scholarly journals Outcomes after incidental durotomy during first-time lumbar discectomy

2011 ◽  
Vol 14 (5) ◽  
pp. 647-653 ◽  
Author(s):  
Atman Desai ◽  
Perry A. Ball ◽  
Kimon Bekelis ◽  
Jon D. Lurie ◽  
Sohail K. Mirza ◽  
...  
Keyword(s):  
Intervertebral Disc ◽  
Disc Herniation ◽  
Lumbar Discectomy ◽  
Intervertebral Disc Herniation ◽  
Long Term Outcome ◽  
Nerve Root Injury ◽  
Incidental Durotomy ◽  
First Time

Object Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery. The effect of a durotomy on long-term outcomes is, however, controversial. The authors sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome. Methods Spine Patient Outcomes Research Trial (SPORT) participants who had a confirmed diagnosis of intervertebral disc herniation and were undergoing standard first-time open discectomy were followed up at 6 weeks and at 3, 6, and 12 months after surgery and annually thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean (± SD) duration of follow-up among all of the intervertebral disc herniation patients whose data were analyzed was 41.5 ± 14.5 months (41.4 months in those with no durotomy vs 40.2 months in those with durotomy, p < 0.68). The median duration of follow-up among all of these patients was 47 months (range 1–95 months). Results A total of 799 patients underwent first-time lumbar discectomy. There was an incidental durotomy in 25 (3.1%) of these cases. There were no significant differences between the durotomy and no-durotomy groups with respect to age, sex, race, body mass index, herniation level or type, or the prevalence of smoking, diabetes, or hypertension. When outcome differences between the groups were analyzed, the durotomy group was found to have significantly increased operative duration, operative blood loss, and length of inpatient stay. However, there were no significant differences in incidence rates for nerve root injury, postoperative mortality, additional surgeries, or SF-36 scores for Bodily Pain or Physical Function, or Oswestry Disability Index scores at 1, 2, 3, or 4 years. Conclusions Incidental durotomy during first-time lumbar discectomy does not appear to impact long-term outcome in affected patients.

Langzeitevaluation postoperativer Schmerzen nach thorakolumbaler Hemilaminektomie

2020 ◽  
Vol 48 (05) ◽  
pp. 377-377
Keyword(s):  
Postoperative Pain ◽  
Intervertebral Disc ◽  
Disc Herniation ◽  
Neuropathischer Schmerz ◽  
Intervertebral Disc Herniation ◽  
Pain Evaluation ◽  
Ca 50

Zidan N, Medland J, Olby NJ. Long-term postoperative pain evaluation in dogs with thoracolumbar intervertebral disc herniation after hemilaminectomy. J Vet Intern Med 2020. doi: 10.1111/jvim.15800. Beim Menschen ist chronischer neuropathischer Schmerz eine häufige Komplikation nach Rückenmarksinsulten, ca. 50–80 % der Patienten entwickeln eine derartige Dolenz. Für den Hund liegen diesbezüglich keine Studiendaten vor, vor allem aufgrund der herausfordernden Evaluierung insbesondere von neuropathischen Schmerzzuständen. Diese Studie prüfte die Verlässlichkeit einer Messung von spinalen mechanisch ausgelösten sensorischen Schwellenwerten (mechanical sensory threshholds, MSTs) und verglich die MSTs gesunder Hunde mit denen von Hunden nach operativer Hemilaminektomie aufgrund einer thorakolumbaren intervertebralen Diskherniation (IVDH).

scholarly journals Higher Risk of Intervertebral Disc Herniation among Neurosurgeons Than Neurologists: 15 Year-Follow-Up of a Physician Cohort

2018 ◽  
Vol 7 (8) ◽  
pp. 198
Author(s):  
Wen-Cheng Huang ◽  
Chao-Hung Kuo ◽  
Jau-Ching Wu ◽  
Yu-Chun Chen
Keyword(s):  
Propensity Score ◽  
Intervertebral Disc ◽  
Disc Herniation ◽  
Cox Regression ◽  
Intervertebral Disc Herniation ◽  
Research Database ◽  
Matched Cohort ◽  
Disc Disease ◽  
One To One

High physical activity or workload has been associated with intervertebral disc degeneration. However, there is little data on physicians’ risks of disc disease. The study aimed to investigate the incidences of spinal problems among neurologists and neurosurgeons. A cohort of neurologists and neurosurgeons was derived from Taiwan’s national research database. During the study period, the incidences of intervertebral disc herniation or spondylosis among these specialists were calculated. Another one-to-one by propensity score matched cohort, composed of neurologists and neurosurgeons, was also analyzed. A Cox regression hazard ratio (HR) model and Kaplan-Meier analysis were conducted to compare the risks and incidences. The entire cohort comprised 481 and 317 newly board-certified neurologists and neurosurgeons, respectively. During the 15 years of follow-up, neurosurgeons were approximately six-fold more likely to develop disc problems than neurologists (crude HR = 5.98 and adjusted HR = 6.08, both p < 0.05). In the one-to-one propensity-score matched cohort (317 neurologists versus 317 neurosurgeons), there were even higher risks among neurosurgeons than neurologists (crude HR = 8.15, and adjusted HR = 10.14, both p < 0.05). Neurosurgeons have a higher chance of intervertebral disc disorders than neurologists. This is potentially an occupational risk that warrants further investigation.

scholarly journals SPORT

Neurosurgery ◽  
2011 ◽  
Vol 76 (suppl_1) ◽  
pp. S57-S63 ◽  
Author(s):  
Atman Desai ◽  
Perry A. Ball ◽  
Kimon Bekelis ◽  
Jon Lurie ◽  
Sohail K. Mirza ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Short Form ◽  
Bodily Pain ◽  
Long Term Outcomes ◽  
Nerve Root Injury ◽  
Lumbar Spinal ◽  
Incidental Durotomy ◽  
The Impact ◽  
First Time

Abstract BACKGROUND: Incidental durotomy is a familiar encounter during surgery for lumbar spinal stenosis. The impact of durotomy on long-term outcomes remains a matter of debate. OBJECTIVE: To determine the impact of durotomy on the long-term outcomes of patients in the Spine Patient Outcomes Research Trial (SPORT). METHODS: The SPORT cohort participants with a confirmed diagnosis of spinal stenosis, without associated spondylolisthesis, undergoing standard, first-time, open decompressive laminectomy, with or without fusion, were followed up from baseline at 6 weeks, and 3, 6, and 12 months and yearly thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean follow-up among all analyzed patients was 43.8 months. RESULTS: Four hundred nine patients underwent first-time open laminectomy with or without fusion. Thirty-seven of these patients (9%) had an incidental durotomy. No significant differences were observed with or without durotomy in age; sex; race; body mass index; the prevalence of smoking, diabetes mellitus, and hypertension; decompression level; number of levels decompressed; or whether an additional fusion was performed. The durotomy group had significantly increased operative duration, operative blood loss, and inpatient stay. There were, however, no differences in incidence of nerve root injury, mortality, additional surgeries, or primary outcomes (Short Form-36 Bodily Pain or Physical Function scores or Oswestry Disability Index) at yearly follow-ups to 4 years. CONCLUSIONS: Incidental durotomy during first-time lumbar laminectomy for spinal stenosis did not impact long-term outcomes in affected patients.

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

2007 ◽  
Vol 65 (3b) ◽  
pp. 758-763 ◽  
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.

scholarly journals Long-Term Follow-Up Results of Day Surgery for Lumbar Disc Herniation Using Percutaneous Endoscopic Lumbar Discectomy: A Single-Center Experience of 267 Cases.

2020 ◽  
Author(s):  
Zhaojun Song ◽  
Maobo Ran ◽  
Juan Luo ◽  
Kai Zhang ◽  
Yongjie Ye ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Day Surgery ◽  
Lumbar Discectomy ◽  
Hospitalized Patients ◽  
Disc Height ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Although numerous studies have shown good clinical results of percutaneous endoscopic lumbar discectomy (PELD) for hospitalized patients with lumbar disc herniation (LDH), there are few articles that report on the day surgery patients undergoing PELD.Methods: Atotal of 267 patients with LDH received PELD during day surgery were followed up for at least 3 years. Relevant data and clinical outcomeswere recorded and assessed. Meanwhile, we compared the clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized patients with LDH (116 patients).Results: Patients treated by PELD had lower blood loss (10.8 ± 4.1 mL, 71.3 ± 23.3 mL,respectively; P < 0.001) and shorter hospital stay ( 22.7 ± 4.2 hours, 48.1 ± 22.6 hours, respectively; P < 0.001 ) compared with patients treated by MED. The visual analogue scale (VAS) for leg and back pain (VAS-L and VAS-B, respectively) and Oswestry disability index (ODI) decreased significantly after PELD than those before the operation at 3 years postoperative, and the postoperative VAS-B in PELD group was significantly decreased from the MED group ( P = 0.001). The complications rate was 9.4% (25/267) in the PELD group and 12.1% (14/116) in the MED group, without significant difference ( P = 0.471). The 1-year postoperative recurrence rate in PELD group ( 5.2%, 14/267) was much higher than that in MED group ( 0.9%, 1/116) ( P = 0.042). The postoperative lumbar lordosis（LL）(34.0 ±10.3 ), and sacral slope（SS) (27.5 ± 5.6) in PELD group improved significantly compared with the values in MED group (26.9 ± 9.8, 23.6 ± 6.8, respectively; all P < 0.001). The disc-height ratio at 3-year follow-up was ( 85.7 ± 6.4) % of the preoperative disc height in PELD group while ( 81.9 ± 7.0) % in MED group，with significant height loss in MED group ( P = 0.014).Conclusions: Day surgery for LDH undergoing PELD has favorable long-term outcomes.

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.

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