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

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.

scholarly journals Open discectomy vs microdiscectomy for lumbar disc herniation - a protocol for a pragmatic comparative effectiveness study

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2170 ◽  
Author(s):  
Andreas Sørlie ◽  
Sasha Gulati ◽  
Charalampis Giannadakis ◽  
Sven M. Carlsen ◽  
Øyvind Salvesen ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Relative Effectiveness ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Leg Pain ◽  
Secondary Outcome ◽  
Clinical Registry

Introduction:  Since the introduction of lumbar microdiscectomy in the 1970’s, many studies have attempted to compare the effectiveness of this method with that of standard open discectomy with conflicting results. This observational study is designed to compare the relative effectiveness of microdiscectomy (MD) with open discectomy (OD) for treating lumbar disc herniation, -within a large cohort, recruited from daily clinical practice. Methods and analysis:   This study will include patients registered in the Norwegian Registry for Spine Surgery (NORspine). This clinical registry collects prospective data, including preoperative and postoperative outcome measures as well as individual and demographic parameters. The primary outcome is change in Oswestry disability index between baseline and 12 months after surgery. Secondary outcome measures are improvement of leg pain and changes in health related quality of life measured by the Euro-Qol-5D between baseline and 12 months after surgery, complications to surgery, duration of surgical procedures and length of hospital stay.

scholarly journals Clinical results of surgical treatment of the lumbar disc herniation.

1985 ◽  
Vol 34 (1) ◽  
pp. 372-378
Author(s):  
Kazumori Arimura ◽  
Ken Takara ◽  
Hiroshi Fukuyama ◽  
Masatoshi Matsuoka
Keyword(s):  
Surgical Treatment ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Clinical Results

scholarly journals LUMBAR ENDOSCOPIC PERCUTANEOUS DISCECTOMY - CLINICAL OUTCOME. PROSPECTIVE STUDY

2017 ◽  
Vol 16 (3) ◽  
pp. 177-179 ◽  
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.

scholarly journals “Visualization” of Pain using Cerebral 18 F-FDG PET/CT Following Surgical Treatment of Lumbar Disc Herniation

2021 ◽  
Author(s):  
Christian Christensen Støttrup ◽  
Caius Constantinescu ◽  
Reza Piri ◽  
Mohsen Khosravi ◽  
Andrew Newberg ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Glucose Metabolism ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Fdg Pet ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Standardized Uptake Values ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract We hypothesised that unilateral leg pain following surgical treatment of lumbar disc herniation (LDH) is associated with an increase in the glucose metabolism of the contralateral thalamus. Patients scheduled for surgery due to LDH underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) less than two weeks prior to surgery. Their thalamic FDG uptake was measured and expressed as the mean and partial volume corrected mean standardized uptake values (SUVmean and cSUVmean). These measures were compared with patient-related outcome measures collected pre- and 1-year postoperatively: back and leg pain on a 0-100 VAS scale and health related quality of life as measured by the EuroQol-5D (EQ-5D). Twenty-six patients (10 females) aged 49.7 ± 7.4 (mean ± SD) years were included. There was a significant correlation between painful body side and increased contralateral thalamic uptake of FDG, with regard to cSUVmean values. Correlation analyses including clinical parameters and cSUVmean indicated some association with 1-year change in EQ-5D. These preliminary data sustain the hypothesis that unilateral pain in patients with LDH is associated with increased glucose metabolism in the contralateral thalamus, suggestion a central role of thalamus in chronic pain perception.

Patient preferences for treatment of lumbar disc herniation: a discrete choice experiment

2021 ◽  
pp. 1-9
Author(s):  
Pravesh S. Gadjradj ◽  
Nicholas V. R. Smeele ◽  
Mandy de Jong ◽  
Paul R. A. M. Depauw ◽  
Maurits W. van Tulder ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Patient Preferences ◽  
Lumbar Disc ◽  
Recovery Period ◽  
Surgical Techniques ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Out Of Pocket Costs

OBJECTIVE Lumbar discectomy is a frequently performed procedure to treat sciatica caused by lumbar disc herniation. Multiple surgical techniques are available, and the popularity of minimally invasive surgical techniques is increasing worldwide. Clinical outcomes between these techniques may not show any substantial differences. As lumbar discectomy is an elective procedure, patients’ own preferences play an important role in determining the procedure they will undergo. The aims of the current study were to determine the relative preference weights patients apply to various attributes of lumbar discectomy, determine if patient preferences change after surgery, identify preference heterogeneity for choosing surgery for sciatica, and calculate patient willingness to pay for other attributes. METHODS A discrete choice experiment (DCE) was conducted among patients with sciatica caused by lumbar disc herniation. A questionnaire was administered to patients before they underwent surgery and to an independent sample of patients who had already undergone surgery. The DCE required patients to choose between two surgical techniques or to opt out from 12 choice sets with alternating characteristic levels: waiting time for surgery, out-of-pocket costs, size of the scar, need of general anesthesia, need for hospitalization, effect on leg pain, and duration of the recovery period. RESULTS A total of 287 patients were included in the DCE analysis. All attributes, except scar size, had a significant influence on the overall preferences of patients. The effect on leg pain was the most important characteristic in the decision for a surgical procedure (by 44.8%). The potential out-of-pocket costs for the procedure (28.8%), the wait time (12.8%), need for general anesthesia (7.5%), need for hospitalization (4.3%), and the recovery period (1.8%) followed. Preferences were independent of the scores on patient-reported outcome measures and baseline characteristics. Three latent classes could be identified with specific preference patterns. Willingness-to-pay was the highest for effectiveness on leg pain, with patients willing to pay €3133 for a treatment that has a 90% effectiveness instead of 70%. CONCLUSIONS Effect on leg pain is the most important factor for patients in deciding to undergo surgery for sciatica. Not all proposed advantages of minimally invasive spine surgery (e.g., size of the scar, no need of general anesthesia) are necessarily perceived as advantages by patients. Spine surgeons should propose surgical techniques for sciatica, not only based on own ability and proposed eligibility, but also based on patient preferences as is part of shared decision making.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
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.

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

2018 ◽  
Vol 28 (3) ◽  
pp. 317-325 ◽  
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.

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

2014 ◽  
Vol 8 (1) ◽  
pp. 237-241 ◽  
Author(s):  
Birgitta Gregebo ◽  
Deliang Dai ◽  
Birgitta Schillberg ◽  
Martin Baehr ◽  
Bo Nyström ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Leg Pain ◽  
Lumbar Pain ◽  
Lumbar Spine Surgery ◽  
Symptom Duration ◽  
International Studies ◽  
Duration Of Symptoms ◽  
Significant Difference

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.

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

2000 ◽  
Vol 92 (2) ◽  
pp. 131-134 ◽  
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.

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

2019 ◽  
Vol 12 (2) ◽  
pp. 139-146
Author(s):  
Mladen E. Ovcharov ◽  
Iliya V. Valkov ◽  
Milan N. Mladenovski ◽  
Nikolay V. Vasilev
Keyword(s):  
Recurrence Rate ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Reoperation Rate ◽  
University Hospital ◽  
Recurrence Rates ◽  
Chi Square ◽  
Common Procedure

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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