that SELD can be used as an effective alternative to PEN to provide improved clinical and functional outcomes in patients with HLD.

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Suprapedicular Circumferential Opening Technique of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for High Grade Inferiorly Migrated Lumbar Disc Herniation

BioMed Research International ◽

10.1155/2018/5349680 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Hyeun Sung Kim ◽

Farid Yudoyono ◽

Byapak Paudel ◽

Ki Joon Kim ◽

Jee-Soo Jang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Clinical Results ◽

Outcome Evaluation ◽

Lumbar Discectomy ◽

Leg Pain ◽

High Grade ◽

The Mean

Purpose. To evaluate the efficacy of suprapedicular circumferential opening technique (SCOT) of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) for high grade inferiorly migrated lumbar disc herniation. Material and Methods. Eighteen consecutive patients who presented with back and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation were included. High grade inferiorly migrated disc was removed by the SCOT through PETLD approach. Outcome evaluation was done with visual analog scale (VAS) and Mac Nab’s criteria. Result. There were 14 males and 4 females. The mean age of patients was 53.3±14.12 years. One, 4, and 13 patients had disc herniation at L1-2, L3-4, and L4-5 levels, respectively, on MRI, which correlated with clinical findings. The mean follow-up duration was 8.4±4.31 months. According to Mac Nab’s criteria, 9 patients (50%) reported excellent and the remaining 9 patients (50%) reported good outcomes. The mean preoperative and postoperative VAS for leg pain were 7.36±0.73 and 1.45±0.60, respectively (p<0.001). Improvement in outcomes was maintained even at final follow-up. There was no complication. Conclusion. In this preliminary study we achieved good to excellent clinical results using the SCOT of PETLD for high grade inferiorly migrated lumbar disc herniation.

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The role of surgical decompression of Cauda equina in lumbar disc herniation in recovery of bladder function

Medicinski pregled ◽

10.2298/mpns0408327r ◽

2004 ◽

Vol 57 (7-8) ◽

pp. 327-330 ◽

Cited By ~ 11

Author(s):

Danilo Radulovic ◽

Goran Tasic ◽

Milos Jokovic ◽

Igor Nikolic

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Surgical Decompression ◽

Bladder Function ◽

Duration Of Symptoms ◽

Significant Difference

INTRODUCTION Cauda equina syndrome from lumbar disc herniation accounts for up to 2-3% of all disc herniations. The aim of this study was to investigate whether recovery of bladder function after surgery depends on preoperative duration of disease. Patients and methods This retrospective study included 47 patients who underwent surgery for cauda equina syndrome due to a herniated disc in the period between 1997 and 2002. Eleven patients were female and 36 male, with a mean age of 43 years (range 23-67). All presented with sciatica and saddle hypoesthesia, whereas 13 presented with motor weakness of legs. All patients had been catheterized at the time of admission to the Neurosurgical unit. Levels of herniation were L4-L5 in 27 (57%), L5-S1 in 14 (30%), and L3-L4 in 6 (13%) patients. In 7 (15%) patients, surgery was performed within 48 hours of the cauda equina syndrome onset. None underwent surgery within 24 hours. 13 (28%) patients were operated between the 2nd and 7th day and 27 (57%) after 7th day of the cauda equina onset. The role of preoperative duration of symptoms in recovery of bladder function was examined (chi 2 analysis). RESULTS The follow-up ranged from 15 to 74 months (mean 24.2 months). In 33 patients (70%) excellent result were achieved, in 9 (19%) patients good results and 5 (11%) patients presented with poor results. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression and subsequent recovery of bladder function (p>0.05). CONCLUSION After accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome due to lumbar disc herniation appear satisfactory regardless of the timing of surgery.

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Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: minimum 2-year follow-up results

Journal of Neurosurgery Spine ◽

10.3171/2017.6.spine172 ◽

2018 ◽

Vol 28 (3) ◽

pp. 317-325 ◽

Cited By ~ 35

Author(s):

Xinyu Liu ◽

Suomao Yuan ◽

Yonghao Tian ◽

Lianlei Wang ◽

Liangtai Gong ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Creatine Phosphokinase ◽

Lumbar Disc ◽

Clinical Results ◽

Leg Pain ◽

Csf Leakage ◽

Vas Scores ◽

Microendoscopic Discectomy

OBJECTIVEThis study aimed to evaluate the clinical outcomes of percutaneous endoscopic transforaminal discectomy (PETD), microendoscopic discectomy (MED), and microdiscectomy (MD) for treatment of symptomatic lumbar disc herniation (LDH).METHODSOne hundred ninety-two patients with symptomatic LDH at L3–4 and L4–5 were included in this study. The mean (± SD) age of patients was 34.2 ± 2.6 years (range 18–62 years). The patients were divided into groups as follows: group A was treated with PETD and included 60 patients (31 men and 29 women) with a mean age of 36.2 years; group B was treated with MED and included 63 patients (32 men and 31 women) with a mean age of 33.1 years; and group C was treated with MD and included 69 patients (36 men and 33 women) with a mean age of 34.0 years. The Japanese Orthopaedic Association (JOA) scale for low-back pain (LBP), Oswestry Disability Index (ODI), creatine phosphokinase activity 3 days after surgery, and visual analog scale (VAS) scores for LBP and leg pain were used for evaluation of clinical results.RESULTSThere were no significant differences in mean preoperative JOA score, ODI score, and VAS scores for LBP and leg pain among groups A, B, and C. Incision length, duration of the operation, blood loss, creatine phosphokinase, length of hospital stay, and postoperative incision pain according to the VAS were best in the PETD group (p < 0.05). The number of seconds of intraoperative fluoroscopy was highest in the PETD group (p < 0.05), whereas there was no difference between the MED and MD groups. Three cases from the MED group and 2 cases from the MD group had an intraoperative durotomy. No CSF leakage was observed after surgery. One case from the MED group and 3 cases from the MD group had incision infections. There were no neurological deficits related to the surgeries in any of the groups. Fifty-five (91.6%), 59 (93.7%), and 62 patients (89.9%) had at least 2 years of follow-up in groups A, B, and C, respectively. At the last follow-up, JOA scores, VAS scores of LBP and leg pain, and ODI scores were significantly better than preoperative correlates in all groups. There were no differences among the 3 groups in JOA scores, JOA recovery rate, ODI scores, and VAS scores for leg pain. The VAS score for LBP was best in the PETD group (p < 0.05). No lumbar instability was observed in any group. Three cases (5.5%) in the PETD group had recurrent LDH, and 2 recurrent cases (3.4%) were confirmed in the MED group.CONCLUSIONSPETD, MED, and MD were all reliable techniques for the treatment of symptomatic LDH. With a restricted indication, PETD can result in rapid recovery and better clinical results after at least 2 years of follow-up.

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Effect of Duration of Symptoms on the Clinical and Functional Outcomes of Lumbar Microdiscectomy: A Randomized Controlled Trial

10.21203/rs.3.rs-78739/v1 ◽

2020 ◽

Author(s):

Sherwan Hamawandi

Keyword(s):

Visual Analogue Scale ◽

Outcome Measures ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Functional Outcomes ◽

Analogue Scale ◽

Lumbar Disc ◽

P Value ◽

Duration Of Symptoms ◽

Significant Difference

Abstract Background Microdiscectomy is the gold standard surgical procedure for symptomatic lumbar disc herniation. The aim of this study is to determine whether the preoperative duration of symptoms can affect the postoperative clinical and functional outcomes after microdiscectomy for symptomatic lumbar disc herniation. Method A single blind, randomized controlled trial was performed by single spine surgeon on patients with symptomatic lumbar disc herniation. 122 patients, who had eligibility criteria, were divided randomly by computer system into 3 groups (A, B and C) who were operated at six weeks, three months and six months from the onset of symptoms respectively. 97 patients were analyzed at the end of this study for outcome measures. Primary outcome measures are Oswestry disability index, Roland-Morris Questionnaire and Visual analogue scale for back pain and leg pain. Secondary outcome measures are post-operative complications, length of hospital stay and time of return to daily activities.Results Better results among study’s groups were in sequence of group A, group B then group C. There was significant difference in Oswestry disability index score until three years of follow up (P-value <0.001). Improvement in Roland-Morris Questionnaire among the groups was significant at three months post-operatively (P-value <0.001). Visual analogue scale for back pain was better significantly at 2 weeks post-operatively (P-value=0.002) while Visual analogue scale for leg pain was better significantly at 3 months postoperatively (P-value=0.003). There was no significant difference among study’s groups regarding other outcome measures.Conclusion Preoperative duration of symptoms in patients with lumbar disc herniation can affect the clinical and functional outcomes after microdiscectomy. The shorter duration of symptoms the better postoperative outcomes are. This effect of duration of symptoms on postoperative outcomes is more significant in early postoperative period.Trial registration NCT, NCT04538027. Registered 1 September 2020 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04538027

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Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up

Journal of Neurosurgery Spine ◽

10.3171/spi.2000.92.2.0131 ◽

2000 ◽

Vol 92 (2) ◽

pp. 131-134 ◽

Cited By ~ 16

Author(s):

Øystein P. Nygaard ◽

Roar Kloster ◽

Tore Solberg

Keyword(s):

Sick Leave ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Duration Of Symptoms ◽

Content Type ◽

Returning To Work ◽

Fine Print

Object. The aim of this study was to investigate different variables in the duration of symptoms that can be used to predict outcome after lumbar microdiscectomy. Methods. In a prospective study of 132 consecutive patients who underwent surgery for lumbar disc herniation, the authors evaluated the prognostic value of different variables in the duration of symptoms for the 1-year period after surgery. The 1-year follow-up investigation was conducted by an independent observer. Assessment of outcome was performed using a clinical overall score (COS), which was recently assessed for its reliability and validity. As for factors predictive of outcome, only duration of leg pain and sick leave reached statistical significance in the multivariate analysis. Results of the univariate analysis demonstrated that in patients experiencing preoperative leg pain fewer than 4 months and between 4 and 8 months, a significantly lower COS at the 1-year follow up was demonstrated compared with those in whom the duration of leg pain was longer (> 8 months). One hundred eight patients returned to work within the 1st year after surgery. Patients who took a sick leave of more than 28 weeks before the operation were at higher risk of not returning to work. Conclusions. Analysis of these results indicates that leg pain lasting more than 8 months correlates with an unfavorable postoperative outcome in patients with lumbar disc herniation, as well as a high risk of not returning to work.

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Lumbar Multifidus Muscle Morphology Changes in Patient with Different Degrees of Lumbar Disc Herniation: An Ultrasonographic Study

Medicina ◽

10.3390/medicina57070699 ◽

2021 ◽

Vol 57 (7) ◽

pp. 699

Author(s):

Neda Naghdi ◽

Mohammad Ali Mohseni-Bandpei ◽

Morteza Taghipour ◽

Nahid Rahmani

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Healthy Subjects ◽

Functional Disability ◽

Lumbar Disc ◽

Muscle Size ◽

Symptom Duration ◽

Lumbar Multifidus ◽

Significant Difference ◽

Group 15

Background and Objective: Previous studies demonstrated that the prevalence of lumbar disc herniation (LDH) is relatively high. This investigation aimed to evaluate the size of lumbar multifidus (LM) muscle in patients with different degrees of LDH compared to healthy group, during rest and contraction, using ultrasonography. Materials and Methods: In this non-experimental, analytic, and case control study, ultrasound imaging was used to assess cross-sectional area (CSA) and thickness of the LM muscle in 15 healthy subjects and 60 patients with different stages of LDH (bulging group = 15, protrusion group = 15, extrusion group = 15, sequestration group = 15). Measurements were taken bilaterally at the L4–L5 level, during rest and contraction and results were compared between groups. Results: There was a significant difference between healthy subjects and the extrusion and sequestration groups during rest and contraction for LM muscle CSA and thickness (p = 0.001), as LM muscle CSA and thickness were significantly smaller in extrusion and sequestration patient groups compared to healthy subjects. LM atrophy was greater in patients with extrusion and sequestration groups than in patients with bulging and protrusion, both at rest and during contraction. Significant correlations were also observed between functional disability and intensity of pain with LM CSA and thickness measurements. Conclusions: Patients with extrusion and sequestration LDH had smaller LM muscle at rest and during contraction compared to healthy subjects. Larger LDH lesions were associated with decreased LM muscle size. Patient with more pain, disability, and extrusion and sequestration LDH had greater LM size changes. LM muscle size was not correlated with symptom duration. Further investigation with greater sample size is warranted.

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