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

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

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2019-0020 ◽

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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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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Facet tropism: possible role in the pathology of lumbar disc herniation in adolescents

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.7.peds15175 ◽

2016 ◽

Vol 18 (1) ◽

pp. 111-115 ◽

Cited By ~ 13

Author(s):

Honggang Wang ◽

Yue Zhou

Keyword(s):

Statistical Analysis ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Chi Square ◽

Chi Square Test ◽

Left And Right ◽

Facet Tropism ◽

Healthy Persons

OBJECTIVE The role of facet tropism (FT) in lumbar disc herniation (LDH) is ambiguous. The present study aimed to investigate the association between FT and LDH in adolescents. METHODS This study included 65 adolescents with LDH with 1- or 2-level LDH, or both. Facet angles were measured with MRI. FT was defined as asymmetry of 10° between the left and right side. The same levels of 30 healthy persons who had no lumbar lesions were used as controls. Statistical analysis was performed using the chi-square test. RESULTS FT was identified in 16 of 39 patients with LDH in L4–5 and in 3 of 30 controls (p = 0.006, OR 6.261, 95% CI 1.619–24.217). It was also identified in 12 of 27 patients with LDH in L5–S1 and in 4 of 30 controls (p = 0.017, OR 5.200, 95% CI 1.420–19.039). One patient had LDH in both L4–5 and L5–S1. CONCLUSIONS FT is associated with LDH in both L4–5 and L5–S1 levels in adolescents.

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PERCUTANEOUS DISCECTOMY: A CURRENT TREATMENT FOR LUMBAR DISC HERNIATION

Coluna/Columna ◽

10.1590/s1808-185120161502155446 ◽

2016 ◽

Vol 15 (2) ◽

pp. 127-130 ◽

Cited By ~ 1

Author(s):

Pablo Gerardo Lima-Ramírez ◽

David Benavides-Rodríguez ◽

Juan Yahir Viera-Ordóñez ◽

José Augusto Ruíz-Gurría ◽

Iván del Castillo-Vergara ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Pain Scale ◽

Current Treatment ◽

Prospective Longitudinal Study ◽

Student’S T ◽

One Year ◽

Prospective Longitudinal

ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1) treated with manual percutaneous nucleotomy (MPN) and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH) treated with (MPN). The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS), Oswestry Disability Index (ODI) and Macnab criteria. Descriptive and inferential statistics for differences. Results: N=110: 58 (52.72%) men, 52 (47.27%) women; average age 37.95 years (14-56) ± 10.60; most affected level: L4-L5 in 63 (57.14%) patients. NPS preoperative average: 7.75 (5-9) ± 1.12, and at 365 days: 2.14 (0-7) ± 2.37. The mean preoperative ODI was 37% (28%-40%) + 3.06, and at 365 days 9.52% (0%-40%) + 13.92. The prognosis (ODI) was good to 79 (71.81%) patients at 365 days, regular in 26 (23.63%) and poor in 5 (4.57%), corresponding respectively to patients with no, mild, moderate and severe disability. The Macnab criteria showed similar results (p = 0.00, 95% CI 0.00 to 0.13 - Student's t). Conclusions: The results were good at one-year follow-up (p = 0.00), demonstrating that the MPN is still a good option for lumbosciatic pain relief.

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Predictors of satisfaction after lumbar disc herniation surgery in elderly

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2975-4 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Niyaz Hareni ◽

Fredrik Strömqvist ◽

Björn Strömqvist ◽

Björn E. Rosengren ◽

Magnus K. Karlsson

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Factors Associated ◽

High Satisfaction ◽

Sf 36 ◽

One Year ◽

Definition Of

Abstract Background The aim of this study was to evaluate satisfaction and factors associated with satisfaction in elderly undergoing lumbar disc herniation surgery. Methods In the national Swedish register for spinal surgery (SweSpine) we identified 2095 patients aged > 65 years (WHO definition of elderly) whom during 2000–2016 had undergone LDH surgery and had pre- and one-year postoperative data (age, gender, preoperative duration and degree of back- and leg pain, quality of life (SF-36) and one-year satisfaction (dissatisfied, uncertain, satisfied). We utilized a logistic regression model to examine preoperative factors that were independently associated with low and high satisfaction and after LDH surgery. Results One year after surgery, 71% of the patients were satisfied, 18% uncertain and 11% dissatisfied. Patients who were satisfied were in comparison to others, younger, had shorter preoperative duration of leg pain, higher SF-36 mental component summary and more leg than back pain (all p < 0.01). Patients who were dissatisfied were compared to others older, had longer preoperative duration of leg pain and lower SF-36 scores (all p < 0.01). 81% of patients with leg pain up to 3 months were satisfied in comparison with 57% of patients with leg pain > 2 years (p < 0.001). Conclusion Only one out of ten elderly, is dissatisfied with the outcome of LDH surgery. Age, preoperative duration of leg pain, preoperative SF 36 score, and for satisfaction also dominance of back over leg pain, are in elderly factors associated to good and poor subjective outcome after LDH surgery.

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Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e488 ◽

2017 ◽

Vol 4 (20;4) ◽

pp. E481-E488

Author(s):

Ying Sheng Cheng

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Type I ◽

Analog Scale ◽

Percutaneous Cementoplasty ◽

Endplate Changes ◽

Modic Type ◽

One Year

Background: Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases. Objective: To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes. Study Design: PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated. Setting: This study was conducted by an interventional therapy group at a medical center in a major Chinese city. Methods: Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 – 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed. Results: The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 – 7) and 7.29 ± 0.76 (range, 6 – 8) preoperatively to 2.29 ± 1.38 (range, 1 – 5) and 2.71 ± 0.60 (range, 1 – 6) one week, 1.86 ± 0.69 (range, 1 – 3) and 2.00 ± 0.58 (range, 1 – 3) 6 months, and 1.71 ± 0.76 (range, 1 – 3) and 1.85 ± 0.69 (range, 1 – 3) one year postoperatively. The ODI dropped from 76.86 ± 7.45 (range, 70 – 82) preoperatively to 26.29 ± 19.47 (range, 16 – 70) one week, 19.14 ± 2.79 (range, 16 – 24) 6 months, and 18.57 ± 2.99 (range, 16 – 24) one year postoperatively. The mean procedure duration was 55.71 ± 6.07 minutes (range, 50 – 65 minutes). The average length of hospital stay was 7.57 ± 1.27 days (range, 6 – 10 days). No obvious complications were noted. Limitations: This was a retrospective study with a relatively small sample size. Conclusion: PLD plus PCP is a feasible technique for symptomatic lumbar disc herniation with Modic type I endplate changes. Key words: Percutaneous lumbar discectomy, percutaneous cementoplasty, lumbar disc herniation, endplate osteochondritis, Modic type I, feasibility, visual analog scale, Oswestry disability index

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A Pilot Study of Full-Endoscopic Annulus Fibrosus Suture Following Lumbar Discectomy: Technique Notes and One-Year Follow-Up

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/e497 ◽

2020 ◽

Vol 5;23 (9;5) ◽

pp. E497-E505

Author(s):

Zhen-zhou Li

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Annulus Fibrosus ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Group I ◽

Interlaminar Approach ◽

One Year ◽

Endoscopic Lumbar Discectomy

Background: An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation. Objective: The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture. Study Design: This study used a prospective cohort design. Setting: The research was conducted in a hospital and outpatient surgery center. Methods: A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded. Results: All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P < .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P > .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the oneyear follow-up (P < .01), but the tendon reflex did not recover significantly (P > .05). Limitations: This is an observational cohort study with relatively small sample sizes and short-term follow-up. Conclusions: Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy. Keywords: Annulus fibrosus suture; full-endoscope; lumbar disc herniation; lumbar discectomy; minimally invasive spinal surgery

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