Discectomy For Lumbar Disc Herniation Research Articles

Long-term clinical outcomes and radiological findings and their correlation with each other after standard open discectomy for lumbar disc herniation.

This retrospective study was designed to evaluate the clinical outcomes and radiological findings after open lumbar discectomy (OLD) in patients who were followed up for 10 years or longer. The authors classified 79 patients who had a mean age (±SD) of 53.6±13.6 years (range 30-78 years) into 4 groups according to the length of their follow-up. Patients in Group 1 were followed up for 10-14 years, in Group 2 for 15-19 years, in Group 3 for 20-24 years, and in Group 4 for more than 25 years. In all of these patients, the clinical outcomes were assessed by using patients' self-reported scores on visual analog scales (VASs) measuring back and leg pain and by using scores from the Oswestry Disability Index (ODI). In addition, 10 radiological parameters suggesting degenerative changes or instability at the operated segment were recorded at various time points and used to calculate a numeric radiological finding (NRF) score by rating a presence for each finding of spinal degeneration or instability as 1. The authors observed that OLD decreased pain and disability scores in all groups. Numeric radiological findings were highest in Group 4, and a significant correlation was detected between NRFs and VAS scores of back pain (p=0.039). In this cohort, the reoperation rate was 13.9% during a mean follow-up period of 15.3 years. Clinical outcomes tended to be most favorable in Group 1, representing patients who had OLD most recently, and they tended to deteriorate in the other 3 groups, indicating some worsening of outcomes over time. Degeneration of the spine at the operated level measured with radiographic methods tended to increase over time, but some stabilization was observed. Although spinal degeneration was stable, clinical outcomes deteriorated over time. This cross-sectional assessment of a retrospective cohort indicates that outcomes after OLD deteriorate over time. Increased back pain indicated a worsening of clinical outcomes, and this worsening was correlated with radiological findings of degeneration at the operated segment.

A 23-year-old spinal textiloma after discectomy for lumbar disc herniation

A 23-year-old spinal textiloma after discectomy for lumbar disc herniation

Systematic review of microendoscopic discectomy for lumbar disc herniation. Smith N, Masters J, Jensen C, Khan A, Sprowson A. Eur Spine J: Nov 2013, Volume 22, Issue 11, pp 2458-2465

Systematic review of microendoscopic discectomy for lumbar disc herniation. Smith N, Masters J, Jensen C, Khan A, Sprowson A. Eur Spine J: Nov 2013, Volume 22, Issue 11, pp 2458-2465

Clinical outcomes of microendoscopic discectomy for lumbar disc herniation in the first 30 cases

Clinical outcomes of microendoscopic discectomy for lumbar disc herniation in the first 30 cases

Does the presence of the fibronectin-aggrecan complex predict outcomes from lumbar discectomy for disc herniation?

Background contextProtein biomarkers associated with lumbar disc disease have been studied as diagnostic indicators and therapeutic targets. Recently, a cartilage degradation product, the fibronectin-aggrecan complex (FAC) identified in the epidural space, has been shown to predict response to lumbar epidural steroid injection in patients with radiculopathy from herniated nucleus pulposus (HNP). PurposeDetermine the ability of FAC to predict response to microdiscectomy for patients with radiculopathy due to lumbar disc herniation Study design/settingSingle-center prospective consecutive cohort study. Patient samplePatients with radiculopathy from HNP with concordant symptoms to MRI who underwent microdiscectomy. Outcomes measuresOswestry disability index (ODI) and visual analog scores (VAS) were noted at baseline and at 3-month follow-up. Primary outcome of clinical improvement was defined as patients with both a decrease in VAS of at least 3 points and ODI >20 points. MethodsIntraoperative sampling was done via lavage of the excised fragment by ELISA for presence of FAC. Funding for the ELISA was provided by Cytonics, Inc. ResultsSeventy-five patients had full complement of data and were included in this analysis. At 3-month follow-up, 57 (76%) patents were “better.” There was a statistically significant association of the presence of FAC and clinical improvement (p=.017) with an 85% positive predictive value. Receiver-operating-characteristic (ROC) curve plotting association of FAC and clinical improvement demonstrates an area under the curve (AUC) of 0.66±0.08 (p=.037). Subset analysis of those with weakness on physical examination (n=48) plotting the association of FAC and improvement shows AUC on ROC of 0.81±0.067 (p=.002). ConclusionsPatients who are “FAC+” are more likely to demonstrate clinical improvement following microdiscectomy. The data suggest that the inflammatory milieu plays a significant role regarding improvement in patients undergoing discectomy for radiculopathy in lumbar HNP, even in those with preoperative weakness. The FAC represents a potential target for treatment in HNP.

Comparison of early and late percutaneous endoscopic lumbar discectomy for lumbar disc herniation

The optimal timing for percutaneous endoscopic lumbar discectomy (PELD) in cases of lumbar disc herniation (LDH) is debatable. This retrospective study sought to determine which category of PELD surgical intervention time resulted in greater improvement in clinical outcomes. We retrospectively reviewed the medical records of 145 patients who underwent PELD for single-level LDH. The patients were divided into three categories according to the duration of leg pain before surgery, the early and late group being symptomatic for ≤3 months and >3 months, ≤6 months and >6 months, ≤12 months and >12 months. Surgical time, blood loss, postoperative hospital stay, hospitalization cost, rates of reoperation due to surgical failure, Macnab criteria assessment, visual analogue scale (VAS) of back pain, leg pain and numbness, Japanese orthopedic association low back pain score (JOA) before and after surgery were compared. No significant differences were found between the early and late groups according to different categories in patients' demographics, surgical time, blood loss, preoperative and postoperative VAS (lower-back pain, leg pain and numbness) scores, JOA scores and distribution of Macnab criteria assessment. Early PELD surgical intervention did not result in greater improvement of clinical outcomes. Later surgical intervention resulted in about one-third surgical failure rates for patients being symptomatic for >6 months (≤6 months, 11/96, 11.5 %; >6 months, 2/49, 4.1 %; P = 0.245) and >12 months (≤12 months, 12/120, 10.0 %; >12 months, 1/25, 4.0 %; P = 0.568) of the early surgical intervention groups. Significant difference was observed between the comorbidities and non-comorbidities group in the rate of reoperation (P = 0.040). Early PELD surgical intervention did not result in greater improvement of clinical outcomes for patients with lumbar disc herniation. Later surgical intervention resulted in less failure rates for patients than the early surgical intervention groups. PELD performed when the leg pain before surgery being symptomatic for >6 months may be good for avoiding surgical failure and reducing the duration of leg pain.

Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety

To evaluate the clinical and radiological risk factors for exiting root injuries during transforaminal endoscopic discectomy. We retrospectively examined cohort data from 233 patients who underwent percutaneous endoscopic lumbar discectomy for lumbar disc herniation between January 1st, 2010 and December 31st, 2011. We divided the patients into the two groups: those who presented a postoperative exiting root injury, such as postoperative dysesthesia or motor weakness (Group A, n = 20), and those who did not suffer from a root injury (Group B, n = 213). We examined the clinical and radiological factors relating exiting root injuries. We measured the active working zone with the exiting root to the upper facet distance (Distance A), the exiting root to disc surface distance at the lower facet line (Distance B) and the exiting root to the lower facet distance (Distance C) in magnetic resonance imaging (MRI). Group A exhibited a shorter Distance C (6.4 ± 1.5 versus 4.4 ± 0.8 mm, p < 0.001) and a longer operation time (67.9 ± 21.8 versus 80.3 ± 23.7 min, p = 0.017) relative to Group B. The complication rate decreased by 23% per each 1-mm increase in Distance C (p = 0.000). In addition, the complication rate increased 1.027-fold per each 1-min increase in the operation time (p = 0.027). We recommend measuring the distance from the exiting root to the facet at the lower disc level according to a preoperative MRI scan. If the distance is narrow, an alternative surgical method, such as microdiscectomy or conventional open discectomy, should be considered.

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

Background Data: Various surgical options exist for lumbar disc herniation. In patients who do not respond to conservative treatment, open discectomy still remains a standard method and it has been reported to have diverse outcomes. Despite a high early success rate with lumbar discectomy procedures, variable long-term results and worsening or recurrence of the patient’s condition overtime have been reported. Purpose: To evaluate the risk factors for recurrence of disc disease in relation to disc pathology, age, and activities. Study Design: A retrospective clinical Case review.Patients and Methods: One hundred twenty patients who had undergone standard discectomy for lumbar disc herniation were studied. All had single level disc herniation. Patients with spondylolysis, spondylolisthesis, or spinal stenosiswere excluded. Indications of surgery were severe radiculopathy of at least two month duration, unresponsive to conservative treatment or neural deficit. A preoperative diagnosis of lumbar disc herniation was based on symptoms, physical examination and MRI findings. A total of 7 patients (6%) were confirmed as having recurrence of disc herniation.Results: All of our 7 patients were in age group of 20-40 years. The recurrence occurred in 2 patients out of 7 through the 1st 5 years after surgery. Most of recurrent patients (5 patients, 71%) had originally a contained disc herniation,2 patients (29%) had originally a protruded discs and none had originally a sequestrated discs. Recurrence in L4-5 level was in 5 patients (71%) while in L5- S1 in 2 cases (29%). Conclusion: The risk of recurrence of disc herniation after open discectomy was higher in young, active men. The recurrence rate of disc herniation increased with time after surgery. Recurrence rate was higher for patients with contained herniation than other types. (2013ESJ043)

The high-risk discectomy patient: prevention of reherniation in patients with large anular defects using an anular closure device

With lumbar discectomy for disc herniation, surgeons must choose between limited nucleus removal associated with higher reherniation risk or more aggressive nucleus removal associated with increased back pain and disc degeneration. This trade-off is particularly challenging in patients with large anular defects, which carry the highest risk of reherniation. We examined the effect of an anular closure device on reherniation and clinical outcomes. Seventy-five primary discectomy patients had a limited discectomy followed by implantation of an anular closure device and were followed-up to 2 years. Anular defect size and volume of removed nucleus was recorded at surgery. Reherniations were reported, pain and function were monitored throughout, and imaging was performed at annual visits. The overall symptomatic reherniation rate was 1.4%, and the asymptomatic reherniation rate was 1.5% at 12 months and 5.1% at 24 months. Both rates compare favorably with literature reports which include symptomatic rates ranging between 2 and 18% (up to 27% for patients with large anular defects) and an asymptomatic rate of 13%. The low reherniation rate in patients at high-risk of reherniation based on anular defect size, despite discectomy being only limited, suggests that an anular closure device may reduce reherniation risk. Clinical outcomes for pain and function at 1 and 2 years post-operatively compared favorably with literature reports. Further study in a randomized controlled trial is required to confirm these results.

Short-term Results of Discectomy for Lumbar Disc Herniation －Comparison between Patients under Twenty Years of Age and Adult Patients

Short-term Results of Discectomy for Lumbar Disc Herniation －Comparison between Patients under Twenty Years of Age and Adult Patients

Recurrence Rate after Herniotomy only versus Discectomy in Lumbar Disc Herniation.

ObjectiveLumbar disc herniation (LDH) recurrence necessitating reoperation can pose problems following spinal surgery, with an overall reported incidence of approximately (3-13%). The purpose of this study is to identify the rate of recurrent disc herniation, to discuss the radiologic indications for herniotomy and to analyze clinical outcomes compared with conventional discectomy.MethodsThis study is a retrospective case control study. The authors retrospectively reviewed 114 patients who underwent herniotomy & conventional discectomy by a single surgeon for single-level LDH between June 2009 and May 2012. Herniotomy group was 57 patients and conventional discectomy group was 57 patients that were selected from 631 patients using stratified randomization. Evaluation for LDH recurrence included detailed medical chart and radiologic review and telephone interview. Postoperative VAS and the Korean version of ODI were examined one week after surgery. Clinical outcome was investigated according to Odom's criteria from three months to three years.ResultsOf the 114 patients for whom the authors were able to definitively assess symptomatic recurrence status, four patients (7%) experienced LDH recurrence following single-level herniotomy and three patients (5.2%) conventional discectomy. There were no differences in the VAS and Korean version of ODI between herniotomy group and conventional discectomy group. The herniotomy group had better results than the conventional discectomy group in clinical outcome from three months to three years, but the difference was not significant.ConclusionThere were no significant differences in clinical outcome between herniotomy and conventional discectomy. Recurrence rates following herniotomy for LDH compare favorably with those in patients who have undergone conventional discectomy, lending further support for its effectiveness in treating herniotomy.

Inflammatory or Mechanical? Can Inflammatory Profiles Predict Outcomes from Lumbar Discectomy for Disc Herniation?

Inflammatory or Mechanical? Can Inflammatory Profiles Predict Outcomes from Lumbar Discectomy for Disc Herniation?

腰椎椎間板ヘルニアに対する内視鏡下椎間板摘出術における早期再手術例の検討

腰椎椎間板ヘルニアに対する内視鏡下椎間板摘出術における早期再手術例の検討

A case of pregnant woman who had an operation of discectomy for lumbar disc herniation at the 21st weeks of gestation

A case of pregnant woman who had an operation of discectomy for lumbar disc herniation at the 21st weeks of gestation

Pregnancy and childbirth after microsurgery for lumbar disc herniation

The influence of previous lumbar discectomy on pregnancy and childbirth has not been extensively studied. This study reports the course of pregnancies after lumbar discectomy. Twenty-six 31.5 ± 3.6-year-old patients who had delivered 39 children were included. All patients underwent lumbar microsurgical discectomy prior to childbirth. Demographic and surgical data were collected from hospital records and patient questionnaires. The presence and course of low back pain (LBP) and radiculopathy signs were noted. Mean latency between surgery and childbirth was 42.5 ± 34.8 months. Delivery was at gestational week 36 to 42, and the average weight of the newborn was 3,390 ± 0.490 g. Prevalence and new onset of symptoms during pregnancy was as follows: low back pain, 76% and 60%; leg pain 37% and 18%; motor deficits 13% and 6%; and sensory deficits 39% and 19%, respectively. No recurrent lumbar disc herniation was diagnosed within 6 months after pregnancy. Patients suffering from radicular pain during pregnancy were at risk of persistence of symptoms 6 months after delivery. Three patients had had surgery because of recurrent lumbar disc herniation during the follow-up of 7.73 ± 2.66 years. The incidence of radicular pain during pregnancy after microsurgical discectomy for lumbar disc herniation was 18%. The incidence and prevalence of LBP are among the highest reported in the literature. The incidence of low back pain and radiculopathy signs does not change significantly with subsequent pregnancies. The operation rate for recurrent lumbar disc herniation or adjacent level disease after pregnancy seems not to be higher than the overall rate reported in the literature.

Comparative Expression of Matrix-associated Genes and Inflammatory Cytokines-associated Genes According to Disc Degeneration

The 2 groups of living human nucleus pulposus were prospectively compared according to disc degeneration. This study was conducted to investigate the expressions of various genes associated with matrix synthesis and expressions of inflammatory cytokines-associated genes according to degrees of disc degeneration in human discs. Degenerated discs were obtained from 18 patients who underwent discectomy for lumbar disc herniation. Disc degeneration was graded by T2-weighted magnetic resonance imaging using Pfirrmann's grading system. Discs were allocated to 2 groups: group I (9 patients)-mildly degenerated discs (grades II and III) and group II (9 patients)-severely degenerated discs (grades IV and V). Cells from the nucleus pulposus were isolated and then cultured as monolayers. The mRNA expressions of aggrecan, type II collagen, Sox9, type I collagen, alkaline phosphatase, osteocalcin, tumor necrosis factor-α, and interleukin-1β in the 2 groups were compared by real-time polymerase chain reaction, and production of matrix-associate proteins (aggrecan, type II collagen, Sox9, type I collagen, alkaline phosphatase, and osteocalcin) were compared by Western blotting. mRNA expressions in group I were upregulated versus group II to the following extents: 1.83 times for aggrecan, 1.82 times for type II collagen, 1.80 times for Sox9, 1.41 times for type I collagen, 1.38 times for alkaline phosphatase, and 1.80 times for osteocalcin. Furthermore, Western blotting showed that aggrecan, type II collagen, Sox9, type I collagen, alkaline phosphatase, and osteocalcin were higher in group I. However, the mRNA levels of tumor necrosis factor-α and interleukin-1β were 1.26 and 1.11-fold, respectively, upregulated in group II. Mildly degenerated discs showed greater matrix, chondrogenic, and osteoblastic gene expressions than severely degenerated discs, indicating that the ability to produce matrix-associated proteins is greater for cells in mildly degenerated than in severely degenerated discs. However, inflammatory cytokine genes associated with disc degeneration were expressed at higher levels in the severely degenerated group. This study shows that a reduction in matrix synthesis and an increase of inflammatory cytokine levels occurs during disc degeneration at the same time.

Microendoscopic versus Open Discectomy for Lumbar Disc Herniation: A Prospective Randomised Study

To compare the outcomes of microendoscopic discectomy (MED) versus open discectomy for lumbar disc herniation. 80 men and 32 women aged 26 to 57 (mean, 37) years with a single-level disc herniation were randomised to undergo MED (n=55) or open (fenestration/laminotomy) discectomy (n=57). Patients were assessed pre- and post-operatively (at week 6, month 6, and year one). The 2 groups were compared with respect to surgical time, anaesthesia time, duration of hospital stay, intra-operative blood loss, weight of disc material removed, and self-evaluated low back pain and functional outcome (using the Oswestry low back pain disability questionnaire). Surgical and anaesthesia times were significantly longer, but blood loss and hospital stay were significantly reduced in patients having MED than open discectomy. The improvement in the Oswestry score in both groups was significant at week one, but not at other follow-ups. The complication rate was similar in both groups. One patient with MED had a recurrence of disc herniation after 7 months and was treated with open discectomy. Both methods are equally effective in relieving radicular pain. MED entailed shorter hospital stay, less morbidity, and earlier return to work. Nonetheless, it is a demanding technique and should not be attempted without specific instruction and training.

Interlaminar discectomy in lumbar disc herniation; shorten postoperative return to work period in recruits undergoing military training

Interlaminar discectomy in lumbar disc herniation; shorten postoperative return to work period in recruits undergoing military training

Microendoscopic discectomy for lumbar disc herniation in the elderly

Introduction: The purpose of this study was to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation in elderly patients over the age of 65. Methods: The elderly group consisted of 44 patients (27 men and 17 women; mean age, 69.6 years; mean follow-up, 27.7 months) with sciatic pain caused by lumbar disc herniation who were treated using MED. The younger group was comprised of 44 sex-matched patients younger than 65 years. The younger group also had lumbar disc herniation treated with MED and served as the control group. The clinical outcomes were evaluated using the Japanese Orthopaedic Association score for low back pain (JOA score). Results: The results revealed that the good surgical outcomes achieved in the younger group were also achieved in the elderly group (JOA scores: 14.8 ± 4.1 in the younger group before surgery versus 13.0 ± 3.2 in the elderly group; 26.0 ± 2.4 at follow-up versus 25.5 ± 2.7; recovery rates of JOA scores: 78.3 ± 17.8% versus 77.9 ± 16.6%, respectively). The mean surgical time was 78.3 ± 31.0 min in the elderly group and 69.2 ± 22.9 min (P=0.12) in the younger group; the blood loss was 33.9 ± 71.9 cc and 28.0 ± 37.8 cc (P=0.63), respectively. Complications included a dural tear in two elderly patients, and postoperative discitis and hematoma in one elderly patient each: all of these complications were managed successfully. Conclusion: The results of this study demonstrated that MED is a feasible minimally invasive surgical option for elderly patients with lumbar disc herniation.

内視鏡下腰椎椎間板ヘルニア摘出術(MED)において手術時間に影響する解剖学的因子

内視鏡下腰椎椎間板ヘルニア摘出術(MED)において手術時間に影響する解剖学的因子