scholarly journals Automated Percutaneous Lumbar Discectomy for the Contained Herniated Lumbar Disc: A Systematic Assessment of Evidence

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 601-620 ◽  
Author(s):  
Joshua Hirsch
Keyword(s):  
Systematic Review ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Low Back ◽  
Disc Prolapse ◽  
Level Ii ◽  
Lumbar Disc Prolapse ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The typical rationale for traditional surgery is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients will recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including automated percutaneous lumbar discectomy (APLD) have been described. However, there is a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. Study Design: A systematic review of the literature. Objective: To determine the effectiveness of APLD. Methods: A comprehensive evaluation of the literature relating to automated lumbar disc decompression was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. A literature search was conducted of English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross references from reviews and systematic reviews. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one-year or less, whereas, long-term effectiveness was defined as greater than one-year. Results: Based on USPSTF criteria, the indicated evidence for APLD is Level II-2 for short- and long-term relief. Limitations: Paucity of RCTs in the literature. Conclusion: This systematic review indicated Level II-2 evidence for APLD. APLD may provide appropriate relief in properly selected patients with contained lumbar disc prolapse. Key words: Intervertebral disc disease, chronic low back pain, mechanical disc decompression, automated percutaneous lumbar discectomy, internal disc disruption, radiculitis.

scholarly journals A Systematic Review of Mechanical Lumbar Disc Decompression with Nucleoplasty

2009 ◽  
Vol 3;12 (3;5) ◽  
pp. 561-572
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Low Back Pain ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Low Back ◽  
Disc Prolapse ◽  
Level Of Evidence ◽  
Level Ii ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, or extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including nucleoplasty, automated percutaneous discectomy, and laser discectomy have been described. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. Study Design: A systematic review of the literature. Objective: To determine the effectiveness of mechanical lumbar disc decompression with nucleoplasty. Methods: A comprehensive evaluation of the literature relating to mechanical lumbar disc decompression with nucleoplasty was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). A literature search was conducted using only English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross-references from reviews and systematic reviews. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. Results: Based on USPSTF criteria the level of evidence for nucleoplasty is Level II-3 in managing predominantly lower extremity pain due to contained disc herniation. Limitations: Paucity of literature, both observational and randomized. Conclusion: This systematic review illustrates Level II-3 evidence for mechanical lumbar percutaneous disc decompression with nucleoplasty in treatment of leg pain. However, there is no evidence available in managing axial low back pain. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, coblation technology, nucleotomy

scholarly journals An Updated Review of Automated Percutaneous Mechanical Lumbar Discectomy for the Contained Herniated Lumbar Disc

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE151-SE184
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Observational Studies ◽  
Randomized Trials ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Low Back ◽  
Disc Prolapse ◽  
Herniated Lumbar Disc ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion are the most common causes of nerve root pain and surgical interventions, and yet they account for less than 5% of all low back problems. The typical rationale for traditional surgery is that it is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients do recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques, including automated percutaneous mechanical lumbar discectomy, have been described. There is, however, a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. Study Design: A systematic review of the literature of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. Objective: To evaluate and update the effectiveness of automated percutaneous mechanical lumbar discectomy. Methods: The available literature on automated percutaneous mechanical lumbar discectomy in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria, as utilized for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor, based on the quality of evidence scale developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas long-term effectiveness was defined as greater than one year. Results: Nineteen studies were included; none of the randomized trials and 19 observational studies met inclusion criteria for methodological quality assessment. Overall, 5,515 patients were studied with 4,412 patients (80%) showing positive results lasting one year or longer. Based on USPSTF criteria, the indicated evidence for automated percutaneous mechanical lumbar discectomy is limited for short- and long-term relief. Limitations: A paucity of randomized controlled trials in the literature describing automated percutaneous mechanical disc decompression. Conclusion: This systematic review shows limited evidence for automated percutaneous mechanical lumbar discectomy. Automated percutaneous mechanical lumbar discectomy may provide appropriate relief in properly selected patients with contained lumbar disc herniation. Key words: Intervertebral disc disease, chronic low back pain, mechanical disc decompression, automated percutaneous mechanical lumbar discectomy, internal disc disruption, radiculitis.

scholarly journals An Update of the Systematic Assessment of Mechanical Lumbar Disc Decompression with Nucleoplasty

2013 ◽  
Vol 2s;16 (2s;4) ◽  
pp. SE25-SE54 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Disc Herniation ◽  
Observational Studies ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Low Back ◽  
Level Of Evidence ◽  
Alternative Techniques ◽  
One Year

Background: Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The primary rationale for any form of surgery for disc prolapse is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques are also utilized, including nucleoplasty, automated percutaneous discectomy and laser discectomy. There is a paucity of evidence for all decompression techniques, specifically alternative techniques including nucleoplasty. Study Design: A systematic review of the literature of mechanical lumbar disc decompression with nucleoplasty. Objective: To determine the effectiveness and update the effectiveness of mechanical lumbar disc decompression with nucleoplasty. Methods: The available literature on mechanical lumbar disc decompression with nucleoplasty was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Pain relief and functional improvement were the primary outcome measures. Other outcome measures were improvement of psychological status, reduction in opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas long-term effectiveness was defined as greater than one year. Results: For this systematic review, 37 studies were considered for inclusion. Of these, there was one randomized trial and 14 observational studies meeting inclusion criteria for methodological quality assessment. Based on USPSTF criteria, the level of evidence for nucleoplasty is limited to fair in managing radicular pain due to contained disc herniation. Limitations: A paucity of literature with randomized trials. Conclusion: This systematic review illustrates limited to fair evidence for nucleoplasty in managing radicular pain due to contained disc herniation. Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion, radiculitis, contained disc herniation, mechanical disc decompression, nucleoplasty, Coblation technology, nucleotomy

scholarly journals Functional outcome of patients undergoing lumbar discectomy

2018 ◽  
Vol 4 (3) ◽  
pp. 514
Author(s):  
Harpreet Singh ◽  
Parth B. Bhavsar ◽  
Ankit Singh ◽  
Saurin Patel
Keyword(s):  
Functional Outcome ◽  
Lumbar Disc ◽  
Subjective Evaluation ◽  
Lumbar Discectomy ◽  
Intervertebral Disc Herniation ◽  
Disc Prolapse ◽  
Duration Of Symptoms ◽  
Lumbar Disc Prolapse ◽  
Lumbar Intervertebral Disc Herniation

<p class="abstract"><strong>Background:</strong> Sciatica resulting from a lumbar intervertebral disc herniation is the most common cause of radicular leg pain in adult working population. It can be treated with both conservative and operative methods. In our study, surgical treatment of lumbar disc prolapse has been done by open discectomy. We wish to assess the outcome of surgery in patients with lumbar disc prolapse undergoing lumbar discectomy.</p><p class="abstract"><strong>Methods:</strong> 40 patients were included in this study and were followed up for up to 1 year postoperatively. We assessed the outcome of each patient with ODI and VAS post-operatively and on follow-up at 3 weeks, 6 months and 1 year. Subjective evaluation of the patient’s satisfaction at the final follow-up was also done.<strong></strong></p><p class="abstract"><strong>Results:</strong> We found that males had higher incidence of PIVD with an average duration of symptoms before surgery about 8.62 months. Left side was most involved and level l4-l5 was most involved level. The mean ODI and VAS score pre-operatively were 26.85±4.20 and 7.73±0.88 respectively, which changed to 4.48±5.15 and 1.70±1.57, respectively at 1 year post-operative follow-up. These were statistically highly significant. Most of the patients (34) gave a subjective evaluation as excellent at 1 year follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Our study established that open discectomy has a satisfactory functional outcome and leads to a significant improvement in the patients’ quality of life.</p>

scholarly journals Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse

2018 ◽  
Vol 4 (3) ◽  
pp. 389
Author(s):  
Ansari Ishtyaque Abdul Aziz ◽  
Ansari Muqtadeer Abdul Aziz
Keyword(s):  
Back Pain ◽  
Lumbar Disc ◽  
Japanese Orthopaedic Association ◽  
Significant Proportion ◽  
Scientific Basis ◽  
Radicular Pain ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Disc Prolapse ◽  
Lumbar Disc Prolapse

<p class="abstract"><strong>Background:</strong> Back pain constitutes significant proportion of orthopaedic practitioner OPD. Lumbar disc prolapse constitutes important cause of back pain with radiculopathic leg pain. Different techniques have evolved to treat this disorder non-operatively and operatively. Operative techniques vary a lot in the field of spine surgery depending on the surgeon, institute, infrastructure and cost. We present simple, cost effective, cosmetic, operative technique with scientific basis which gives better visualization for decompression of nerve root in this paper called microscopic lumbar discectomy (MLD).</p><p class="abstract"><strong>Methods:</strong> On the basis of inclusion and exclusion criteria 26 patients were operated by microscopic lumbar discectomy (MLD) technique. All the patients were followed up at the interval of 1 month, 3 months and 6 months and assessment was done of subjective and objective findings with Japanese orthopaedic association (JOA) score and rate of improvement (RI) was calculated. Out of 26 patients 18 were men and 8 were women. Age ranges from 28 years to 72 years. Mean age being 47.8 years.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 26 patients at the time of discharge, 20 patients (87.5%) could walk independently without any aid and without any radicular pain. In most of the patients 19 (73.07%) sciatica improved immediately. The pre-operative mean±SD (SE) JOA score was 8.346±0.85 (0.169) which improved to 11.807±0.694 (0.136) after 1 month and 13.19±0.895 (0.175) after 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Excellent to good results and improvement can be achieved surgically, economically and cosmetically by microscopic lumbar discectomy technique in the spine lumbar disc prolapse patients at many spine centre with cosmesis, good results and rehabilitation of the patient.</p><p class="abstract"> </p>

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