1-level Discectomy Research Articles

Return to Sport After Lumbar Microdiscectomy in High School and College-Age Athletes

Previous studies have reported the return to play (RTP) rates for athletes after lumbar discectomy but not specifically for younger athletes. The purpose of the present study was to evaluate the RTP rate for young athletes after lumbar microdiscectomy. The medical records from a single spine surgeon were reviewed to identify patients who had undergone lumbar microdiscectomy. The patients were included if they were aged ≤21 years at surgery and were athletes. A total of 38 patients (25 males and 13 females) were identified, with a mean age at surgery of 19 years. The level of the herniated nucleus pulposus, variant anatomy, degenerative changes, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. The patients were interviewed to determine when and if they had returned to play. Most patients had had degenerative changes at surgery, with a mean Pfirrmann score of 2.2. The average time from symptom onset to surgery was 11 months. All patients were reached for follow-up at an average of 51 months postoperatively. Of the 38 patients, 71% had returned to play at an average of 4.5 months postoperatively. No statistically significant differences were found in the Pfirrmann grade and RTP rates between the high school and collegiate athletes, between the genders, nor between patients with 2-level and 1-level discectomy. The Pfirrmann grade was not significantly different between the patients who had and had not returned to play. The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. The RTP rate and Pfirrmann grade were not related to gender, sport level, or discectomy level.

Anterior Cervical Discectomy and Fusion Versus Hybrid Decompression and Fusion for the Treatment of 3-Level Cervical Spondylotic Myelopathy: A Comparative Analysis of Cervical Sagittal Balance and Outcomes

To compare the cervical sagittal balance and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid decompression and fusion (HDF; 1-level corpectomy combined with 1-level discectomy) for consecutive 3-level cervical spondylotic myelopathy (CSM). From January 2013 to June 2016, 82 patients with 3-level CSM who underwent ACDF (n= 40) and HDF (n= 42) were retrospectively reviewed. Perioperative parameters, clinical outcomes, and radiologic sagittal alignment were analyzed and compared. Patients were followed up for 35.5 ± 6.5 months (range, 25-53 months). All patients had achieved significant improvement in Neck Disability Index and Japanese Orthopedic Association scores after operation, with similar clinical outcomes between both groups (P > 0.05). In the ACDF group, 2 patients were found with axial symptoms, and 1 with hoarseness. In the HDF group, 5 patients were found with axial symptoms, 1 with hoarseness, 1 with dysphagia, and 1 with pseudarthrosis. The ACDF group had less operation time and bleeding compared with the HDF group (P < 0.05). The restoration of segmental and C2-7 lordosis were significantly greater in the ACDF group than the HDF group (P < 0.05). The C2-7 sagittal vertical axis and T1 slope minus C2-7 lordosis decreased in the ACDF group at final follow-up (P < 0.05); however, there was no obvious change in those of the HDF group (P > 0.05). Both ACDF and HDF were safe and effective for the treatment of 3-level CSM. ACDF showed superiority to HDF in terms of less blood loss, shorter operation time, and better postoperative sagittal balance.

An Affordable and Feasible Technique for Minimally Invasive Tubular Lumbar Discectomy

The benefits of minimally invasive spine surgery are attainable only if hospitals have the financial resources to acquire essential equipment. We present a surgical approach readily available to countries where unacceptably expensive materials are the main limitation for use of minimally invasive spine surgery. This retrospective study included 30 patients who underwent minimally invasive spine surgery using syringes as dilators and retractors for posterior lumbar approaches. Inclusion criteria were lumbar radicular/back pain, degenerative disc, spondylolysis, unilateral approach, and maximum of 2 affected spine levels. Demographic characteristics, affected radicular level, diagnosis, type and length of surgery, hospital length of stay, MacNab criteria, complications, and resumption of daily activities were analyzed. Of 30 patients, 17 (56.6%) presented with S1 radicular pain. Pain was mainly due to posterolateral hernia (70%; n= 21) requiring 1-level discectomy. In 6 patients (20%), discectomy and an interspinous process device were required. One patient (3.33%) underwent 2-level discectomy. All surgeries were performed using syringes as dilators and retractors. Maximum syringe diameter used was 2 cm (20-mL syringes) in 29 patients (96.6%) and 3 cm (60-mL syringe) in 1 patient. Average length of surgery was 1.5 hours, and average hospital stay was 1.8 days. Based on MacNab criteria, excellent, good, and fair outcomes were achieved in 25 patients (83%), 3 patients (10%), and 2 patients (6.7%). Complications were observed in 5 patients (16.7%). This is a safe and feasible technique with excellent results obtained at low cost and is becoming an attractive surgical option in developing countries.

Biomechanical comparison of anterior cervical spine instrumentation techniques with and without supplemental posterior fusion after different corpectomy and discectomy combinations

The objective of this study was to compare the stiffness and range of motion (ROM) of 4 cervical spine constructs and the intact condition. The 4 constructs consisted of 3-level anterior cervical discectomy with anterior plating, 1-level discectomy and 1-level corpectomy with anterior plating, 2-level corpectomy with anterior plating, and 2-level corpectomy with anterior plating and posterior fixation. Eight human cadaveric fresh-frozen cervical spines from C2-T2 were used. Three-dimensional motion analysis with an optical tracking device was used to determine motion following various reconstruction methods. The specimens were tested in the following conditions: 1) intact; 2) segmental construct with discectomies at C4-5, C5-6, and C6-7, with polyetheretherketone (PEEK) interbody cage and anterior plate; 3) segmental construct with discectomy at C6-7 and corpectomy of C-5, with PEEK interbody graft at the discectomy level and a titanium cage at the corpectomy level; 4) corpectomy at C-5 and C-6, with titanium cage and an anterior cervical plate; and 5) corpectomy at C-5 and C-6, with titanium cage and an anterior cervical plate, and posterior lateral mass screw-rod system from C-4 to C-7. All specimens underwent a pure moment application of 2 Nm with regards to flexion-extension, lateral bending, and axial rotation. In all tested motions the statistical comparison was significant between the intact condition and the 2-level corpectomy with anterior plating and posterior fixation construct. All other statistical comparisons between the instrumented constructs were not statistically significant except between the 3-level discectomy with anterior plating and the 2-level corpectomy with anterior plating in axial rotation. There were no statistically significant differences between the 1-level discectomy and 1-level corpectomy with anterior plating and the 2-level corpectomy with anterior plating in any tested motion. There was also no statistical significance between the 3-level discectomy with anterior plating and the 2-level corpectomy with anterior plating and posterior fixation. This study demonstrates that segmental plate fixation (3-level discectomy) affords the same stiffness and ROM as circumferential fusion in 2-level cervical spine corpectomy in the immediate postoperative setting. This obviates the need for staged circumferential procedures for multilevel cervical spondylotic myelopathy. Given that the posterior segmental instrumentation confers significant stability to a multilevel cervical corpectomy, the surgeon should strongly consider the placement of segmental posterior instrumentation to significantly improve the overall stability of the fusion construct after a 2-level cervical corpectomy.

A simple method for making a hollow cylindrical polymethylmethacrylate strut for cervical spinal reconstruction

The purpose of this study was to introduce a method for making a hollow cylindrical polymethylmethacrylate (PMMA) strut for perioperative anterior spinal reconstruction after discectomy and/or corpectomy. For use after anterior cervical discectomy or corpectomy, the authors created a hollow cylindrical PMMA strut using 10- and 3-ml disposable plastic syringes filled with PMMA containing 10% BaSO(4) for anterior spinal reconstruction. With this method, the authors were able to make a PMMA strut that was approximately 50 mm in length with a 14-mm outer diameter and a 10-mm inner diameter. The PMMA strut could easily be cut with a saw to any desired length and molded with a cutting bur. The PMMA strut was used as a substitute for the cortical bone and was filled with bone graft for cervical spinal reconstruction after discectomy and/or corpectomy. The whole process of making the PMMA strut can be completed within 30 minutes, and it reduces costs by at least $1000 US (in 1-level discectomy), making the procedure cost effective. It is simple to make a hollow cylindrical PMMA strut with plastic syringes during a discectomy and/or corpectomy. The strut can provide adequate support at less cost than other methods. The hollow cylindrical strut is also of suitable size and length for anterior spinal reconstruction. It serves as an alternative for patients who cannot afford the expense of similar instruments or who cannot or do not want to take the risk of a human graft for anterior spinal reconstruction.

Reconstructive Techniques Study After Anterior Decompression of Multilevel Cervical Spondylotic Myelopathy

Retrospectively compared 2 reconstructive techniques after the anterior decompression of multilevel cervical spondylotic myelopathy. To clinically compare the biomechanical stability and neurologic results of 2 reconstructive techniques after the anterior decompression of multilevel cervical spondylotic myelopathy retrospectively. Previous studies comparing different reconstruction techniques after the anterior decompression of multilevel cervical spondylotic myelopathy have yielded mixed results. Some studies have reported a high incidence of graft-plate extrusion when 2 or more corpectomies are performed and reconstructed with a long segmental anterior plate fixation that spans the strut graft without supplemental posterior cervical fixation, a standalone cage and segmental plate fixation after combination 1 level discectomy and 1 level corpectomy used to treat multilevel cervical spondylotic myelopathy were reported have no evidence of late-onset instrumentation-related failure, although 2 techniques have never been directly compared in a consecutive series of patients clinically. A retrospective study of 59 patients with multilevel (3 levels) cervical spondylotic myelopathy treated with 1 of 2 anterior decompression and reconstruction methods were compared. Copectomy method (39 patients) is 2-level corpectomies and long segment end-construct plate fixation; hybrid method (20 patients) is standalone cage and segmental plate fixation after 1-level discectomy combined with 1-level corpectomy. The follow-up (mean18 mo) results show both methods had similar, satisfactory recovery of neurologic function (P>0.05). There were 7 cases of graft/plate migrations or dislodgments (17.9%) and 4 of these required revision surgery among 39 patients with corpectomy method, as compared with no graft/implant-related complications or nonunion among 20 patients with hybrid method (P<0.001). This study clearly demonstrates that, adequate decompression can be achieved for the multilevel cervical spondylotic myelopathy with both methods, and the hybrid method offers better biomechanical stability and fusion results than the corpectomy method, and obviates the need for staged circumferential procedures.

Anterior Cervical Fusion With Tantalum Implant

A prospective randomized controlled study was carried out. To determine the effectiveness and safety of a tantalum implant in achieving anterior cervical fusion following 1-level discectomy as treatment of degenerative cervical disc disease with radiculopathy. The gold standard for the treatment of degenerative cervical disc disease could not be already identified. The morbidity of autologous graft and plating, and the doubt about the mechanical efficacy of plate fixation and the clinical benefits in 1-level fusion have promoted the use of other constructs. Sixty-one patients were randomized to anterior cervical discectomy and fusion with interbody implant of tantalum (n = 28) or by means of autologous iliac bone graft and plating (n = 33). Fusion rate and segmental height and alignment were blind assessed by radiographs by 2 independent reviewers. Clinical status was evaluated using pain visual analogue scale, the Neck Disability Index, and the Zung Depression Scale. Patient's subjective satisfaction was recorded. Complications and operative parameters were also taken into account. With an endpoint of 24 months, radiologic and clinical outcomes were similar for both treatments without significant difference. The safety of fusion with tantalum implant was obvious, based on the analysis of complications. Complication rate was considerably higher for the autologous graft plus plating procedure than for implant tantalum (P < 0.005). The efficacy to achieve fusion after 1-level anterior cervical discectomy, with a good radiologic and clinical outcome, using tantalum implant is equivalent to that of autologous graft and anterior plate, being safer as avoids donor-site graft harvesting and plating complications.