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

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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EFFICACY OF ANTIBIOTICS PROPHYLAXIS IN PATIENTS WITH LUMBAR DISC HERNIATION UNDERGOING LUMBAR DISCETOMY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.5.2 ◽

2018 ◽

Vol 8 (5) ◽

pp. 14-19

Author(s):

Tri Truong Van ◽

Tri Tran Duc Duy ◽

Khai Vo Le Quang

Keyword(s):

Surgical Site Infection ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

University Hospital ◽

Site Infection ◽

Surgical Wound ◽

A Prospective Study ◽

Length Of Hospitalization

Introduction: Surgical wound infection in developing coutries is about 3%. Antibiotics prophylaxis may help to reduce the surgical site infection. The objective of this study was to evaluate the efficacy of antibiotics prophylaxis in patients with lumbar disc herniation who were treated with lumbar discectomy at Hue University hospital. Materials and Methods: A prospective study was conducted at Hue University hospital from March 2015 to May 2018 on 54 patients with lumbar disc herniation who were used antibiotics prophylaxis when undergoing discectomy. Results: The infection rate in our study was 0%. Antibiotics prophylaxis reduced the length of hospitalization as well as the medical cost. Conclusion: Antibiotics prophylaxis was effective in preventing surgical site infection despite the fact that the condition of operating rooms did not meet the standard rules. Key words: prophylaxis antibiotics, lumbar disc herniation

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A Transforaminal Endoscopic Surgical Technique for Treating Lumbar Disc Herniation in the Setting of Spina Bifida

Case Reports in Neurological Medicine ◽

10.1155/2020/1076847 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Albert E. Telfeian ◽

Adetokunbo Oyelese ◽

Jared Fridley ◽

Rohaid Ali ◽

Deus Cielo ◽

...

Keyword(s):

Spina Bifida ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Recent Literature ◽

Lumbar Disc ◽

Surgical Techniques ◽

Surgical Decompression ◽

Minimally Invasive Approach ◽

Disc Disease ◽

Invasive Approach

Recent literature suggests that adult patients with spina bifida receive surgery for degenerative disc disease at higher rates than the general population. However, sometimes the complex anatomic features of co-occurring spina bifida and lumbar disc herniation can significantly challenge standard surgical techniques. Here, the technical steps are presented for treating a foraminal lumbar 4-5-disc herniation in the setting of a patient with multifaceted degenerative and spina bifida occulta anatomy. Utilized is a minimally invasive approach that does not require general anesthesia or fusion and allows the patient to leave the same day. To the best of our knowledge, this is the first-reported case of endoscopic surgical decompression of a lumbar disc in a patient with spina bifida.

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Microsurgical Excision of Herniated Lumber Disc in Pediatric Population

Neuroscience and Neurological Surgery ◽

10.31579/2578-8868/008 ◽

2018 ◽

Vol 2 (3) ◽

pp. 01-05

Author(s):

Ahmed Zaher

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pediatric Population ◽

Lumbar Disc ◽

Radicular Pain ◽

University Hospital ◽

Csf Leak ◽

Degree Relative ◽

History Of

Lumbar disc herniation is a relatively rare disorder among children and adolescent population compared to adults. The objectives of this work are to study the lumbar disc herniation in pediatric population and determine the surgical outcome of lumbar microdiscectomy in such population. Patients and methods: A series of 32 pediatric patients less than 18 years operated by microdiscectomy at Mansoura University hospital during the period from January 2005 to March 2015 were retrospectively analyzed. Clinical presentation, physical signs, predisposing factors, radiological investigations and operative findings were retrieved from medical records. Improvement of pain was assessed by visual analogue scale. Results: The study included 17 females (53.1%) and 15 males (46.9%) ranging in age from 10 to18 years (mean, 14.2 year). The patients were followed up for periods ranging from three to 115 months (mean, 55 months). All patients had radicular pain (100%) with additional back pain in twenty one patients (65.63%), twenty eight patients (87.5%) presented by sciatic pain while six patients (18.75%) showed femoral neuralgia. Straight leg raising test was positive in 90.62%. L4/5 was the commonest affected level in eighteen patients (56.25%) while twelve patients (37.5%) had disc herniation at L5-S1 level and only two patients had herniation at L3-4 disc level. Family history of lumbar disc herniation in first degree relative was positive in twenty one patients (65.63%). History of relevant trauma was documented in only twelve patients (37.5%). During surgery the disc was soft, rubbery and well hydrated in 90.6% of cases. Subligamentous disc herniation was observed in 81%, while 12.5% of patients had disc bulge with intact annulus and only 6.5% had extruded disc. All patients showed significant improvement of radicular pain at the time of discharge while back pain continued to improve during early postoperative follow up. Low back pain and radicular pain equally improved after three months despite instant postoperative improvement of radicular pain. Postoperative complications were rare and included one case of wound infection, one case of iatrogenic CSF leak and new neurological deficit in another case. Conclusion: Lumbar disc herniation in pediatric population differs from that of adults in many aspects. Microdiscectomy is safe and reliable procedure for management of pediatric lumbar disc herniation with good outcome and minimal morbidity

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Recurrence Rate and Survival Analysis of the Lumbar Disc Herniation After Open Discectomy

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2004.39.6.636 ◽

2004 ◽

Vol 39 (6) ◽

pp. 636 ◽

Cited By ~ 1

Author(s):

Bo Kyu Yang ◽

Jeong Hyun Ha ◽

Sung Ho Hahn ◽

Seung Rim Yi ◽

Shun Wook Chung ◽

...

Keyword(s):

Survival Analysis ◽

Recurrence Rate ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc

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Pattern of Neurological Improvements in Patient with Lumbar Disc Herniation after Microdiscectomy: Experience at the Fourth Oldest Western Medical Facility in South Asia

Nepal Journal of Neuroscience ◽

10.3126/njn.v14i2.19698 ◽

2017 ◽

Vol 14 (2) ◽

pp. 8-15

Author(s):

Kiran Niraula ◽

Muhammad Irfan ◽

Chandra P Limbu ◽

Raj Kumar KC ◽

Muhammad A Shaheen ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Muscle Power ◽

Lumbar Disc ◽

Sampling Technique ◽

Neurological Status ◽

T Test ◽

Mri Findings ◽

Chi Square ◽

Paired T Test

The pattern of improvement in Neurological status after disc surgery is different. The chronology of improvement in Medical Research Council (MRC) scores, sensory status and improvement in Straight Leg Raise (SLR) test degrees is beneficial in management part to surgeons, relatives and the patients.To assess pattern of neurological outcomes in patients with lumbar disc herniation after microdiscectomy in terms of muscle power, sensory status and SLR.A Quasi experimental study comprising 70 consecutive cases though non-probability purposive sampling technique of both the sexes admitted in Neurosurgery department, Mayo Hospital operated for the 1st time for any disc pathology with no other spinal lesions giving consent themselves or though legal guardians was conducted. Pain for leg and back was measured pre and post-operatively was done by VAS which had 42 days of follow up. Standard Neurological examinations were conducted pertaining to muscle power (by MRC), sensory status and SLR test pre and post-operatively. Variables according to their nature were expressed in the form of Mean±SD, Median (Range) and Frequency (percentage). Mc Neumer’s chi square test and paired t test were used to see association between preoperative and post-operative Neurological status depending on their nature viz: qualitative or quantitative respectively in SPSS version 15.Out of 70 patients 74% were male and 26% were females. Mean±SD of patients was 37.6±13.0 years. Majority were Laborers after housewives. Illiterates, Poor lifting techniques were the most common characteristics in the respective headings of education and employment. Most common level of disc herniation was L4-L5, L5- S1 level (96%) where Prolapse and extrusion were most common MRI findings. As compared to pre-operative (3.4) muscle power 1st and 42nd day power were respectively 4.0 and 4.7 (p=0.001). Pre-operatively only 32 (45.7%) had normal sensation which improved to 38 (54.3%) and 51 (72.9%) respectively in 1st and 42nd day of surgery (p=0.001). Pre-operative mean SLR improved to 98.6 degrees in 1st POD and continued to be the same till 42nd day (p=0.001). All the MRC findings, sensory status and SLR values in each post-operative days were statistically significant with the baseline by paired t test (p=0.001). MRC and Sensory status had same pattern of improvement (r=0.0. p=0.04) unlike SLR which total improvements were see in 1st POD itself.In conclusion, muscle power and sensory improvement follows same improvement pattern whereas maximum SLR improves in the 1st POD itself.Nepal Journal of Neuroscience, Vol. 14, No. 2, 2017 Page: 8-15

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Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation

European Journal of Translational Myology ◽

10.4081/ejtm.2020.8748 ◽

2020 ◽

Vol 30 (2) ◽

pp. 325-333

Author(s):

Pooya Torkian ◽

Keivan Daneshvar ◽

Ebrahim Taherian ◽

Yasaman Rezaeifar ◽

Shahram Akhlaghpoor

Keyword(s):

Recurrence Rate ◽

Disc Herniation ◽

Fibrin Sealant ◽

Lumbar Disc ◽

Primary Outcome Measure ◽

Recurrence Rates ◽

Fibrin Sealants ◽

Endoscopic Discectomy ◽

And Control ◽

Sealant Group

Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.

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LUMBAR ENDOSCOPIC PERCUTANEOUS DISCECTOMY - CLINICAL OUTCOME. PROSPECTIVE STUDY

Coluna/Columna ◽

10.1590/s1808-185120171603166520 ◽

2017 ◽

Vol 16 (3) ◽

pp. 177-179 ◽

Cited By ~ 1

Author(s):

ANDRÉ LUÍS SEBBEN ◽

XAVIER SOLER I GRAELLS ◽

MARCEL LUIZ BENATO ◽

PEDRO GREIN DEL SANTORO ◽

ÁLYNSON LAROCCA KULCHESKI

Keyword(s):

Surgical Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Gold Standard ◽

Lumbar Disc ◽

Surgical Techniques ◽

Preoperative Period ◽

Percutaneous Discectomy ◽

Common Indication ◽

Endoscopic Techniques

ABSTRACT Objective: Lumbar disc herniation is a common indication for surgical treatment of the spine. Open microdiscectomy is the gold standard. New surgical techniques have emerged, such as spinal endoscopy. We compared and evaluated two endoscopic techniques: the transforaminal and the interlaminar. Methods: Fifty-five patients underwent endoscopic technique and were assessed by VAS and ODI in the preoperative period, and in the first and sixth month after the procedure. Results: We had 89.1% of good results and 10.9% of complications. Conclusion: We conclude that endoscopic techniques are safe and effective for the surgical treatment of lumbar disc herniation.

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P144. Analysis of the Recurrence Rate of the Lumbar Disc Herniation

The Spine Journal ◽

10.1016/j.spinee.2006.06.353 ◽

2006 ◽

Vol 6 (5) ◽

pp. 153S

Author(s):

Min-Seok Kim ◽

Young-Kyun Lee ◽

Changju Hwang ◽

Dong-Ho Lee ◽

Choon-Ki Lee ◽

...

Keyword(s):

Recurrence Rate ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc

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One-year outcomes of early-crossover patients in a cohort receiving nonoperative care for lumbar disc herniation

Journal of Neurosurgery Spine ◽

10.3171/2017.2.spine16760 ◽

2017 ◽

Vol 27 (4) ◽

pp. 391-396 ◽

Cited By ~ 2

Author(s):

Anurekha Ramakrishnan ◽

K. Michael Webb ◽

Matthew C. Cowperthwaite

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Regression Models ◽

Lumbar Disc ◽

Recursive Partitioning ◽

Chi Square ◽

Logistic Regression Models ◽

Spine Intervention ◽

Euroqol 5D ◽

One Year

OBJECTIVEThe authors comprehensively studied the recovery course and 1-year outcomes of early-crossover patients who were randomized to the nonoperative care arm of the Leiden–The Hague Spine Intervention Prognostic Study. The primary goal was to gain insight into the differences in the recovery patterns of early-crossover patients and those treated nonoperatively; secondary goals were to identify predictors of good 1-year outcomes, and to understand when and why patients were likely to cross over.METHODSIndividual EuroQol-5D scores were obtained at baseline and at 2, 4, 8, 12, 26, 38, and 52 weeks for 142 patients. Early-crossover patients were defined as those electing to undergo surgery during the first 12 weeks of treatment. Crossover and noncrossover groups were compared using Kruskal-Wallis, Wilcoxon-Mann-Whitney, and chi-square tests. Linear mixed-effects models were used to examine the growth trajectories of crossover and noncrossover groups. Recursive partitioning trees were used to model crossover events and the timing of crossover decisions. Multivariable logistic regression models were used to identify predictors of good 1-year outcomes.RESULTSOf the 142 patients randomized to receive prolonged nonoperative care, 136 were selected for the study. In this cohort, 43/136 (32%) opted for surgery, and 31/43 (72%) of crossover events occurred before the 12-week time point. Early-crossover patients had significantly greater functional impairment at Week 2 than noncrossover patients (p = 0.031), but experienced greater recovery by 26 weeks and better 1-year outcomes (p = 0.045). Patients who did not experience an improvement in their symptoms between 2 and 8 weeks were more likely to cross over (OR 3.5, 95% CI 1.2–10.1; p = 0.01). Recursive partitioning trees were able to identify crossover patients with 76% accuracy. Regression models suggested that better recovery at 26 weeks (p < 0.01) was predictive of good 1-year outcome; declining health status between Weeks 4 and 8 was negatively predictive of good outcome (p < 0.01).CONCLUSIONSThis study is the first to comprehensively analyze the recovery and outcomes of crossover patients, and compare them to nonoperatively treated patients. The results suggest that patients who have a low EuroQol-5D score during the early weeks of treatment and who do not respond to nonoperative care during the first few weeks of treatment are most likely to cross over. Early-crossover patients experience a greater rate of recovery and more frequently have a good 1-year outcome when compared with nonoperatively treated patients. The current results motivate a broader investigation into the timing of surgery and the identification of patient populations that will be most benefited by early surgical treatment for lumbar disc herniation.

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