Microdecompression for Extraforaminal L5-S1 Disc Herniation; The Significance of Concomitant Foraminal Disc Herniation for Postoperative Leg Pain

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.

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Percutaneous laser disc decompression versus conventional microdiscectomy for patients with sciatica: Two-year results of a randomised controlled trial

Interventional Neuroradiology ◽

10.1177/1591019917699981 ◽

2017 ◽

Vol 23 (3) ◽

pp. 313-324 ◽

Cited By ~ 13

Author(s):

Patrick A Brouwer ◽

Ronald Brand ◽

M Elske van den Akker-van Marle ◽

Wilco CH Jacobs ◽

Barry Schenk ◽

...

Keyword(s):

Outcome Measures ◽

Disc Herniation ◽

Randomised Trial ◽

Prospective Trial ◽

Leg Pain ◽

Conventional Surgery ◽

Laser Disc ◽

Operation Rate ◽

Significant Difference

Background Percutaneous laser disc decompression is a minimally invasive treatment, for lumbar disc herniation and might serve as an alternative to surgical management of sciatica. In a randomised trial with two-year follow-up we assessed the clinical effectiveness of percutaneous laser disc decompression compared to conventional surgery. Materials and methods This multicentre randomised prospective trial with a non-inferiority design, was carried out according to an intent-to-treat protocol with full institutional review board approval. One hundred and fifteen eligible surgical candidates, with sciatica from a disc herniation smaller than one-third of the spinal canal, were randomly allocated to percutaneous laser disc decompression ( n = 55) or conventional surgery ( n = 57). The main outcome measures for this trial were the Roland-Morris Disability Questionnaire for sciatica, visual analogue scores for back and leg pain and the patient's report of perceived recovery. Results The primary outcome measures showed no significant difference or clinically relevant difference between the two groups at two-year follow-up. The re-operation rate was 21% in the surgery group, which is relatively high, and with an even higher 52% in the percutaneous laser disc decompression group. Conclusion At two-year follow-up, a strategy of percutaneous laser disc decompression, followed by surgery if needed, resulted in non-inferior outcomes compared to a strategy of microdiscectomy. Although the rate of reoperation in the percutaneous laser disc decompression group was higher than expected, surgery could be avoided in 48% of those patients that were originally candidates for surgery. Percutaneous laser disc decompression, as a non-surgical method, could have a place in the treatment arsenal of sciatica caused by contained herniated discs.

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New treatment of lumbar disc herniation involving 5-hydroxytryptamine2A receptor inhibitor: a randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.4.0441 ◽

2005 ◽

Vol 2 (4) ◽

pp. 441-446 ◽

Cited By ~ 22

Author(s):

Masahiro Kanayama ◽

Tomoyuki Hashimoto ◽

Keiichi Shigenobu ◽

Fumihiro Oha ◽

Shigeru Yamane

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Low Back ◽

Content Type ◽

Medical Interventions ◽

Randomized Controlled ◽

Nsaid Group ◽

Fine Print

Object. Serotonin or 5-hydroxytryptamine (5-HT) is a chemical mediator associated with nucleus pulposus—induced radiculopathy. Inhibition of 5-HT receptors may potentially alleviate symptoms in patients with lumbar disc herniation. This prospective randomized controlled study was performed to evaluate the efficacy of the 5-HT2A receptor inhibitor in the treatment of symptomatic lumbar disc herniation. Methods. Forty patients with sciatica due to L4–5 or L5—S1 disc herniation were randomly allocated to treatment with the 5-HT2A inhibitor (sarpogrelate 300 mg/day) or nonsteroidal antiinflammatory drugs (NSAIDs; diclofenac 75 mg/day). Low-back pain, leg pain, and numbness were evaluated using a visual analog scale (VAS) before and after a 2-week course of treatment. The patients received only allocated medicine during the 2-week regimen and were thereafter allowed to choose any treatment options depending on their residual symptoms. One-year clinical outcomes were assessed based on the rates of additional medical interventions. The mean VAS score improvements in the 5-HT2A and NSAID groups were 33 and 46% for low-back pain, 32 and 32% for leg pain, and 35 and 22% for leg numbness, respectively. After the 2-week regimen, no additional medical interventions were required in 50% of 5-HT2A—treated patients and 15% of those receiving NSAIDs. Epidural or nerve root block procedures were performed in 35% of the 5-HT2A group and 45% of the NSAID group. Surgery was required in 20% of the 5-HT2A group and 30% of the NSAID group patients. Conclusions. The current study provided evidence that the efficacy of the 5-HT2A inhibitor was comparable with that of NSAID therapy for lumbar disc herniation. The 5-HT2A inhibitor has the potential to alleviate symptoms in patients with lumbar disc herniation.

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Effectiveness and safety of acupotomy for treating back and/or leg pain in patients with lumbar disc herniation

Medicine ◽

10.1097/md.0000000000011951 ◽

2018 ◽

Vol 97 (34) ◽

pp. e11951 ◽

Cited By ~ 2

Author(s):

Jeong Kyo Jeong ◽

Young Il Kim ◽

Eunseok Kim ◽

Hae Jin Kong ◽

Kwang Sik Yoon ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain

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Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation

Asian Spine Journal ◽

10.4184/asj.2017.11.1.71 ◽

2017 ◽

Vol 11 (1) ◽

pp. 71-74 ◽

Cited By ~ 4

Author(s):

Idiris Altun ◽

Kasım Zafer Yüksel

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Disc Herniation ◽

Ligamentum Flavum ◽

Elastic Fiber ◽

Leg Pain ◽

Histopathological Analysis ◽

Significant Difference ◽

Fiber Number ◽

Lumbar Spinal

<sec><title>Study Design</title>Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH).</sec><sec><title>Purpose</title>The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH.</sec><sec><title>Overview of Literature</title>LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS.</sec><sec><title>Methods</title>A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification.</sec><sec><title>Results</title>The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (<italic>p</italic><0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (<italic>p</italic><0.001) between groups.</sec><sec><title>Conclusions</title>LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed.</sec>

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Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Journal of Neurosurgery Spine ◽

10.3171/2015.4.spine14883 ◽

2016 ◽

Vol 24 (1) ◽

pp. 48-53 ◽

Cited By ~ 10

Author(s):

Ulrich Hubbe ◽

Pamela Franco-Jimenez ◽

Jan-Helge Klingler ◽

Ioannis Vasilikos ◽

Christoph Scholz ◽

...

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operating Time ◽

Leg Pain ◽

P Value ◽

Vas Scores ◽

Recurrent Lumbar Disc Herniation

OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

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Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Medicina ◽

10.3390/medicina56120710 ◽

2020 ◽

Vol 56 (12) ◽

pp. 710

Author(s):

Muneyoshi Fujita ◽

Tomoaki Kitagawa ◽

Masahiro Hirahata ◽

Takahiro Inui ◽

Hirotaka Kawano ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Disc Height ◽

Leg Pain ◽

Height Loss ◽

Common Disease ◽

Low Back ◽

Endoscopic Discectomy ◽

Microendoscopic Discectomy

Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.

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Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis

Operative Neurosurgery ◽

10.1093/ons/opaa360 ◽

2020 ◽

Author(s):

Kuo-Tai Chen ◽

Kyung-Chul Choi ◽

Myung-Soo Song ◽

Hussam Jabri ◽

Yadhu K Lokanath ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Lumbar Decompression ◽

Lateral Recess Stenosis ◽

Endoscopic Discectomy ◽

The Mean

Abstract BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P < .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P < .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.

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Foraminal Cervical Herniated Disc Treated by Anterior Discoforaminotomy

Neurosurgery ◽

10.1227/00006123-198709000-00009 ◽

1987 ◽

Vol 21 (3) ◽

pp. 334-338 ◽

Cited By ~ 20

Author(s):

F. Lesoin ◽

A. Biondi ◽

M. Jomin

Keyword(s):

Disc Herniation ◽

Herniated Disc ◽

Computed Tomographic ◽

Computed Tomographic Scan ◽

Foraminal Disc Herniation

Abstract The authors report their experience with cervical foraminal disc herniation. The importance of the computed tomographic scan in its diagnosis is emphasized, and discoforaminotomy is described.

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