scholarly journals Risk Factors for Recurrence of Disc Herniation After Single-Level Lumbar Discectomy

2021 ◽  
Author(s):  
Yong Guk Kim ◽  
Joo Chul Yang ◽  
Tae Wan Kim
Keyword(s):  
Risk Factors ◽  
Disc Herniation ◽  
Lumbar Discectomy ◽  
Single Level ◽  
Risk Factors For Recurrence

scholarly journals The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry

2013 ◽  
Vol 19 (5) ◽  
pp. 555-563 ◽  
Author(s):  
Zoher Ghogawala ◽  
Christopher I. Shaffrey ◽  
Anthony L. Asher ◽  
Robert F. Heary ◽  
Tanya Logvinenko ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Patient Reported Outcome ◽  
Lumbar Discectomy ◽  
Cooperative Research ◽  
Single Level ◽  
Sf 36 ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis ◽  
Level Fusion

Object There is significant practice variation and considerable uncertainty among payers and other major stakeholders as to whether many surgical treatments are effective in actual US spine practice. The aim of this study was to establish a multicenter cooperative research group and demonstrate the feasibility of developing a registry to assess the efficacy of common lumbar spinal procedures using prospectively collected patient-reported outcome measures. Methods An observational prospective cohort study was conducted at 13 US academic and community sites. Unselected patients undergoing lumbar discectomy or single-level fusion for spondylolisthesis were included. Patients completed the 36-item Short-Form Survey Instrument (SF-36), Oswestry Disability Index (ODI), and visual analog scale (VAS) questionnaires preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: 125 patients with lumbar disc herniation, and 35 with lumbar spondylolisthesis. All patient data were entered into a secure Internet-based data management platform. Results Of 249 patients screened, there were 198 enrolled over 1 year. The median age of the patients was 45.0 years (49% female) for lumbar discectomy (n = 148), and 58.0 years (58% female) for lumbar spondylolisthesis (n = 50). At 30 days, 12 complications (6.1% of study population) were identified. Ten patients (6.8%) with disc herniation and 1 (2%) with spondylolisthesis required reoperation. The overall follow-up rate for the collection of patient-reported outcome data over 1 year was 88.3%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, VAS, and SF-36 scores (p ≤ 0.0002), which persisted over the 1-year follow-up period (p < 0.0001). By the 1-year follow-up evaluation, more than 80% of patients in each cohort who were working preoperatively had returned to work. Conclusions It is feasible to build a national spine registry for the collection of high-quality prospective data to demonstrate the effectiveness of spinal procedures in actual practice. Clinical trial registration no.: 01220921 (ClinicalTrials.gov).

Results and risk factors for recurrence following single-level tubular lumbar microdiscectomy

2010 ◽  
Vol 12 (6) ◽  
pp. 680-686 ◽  
Author(s):  
Jennifer A. Moliterno ◽  
Jared Knopman ◽  
Karishma Parikh ◽  
Jessica N. Cohan ◽  
Q. Daisy Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Body Mass ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lower Body ◽  
Single Level ◽  
Lower Body Mass Index ◽  
Lumbar Microdiscectomy ◽  
Nonobese Patients

Object The use of minimally invasive surgical techniques, including microscope-assisted tubular lumbar microdiscectomy (tLMD), has gained increasing popularity in treating lumbar disc herniations (LDHs). This particular procedure has been shown to be both cost-efficient and effective, resulting in outcomes comparable to those of open surgical procedures. Lumbar disc herniation recurrence necessitating reoperation, however, remains an issue following spinal surgery, with an overall reported incidence of approximately 3–13%. The authors' aim in the present study was to report their experience using tLMD for single-level LDH, hoping to provide further insight into the rate of surgical recurrence and to identify potential risk factors leading to this complication. Methods The authors retrospectively reviewed the cases of 217 patients who underwent tLMD for single-level LDH performed identically by 2 surgeons (J.B., R.H.) between 2004 and 2008. Evaluation for LDH recurrence included detailed medical chart review and telephone interview. Recurrent LDH was defined as the return of preoperative signs and symptoms after an interval of postoperative resolution, in conjunction with radiographic demonstration of ipsilateral disc herniation at the same level and pathological confirmation of disc material. A cohort of patients without recurrence was used for comparison to identify possible risk factors for recurrent LDH. Results Of the 147 patients for whom the authors were able to definitively assess symptomatic recurrence status, 14 patients (9.5%) experienced LDH recurrence following single-level tLMD. The most common level involved was L5–S1 (42.9%) and the mean length of time to recurrence was 12 weeks (range 1.5–52 weeks). Sixty-four percent of the patients were male. In a comparison with patients without recurrence, the authors found that relatively lower body mass index was significantly associated with recurrence (p = 0.005), such that LDH in nonobese patients was more likely to recur. Conclusions Recurrence rates following tLMD for LDH compare favorably with those in patients who have undergone open discectomy, lending further support for its effectiveness in treating single-level LDH. Nonobese patients with a relatively lower body mass index, in particular, appear to be at greater risk for recurrence.

scholarly journals MRI Radiological Predictors of Requiring Microscopic Lumbar Discectomy After Lumbar Disc Herniation

2019 ◽  
Vol 10 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Christopher G. Varlotta ◽  
David H. Ge ◽  
Nicholas Stekas ◽  
Nicholas J. Frangella ◽  
Jordan H. Manning ◽  
...  
Keyword(s):  
Risk Factors ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Binary Logistic Regression ◽  
Primary Treatment ◽  
Nonoperative Treatment ◽  
Lumbar Discectomy ◽  
Binary Logistic Regression Analysis ◽  
Chi Square ◽  
Cutoff Values

Study Design: Retrospective cohort study. Objective: To investigate radiological differences in lumbar disc herniations (herniated nucleus pulposus [HNP]) between patients receiving microscopic lumbar discectomy (MLD) and nonoperative patients. Methods: Patients with primary treatment for an HNP at a single academic institution between November 2012 to March 2017 were divided into MLD and nonoperative treatment groups. Using magnetic resonance imaging (MRI), axial HNP area; axial canal area; HNP canal compromise; HNP cephalad/caudal migration and HNP MRI signal (black, gray, or mixed) were measured. T test and chi-square analyses compared differences in the groups, binary logistic regression analysis determined odds ratios (ORs), and decision tree analysis compared the cutoff values for risk factors. Results: A total of 285 patients (78 MLD, 207 nonoperative) were included. Risk factors for MLD treatment included larger axial HNP area ( P < .01, OR = 1.01), caudal migration, and migration magnitude ( P < .05, OR = 1.90; P < .01, OR = 1.14), and gray HNP MRI signal ( P < .01, OR = 5.42). Cutoff values for risks included axial HNP area (70.52 mm2, OR = 2.66, P < .01), HNP canal compromise (20.0%, OR = 3.29, P < .01), and cephalad/caudal migration (6.8 mm, OR = 2.43, P < .01). MLD risk for those with gray HNP MRI signal (67.6% alone) increased when combined with axial HNP area >70.52 mm2 (75.5%, P = .01) and HNP canal compromise >20.0% (71.1%, P = .05) cutoffs. MLD risk in patients with cephalad/caudal migration >6.8 mm (40.5% alone) increased when combined with axial HNP area and HNP canal compromise (52.4%, 50%; P < .01). Conclusion: Patients who underwent MLD treatment had significantly different axial HNP area, frequency of caudal migration, magnitude of cephalad/caudal migration, and disc herniation MRI signal compared to patients with nonoperative treatment.

scholarly journals Cost-effectiveness of lumbar discectomy and single-level fusion for spondylolisthesis: experience with the NeuroPoint-SD registry

2014 ◽  
Vol 36 (6) ◽  
pp. E3 ◽  
Author(s):  
Praveen V. Mummaneni ◽  
Robert G. Whitmore ◽  
Jill N. Curran ◽  
John E. Ziewacz ◽  
Rishi Wadhwa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Single Level ◽  
Sf 36 ◽  
Repeat Operation ◽  
Lumbar Spinal ◽  
Lumbar Spondylolisthesis ◽  
Level Fusion

Object There is significant practice variation and uncertainty as to the value of surgical treatments for lumbar spine disorders. The authors' aim was to establish a multicenter registry to assess the efficacy and costs of common lumbar spinal procedures by using prospectively collected outcomes. Methods An observational prospective cohort study was completed at 13 academic and community sites. Patients undergoing single-level fusion for spondylolisthesis or single-level lumbar discectomy were included. The 36-Item Short Form Health Survey (SF-36) and Oswestry Disability Index (ODI) data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. Power analysis estimated a sample size of 160 patients: lumbar disc (125 patients) and lumbar listhesis (35 patients). The quality-adjusted life year (QALY) data were calculated using 6-dimension utility index scores. Direct costs and complication costs were estimated using Medicare reimbursement values from 2011, and indirect costs were estimated using the human capital approach with the 2011 US national wage index. Total costs equaled $14,980 for lumbar discectomy and $43,852 for surgery for lumbar spondylolisthesis. Results There were 198 patients enrolled over 1 year. The mean age was 46 years (49% female) for lumbar discectomy (n = 148) and 58.1 years (60% female) for lumbar spondylolisthesis (n = 50). Ten patients with disc herniation (6.8%) and 1 with listhesis (2%) required repeat operation at 1 year. The overall 1-year follow-up rate was 88%. At 30 days, both lumbar discectomy and single-level fusion procedures were associated with significant improvements in ODI, visual analog scale, and SF-36 scores (p = 0.0002), which persisted at the 1-year evaluation (p < 0.0001). By 1 year, more than 80% of patients in each cohort who were working preoperatively had returned to work. Lumbar discectomy was associated with a gain of 0.225 QALYs over the 1-year study period ($66,578/QALY gained). Lumbar spinal fusion for Grade I listhesis was associated with a gain of 0.195 QALYs over the 1-year study period ($224,420/QALY gained). Conclusions This national spine registry demonstrated successful collection of high-quality outcomes data for spinal procedures in actual practice. These data are useful for demonstrating return to work and cost-effectiveness following surgical treatment of single-level lumbar disc herniation or spondylolisthesis. One-year cost per QALY was obtained, and this cost per QALY is expected to improve further by 2 years. This work sets the stage for real-world analysis of the value of health interventions.

scholarly journals Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

2017 ◽  
Vol 3 (6) ◽  
pp. 1141
Author(s):  
Prakash U. Chavan ◽  
Mahendra Gudhe ◽  
Ashok Munde ◽  
Balaji Jadhav
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operating Time ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Single Level ◽  
Group I ◽  
Endoscopic Lumbar Discectomy

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare surgical outcome of micro-discectomy with transforaminal percutaneous endoscopic lumbar discectomy for single level lumbar disc herniation in Indian rural population.</p><p class="abstract"><strong>Methods:</strong> Retrospective comparative study was designed during the period of October 2012 to June 2015, patients in the age group of 22-75 years with unremitting sciatica with/without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression as revealed on MRI, with single level lumbar disc herniation who underwent either microdiscectomy or TPELD were included in the study. Patients were assessed on visual analogue scale (VAS) for back and leg pain, modified macnabs criteria, the Oswestry Disability Index (ODI).<strong></strong></p><p class="abstract"><strong>Results:</strong> Group I (MD) included 44 patients and Group II (TPELD) included 20 patients. Significant improvement was seen in claudication symptom post-operatively in both MD and TPELD. Mean operating time was significantly shorter in MD group (1.11 hrs vs. 1.32 hrs; p&lt;0.01). According to modified MacNab's criteria,<strong> </strong>outcome were excellent (81.8%), good (9.09%) and fair<strong> </strong>(9.09%) in MD. Similarly, in TPELD, 80%, 15% and 5% patients had excellent, good and fair outcome respectively. In both groups, no one had a poor outcome. Thus, overall success rate was 100% in the study.</p><strong>Conclusions:</strong> TPELD and MD have comparable post-operative outcome in most of the efficacy parameters in Indian rural patients undergoing treatment of single level lumbar disc herniation. Additionally, TPELD offers distinct advantages such as performed under local anaesthesia, preservation of structure, lesser post-operative pain and early mobilization and discharge from hospital.

scholarly journals Prevalence of Recurrent Herniation Following Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis

2018 ◽  
Vol 1 (21;1) ◽  
pp. 337-350
Author(s):  
Huiren Tao
Keyword(s):  
Risk Factors ◽  
Disc Herniation ◽  
Retrospective Studies ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Older Age ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Recurrent Herniation ◽  
Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgery for the treatment of lumbar disc herniation (LDH) with a smaller incision, decreased damage to soft tissues, faster recovery, and fewer postoperative complications. However, the exactly epidemiological prevalence of recurrent herniation after PELD remains unclear. Objectives: To investigate the epidemiological prevalence of recurrent herniation in patients following PELD and to analyze the potentially related risk factors. Study Design: Meta-analysis and systematic review of prospective and retrospective studies. Methods: We conducted a comprehensive search in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials that mentioned the incidence of recurrent herniation after PELD. The overall prevalence estimate was calculated by an appropriate meta-analysis. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed in our study, respectively. Results: Our results showed the overall prevalence of recurrent herniation after PELD was 3.6% (95% CI 3.0-4.3%). The prevalence estimates after percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) were 4.2% and 3.4%, respectively. Individuals with older age (≥ 50 years) and higher BMI (≥ 25) had increased recurrence rates after PELD than those with younger age (4.3% vs. 2.7%) and normal body mass index (BMI) (4.8% vs. 1.5%). The prevalence was significantly higher at upper discs (5.4%) than that at L4-5 (2.7%) and L5-S1 (3.1%) level. The incidence of recurrent herniation at lateral disc was 4.7%, and the recurrence rate of migrated herniation was 3.8%. In most cases, the recurrent herniation occurred within 6 months postoperatively (accounting for 61.7%). Limitations: A majority of the included articles were relatively low quality retrospective studies with significant heterogeneity among them. Furthermore, owing to the paucity of data focused on recurrence, many potentially predictive factors related to subgroup analyses could not be conducted, which might have influenced the accuracy and comprehensiveness of our meta-analysis. Conclusions: PELD is associated with a certain rate of recurrence (3.6%), which usually occurred within 6 months postoperatively. Older age (≥ 50 years), obesity (BMI ≥ 25), upper lumbar disc and central disc herniation might be independent risk factors for recurrence after PELD; however, different surgical approaches (PETD or PEID), lateral discs, migrated discs and foraminoplasty did not affect the incidence. These factors could be useful in preoperative evaluation, appropriate patient selection and informed consent before PELD. Key words: Percutaneous endoscopic lumbar discectomy, prevalence, recurrent herniation, meta-analysis

scholarly journals Isolated Bowel and Bladder Dysfunction following Single Level Lumbar Discectomy : A Rare Observation

2019 ◽  
Vol 9 (1) ◽  
pp. 54-56
Author(s):  
Moududul Haque ◽  
Mohammad Sujan Sharif ◽  
Nowshin Jahan ◽  
Abdullah Al Mahbub ◽  
Rajib Bhattacherjee
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Bladder Dysfunction ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Imaging Studies ◽  
Single Level ◽  
Bowel And Bladder Dysfunction

Cauda equina syndrome is reported as a complication in 0.2% - 1% following lumbar disc herniation . The pathophysiologic mechanism of this complication and its management is yet poorly understood. Though some factors has postulated in different studies. In this case, patient’s back pain and leg pain is satisfactorily improved with newly onset retention of urine followed by overflow incontinence and constipation after a single level lumbar discectomy. No abnormalities were seen on the postoperative imaging studies. This is a retrospective analysis of records and radiographs in a patient who developed acute bowel and bladder dysfunction after surgery for lumbar disc herniation. Bang. J Neurosurgery 2019; 9(1): 54-56

Early Outcomes: A Comparison between Biportal Endoscopic Spine Surgery and Open Lumbar Discectomy for Single-Level Lumbar Disc Herniation

2021 ◽  
Vol 104 (1) ◽  
pp. 123-128
Keyword(s):  
Postoperative Pain ◽  
Lumbar Disc Herniation ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Hospital Costs ◽  
Lumbar Discectomy ◽  
Morphine Consumption ◽  
Single Level ◽  
Endoscopic Spine Surgery

Objective: To compare early outcomes between biportal endoscopic spine surgery (BESS) and open lumbar discectomy (OLD) for treating single-level lumbar disc herniation. Materials and Methods: A retrospective cohort study was conducted in 80 cases of single-level lumbar disc herniation that underwent either BESS or OLD. The author compared the perioperative data between BESS and OLD, including operative time (OT), level, side, estimated blood loss (EBL), surgical drain output, hospital stay (HS), hospital costs, visual analogue scale (VAS) scores, morphine consumption, complication, and McNab’s satisfaction outcome. Results: Forty-three patients underwent BESS and 37 underwent OLD. There was 55% female and 45% male. The mean age was 37.8±9.5 years. The BESS group showed significantly (a) lower median morphine consumption than the OLD group (five mg versus nine mg, p<0.001), (b) lower postoperative pain (VAS) at 2-, 4-, 12-, 24-, 48- (p<0.001), and 72-hours post-surgery (p=0.017), and (c) shorter HS (4.8±2.9 days versus 7.4±4.6 days, p=0.003). McNab’s satisfaction outcome of a good or excellent result was comparable between BESS and OLD group (97.7% versus 86.5%, p=0.090). The BESS group, however, had a longer OT than the OLD group (100.4±28.5 versus 67.9±23.2 minutes, p<0.001), and had a higher hospital cost (1,256±360.9 USD versus 910.6±269.8 USD, p<0.001). Complications were not significantly different between the BESS and OLD groups. Conclusion: BESS for single-level lumbar discectomy had less postoperative pain for up to 72 hours, less opioid consumption, and shorter HS, but longer OT and higher hospital costs than OLD. Patient satisfaction outcomes were comparable between the two groups. Keywords: Biportal endoscopic spine surgery, Unilateral biportal endoscopic discectomy, Open lumbar discectomy, Single-level lumbar disc herniation

scholarly journals Standard Single Level discectomy; Evaluation of the Risk Factors for Recurrence

2013 ◽  
Vol 6 (1) ◽  
pp. 25-29
Author(s):  
Ehab El Gamal ◽  
Ashraf Farid
Keyword(s):  
Risk Factors ◽  
Single Level ◽  
Risk Factors For Recurrence

scholarly journals Surgical Results and Risk Factors for Recurrence of Lumbar Disc Herniation

2012 ◽  
Vol 9 (3) ◽  
pp. 170 ◽  
Author(s):  
Jung Tae Oh ◽  
Ki Seok Park ◽  
Sung Sam Jung ◽  
Seung Young Chung ◽  
Seong Min Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Results ◽  
Risk Factors For Recurrence
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