Lumbar Discectomy Patients Research Articles

Early Outcome of Sciatica after Redo Surgeries for Recurrent Lumbar Disc Herniation

Background Data: Result of redo discectomies varies widely in the literature. This may be due to variability in inclusion criteria and associated pathologies which may alter results. We tried to evaluate the early outcome of recurrent sciatica after redo discectomies in highly selected cases and risk factors for poor outcome. Purpose: to assess the rate of success of redo lumbar discectomy in patients with recurrent sciatica. Study Design: A retrospective clinical case studyPatients and Methods: A retrospective study including 30 cases with recurrent sciatica caused by true recurrent disc herniation over a period of 8 years. Clinical and radiological data were analyzed for proper selection and to exclude cases with associated pathologies. A Visual Analogue Scale was used to score pain severity before and after surgeries. Complications following redo surgeries were classified as minor and major. The outcome depended on pain relief and complications. Probable risk factors were recorded to detect those that might have contributed for unsatisfactoryresults. Results: Outcome was satisfactory in 20 cases, accepted in 6 cases and unsatisfactory in 4 cases. The overall improvement in sciatic pain after redo surgeries was comparable with that following primary surgery. We found diabetes the major risk factor for unsatisfactory results. Conclusion: Redo discectomy for recurrent sciatica proved to be of value and high rate of success when attempted in well-selected cases. (2014ESJ065)

Evaluation of the Back Muscle Exercise for the Lumbar Discectomy Patients

Evaluation of the Back Muscle Exercise for the Lumbar Discectomy Patients

Primary limited lumbar discectomy with an annulus closure device: one-year clinical and radiographic results from a prospective, multi-center study.

ObjectiveDiscectomy as a treatment for herniated lumbar discs results in outcomes after surgery that are not uniformly positive. Surgeons face the dilemma between limited nucleus removal which is associated with a higher risk of recurrence, or more aggressive nucleus removal which may lead to disc height loss and persistent back-pain. annulus closure devices may allow for the benefits of limited nucleus removal without the increased risk of recurrence. This is an interim report of an ongoing 24-month post-marketing study of the Barricaid® annulus closure device, consisting of a flexible polymer mesh that blocks the defect, held in place by a titanium bone anchor.MethodsWe prospectively enrolled 45 patients at four hospitals, and implanted the Barricaid® after a limited discectomy. annulus defect size and volume of removed nucleus were recorded. Reherniations were reported, pain and function were monitored and imaging was performed at regular intervals during 24 months of follow-up.ResultsAt 12 months postsurgery, pain and function were significantly improved, comparing favorably to reported results from limited discectomy. Disc height has been well maintained. One reherniation has occurred (2.4%), which was associated with a misplaced device. No device fracture, subsidence or migration has been observed.ConclusionThe use of an annulus closure device may provide a reduction in reherniation rate for lumbar discectomy patients with large annulus defects who are at the greatest risk of recurrence. Using such a device should provide the surgeon increased confidence in minimizing nucleus removal, which, in turn, may preserve disc height and biomechanics, reducing degeneration and associated poor clinical outcomes in the long-term. A randomized multicenter study evaluating limited discectomy with and without the Barricaid® is currently underway, and will provide a higher level of evidence.

Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients

BackgroundNo consensus exists on how rehabilitation programs for lumbar discectomy patients with persistent complaints after surgery should be composed. A better understanding of normal and abnormal postoperative trunk muscle condition might help direct the treatment goals.MethodsA three-dimensional CT scan of the lumbar spine was obtained in 18 symptomatic and 18 asymptomatic patients who had undergone a lumbar discectomy 42 months to 83 months (median 63 months) previously. The psoas muscle (PS), the paraspinal muscle mass (PA) and the multifidus muscle (MF) were outlined at the L3, L4 and L5 level. Of these muscles, fat free Cross Sectional Area (CSA) and fat CSA were determined. CSA of the lumbar erector spinae (LES = longissimus thoracis + iliocostalis lumborum) was calculated by subtracting MF CSA from PA CSA. Mean muscle CSA of the left and right sides was calculated at each level. To normalize the data for interpersonal comparison, the mean CSA was divided by the CSA of the L3 vertebral body (mCSA = normalized fat-free muscle CSA; fCSA = normalized fat CSA). Differences in CSA between the pain group and the pain free group were examined using a General Linear Model (GLM). Three levels were examined to investigate the possible role of the level of operation.ResultsIn lumbar discectomy patients with pain, the mCSA of the MF was significantly smaller than in pain-free subjects (p = 0.009) independently of the level. The mCSA of the LES was significantly smaller in pain patients, but only on the L3 slice (p = 0.018). No significant difference in mCSA of the PS was found between pain patients and pain-free patients (p = 0.462). The fCSA of the MF (p = 0.186) and of the LES (p = 0.256) were not significantly different between both populations. However, the fCSA of the PS was significantly larger in pain patients than in pain-free patients. (p = 0.012).The level of operation was never a significant factor.ConclusionsCT comparison of MF, LES and PS muscle condition between lumbar discectomy patients without pain and patients with protracted postoperative pain showed a smaller fat-free muscle CSA of the MF at all levels examined, a smaller fat- free muscle CSA of the LES at the L3 level, and more fat in the PS in patients with pain. The level of operation was not found to be of importance. The present results suggest a general lumbar muscle dysfunction in the pain group, in particular of the deep stabilizing muscle system.

Change of Pain Score for One Month after Endoscopic Lumbar Discectomy in Patients Who Showed Substantial Improvement of Pain and Who Did Not at Postoperative One Day

Objective: After endoscopic disectomy (ED), some patients may get substantial improvement just after the operation or may not. If we could expect short-term change of pain status, it would be helpful for consultation with patients. The object of this study was to present change of pain score for one month after ED in patients who showed substantial improvement of pain and who did not at postoperative one day. Methods: From Jan 2007 to Dec 2008, 116 patients (M:F=114:2; Age, 22.4±5.3) were operated on endoscopic discectomy (ED) due to lumbar herniated intervertebral disc (HIVD). The operated levels were L4-5 in 90 cases and L5-S1 in 26 cases. At 30 days postoperative, outcome was assessed by Macnab’s criteria. All patients were followed-up for at least one month. Results: At one month postoperative, outcome was assessed (excellent, 94/116, 81%; good, 6/116, 5%; fair, 14/116, 12%, and poor, 2/116, 2%). The outcome was divided into favorable (n=100, excellent and good outcome) and unfavorable (n=16, fair and poor outcome) group. There was no difference in age, preoperative VAS on trunk and leg between groups (p>0.05). The change of pain score started to differ from the postoperative one day between groups. The VAS was reduced 61% on the trunk and 84% on the leg in a favorable group comparing preoperative score at postoperative one day. On the contrary, the pain was improved 22% on the trunk and 42% on the leg in an unfavorable group. Conclusions: If patients did not show substantial improvement at postoperative one day after endoscopic lumbar discectomy, the pain may persist for at least one month.

Low Back Pain After Lumbar Discectomy in Patients Showing Endplate Modic Type 1 Change

Prospective cohort study. To examine the relationship between low back pain after discectomy for disc herniation and Modic type 1 change. Lumbar vertebral bone marrow change is divided into Modic types. Some reports indicate that Modic type 1 is related to low back pain, but the reliability of this assertion is unclear. The current study examines changes in low back pain in patients with lumbar disc herniation and Modic type 1 change after lumbar discectomy without fusion surgery. Forty-five patients with lumbar disc herniation showing normal or Modic type 1 signals in their bone marrow were selected (mean age 35 years). All patients suffered low back and leg pain because of lumbar disc herniation, and underwent a discectomy without fusion. We evaluated change in low back pain [Visual analogue scale (VAS) score, Japanese Orthopedic Association score (JOAS), and Oswestry Disability Index (ODI)] before, 12 and 24 months after surgery. Twenty-three patients showed Modic type 1 signals and 22 patients showed normal intensity before surgery. VAS score, JOAS, and ODI were not significantly different between the normal and Modic type 1 groups. VAS score, JOAS, and ODI improved after surgery in both groups (P>0.05). Low back pain after surgery evaluated from the 3 scores was not significantly different in the 2 groups 12 or 24 months after surgery (P>0.05). Discectomy improved low back pain in patients suffering from lumbar disc herniation. Patients with or without Modic type 1 change showed a similar improvement of low back pain score. Low back pain in patients with disc herniation appears to mainly originate from disc or nerve root compression, and decompression surgery without fusion is an option for these patients, even those with Modic type 1 changes.

Magnetic resonance myelography in early postoperative lumbar discectomy: An efficient and cost effective modality

Background:Magnetic resonance myelography (MRM) after lumbar discectomy is all too often an unrewarding challenge. A constellation of findings are inevitable, and determining their significance is often difficult. MRM is a noninvasive technique that can provide anatomical information about the subarachnoid space. Until now, there is no study reported in literature showing any clinico-radiological correlation of post operative MRM. The objective of this study was to prospectively evaluate the diagnostic effectiveness of MRM for the demonstration of decompression in operated discectomy patients and its correlation with subjective and objective outcome (pain and SLR) in immediate postoperative period.Materials and Methods:Fifty three patients of single level lumbar disc herniation (LDH) justifying the inclusion criteria were operated for discectomy. All patients underwent MRM on second/third postoperative day. The pain relief and straight leg raise sign improvement was correlated with the postoperative MRM images to group the patients into: A- Subjective Pain relief, SLR improved and MRM image showing myelo regression; B- Subjective Pain relief, SLR improved and MRM image showing no myelo regression; C- No Subjective Pain relief, no SLR improved and MRM image showing myelo regression and; D- No Subjective Pain relief, no SLR improved and MRM image showing no myelo regression.Results:The result showed that Group A had 46 while Group B, C and Group D had 4, 2 and one patients respectively. Clinico-radiological correlation (Clinically diagnosed patient and findings with MRM correlation) was present in 47 patients (88.68%) which includes both A and D groups. The MRM specificity and sensitivity were 92% and 33.33% respectively.Conclusion:MRM is a non-invasive, efficient and reliable tool in confirming postoperative decompression in lumbar discectomy patients, especially when economic factors are to be considered and the required expertise to reliably read a complex confusing post-operative MRI is not available readily. Further, controlled double blinded multicentric study in operated and non operated LDH, with MRI comparison would give better evidence to justify its use in screening to detect persisting compression and to document decompression.

Economic impact of improving outcomes of lumbar discectomy

Background Lumbar discectomy is usually a successful operation with a relatively low cost. Potential adjunctive procedures, such as repairing the anulus fibrosus or nucleus replacements, necessitate a cost-benefit analysis. Purpose This economic analysis was performed to understand the potential value of advanced implantable technologies designed to improve outcomes after discectomy. Study design/setting Using an insurance claims–based database, the economics of less-than-favorable outcomes after lumbar discectomy were studied. Estimates of improved clinical outcomes because of adjunctive surgical procedural items were modeled. Patient sample Using Current Procedural Terminology (CPT-4) codes and International Classification of Diseases, Clinical Modification procedure codes (ICD-9 CM), all lumbar discectomy patients were identified in a 6-month period from a large, 2002, commercially available claims-based data set representing 3.1 million insured lives. Outcome measures Not applicable. Methods Longitudinal data analysis from 3 years (2002–2004) of the database was performed for evidence of claims after the insured's discectomy (up to 18 months post) as a utilization estimate of surgical and medical treatment resultant of less-than-favorable outcomes. Incidence and cost of secondary operations, medical management, and complications were determined. Using these inputs, an economic model was generated to estimate the effect of improvement in discectomy outcomes. Results Of the 494 patients who had a discectomy within a 6-month period, 137 (28%) had subsequent claims that suggested the outcome was less than favorable within 18 months. Patients whose insurance claims included codes for a second operation (n=52 patients with 56 operations; 11%) and patients being medically/nonsurgically managed (n=85, 17%) were studied. Average reimbursed charges incurred (2006 dollars) of repeated discectomy (80% of cases) was $6,907 and for arthrodesis (20% of cases) was $24,375. Average additional medical treatment cost to diagnose or manage poor outcome requiring another surgery was $3,365. Procedure-related complications within 40 days of surgery were evident in 15% of the group; with additional average cost to manage of $3,939. Conclusions Substantial cost associated with poor discectomy outcomes is often overlooked or underappreciated. Surgical technologies that can improve outcomes of discectomy by 50% to 70% thus improving patient quality of life can be overall cost-neutral between $971 and $1,655 additionally per patient.

The Effect of Web based Information Providing Program on Knowledge Improvement for Patients undergoing Lumbar Discectomy

Objectives: The purposes of this study were to 1) develope web-based information program for the patients undergoing lumbar discectomy, and 2) test the effectiveness of web-based information program for improving patients knowledge level on lumbar discectomy. Methods: First, to improve the validity of contents of web-based program, the information needs were identified from 30 patients admitted for lumbar discectomy and experts’ validation of preliminary contents of program was performed. Second, satisfaction level of the developed program was measured by 15 experts and 20 patients. Finally, the outcome of web-based program was compared by each of 20 lumbar discectomy patients allocated to experimental group (EG) and control group(CG) in term of knowledge level. Results: The web-based program was developed with 24 screens categorized 6 categories. Satisfaction scores on information relevance and information usefulness of experts were higher than those of patients. The EG’s scores on knowledge level was significantly higher than those of CG. Conclusions: We can conclude that web-based information program is more effective tool than the traditional education method to enhancing knowledge level. We suggest that various web-based programs for other patient groups expecting surgeries should be developed in order to satisfy the patients’ needs more effectively. (Journal of Korean Society of Medical Informatics 14-2, 97-109, 2008)

Comparison of usual surgical advice versus a nonaggravating six-month gym-based exercise rehabilitation program post–lumbar discectomy: results at one-year follow-up

Background context Discectomy is the surgery of choice for the lumbosacral radicular syndrome. Previous studies on the postsurgical management of these cases compare one exercise regime to another. This study compares an exercise-based group with a control group involving no formal exercise or rehabilitation. Purpose The outcomes of a formal postsurgical exercise-based rehabilitation when compared with the usual rehabilitative surgical advice were evaluated. Study design A randomized clinical trial comparing management regimes after lumbar discectomies. Patient sample Ninety-three lumbar discectomy patients were randomized to two groups. Outcome measures The following postoperative outcomes were used: levels of pain; levels of function; psychological well-being; time off work; levels of medication; and number of doctor/therapist visits. Methods Ninety-three lumbar discectomy patients were randomized to two groups. The treatment group undertook a 6-month supervised nonaggravating exercise program. The control group followed the usual surgical advice to resume normal activities as soon as the pain allowed. Both groups were followed for 1 year by using validated outcome measures. Results The results are based on an intention-to-treat analysis. Patients in both groups improved during the 1-year follow-up (p=.001). There was no statistical significance between the groups at the clinical endpoint. The treatment group returned to work 7 days earlier and had fewer days off work in the 1-year follow-up period. Conclusion There was no statistical advantage gained by the group that performed the 6-month supervised nonaggravating exercise program at 1-year follow-up. They did, however, have fewer days off work.

Comparison of postural control in unilateral stance between healthy controls and lumbar discectomy patients with and without pain

Previous studies have demonstrated that sciatica patients have poorer postural control than healthy controls and that postural control remains unchanged 3 months after lumbar discectomy in sciatica patients. The aims of the current study were to investigate whether static balance control recovers in pain-free discectomy patients long-term after lumbar discectomy. Next is to determine whether static balance responses of asymptomatic and symptomatic lumbar discectomy patients differed from each other and from healthy controls. In addition, the influence of the extent of disc resection (unilateral/bilateral removal) and the side of operation on static balance control were investigated. Fifteen pain-free lumbar discectomy patients, 23 lumbar discectomy patients with residual pain and 72 controls performed unilateral stance tasks with eyes open and eyes closed on a force plate were taken up for the investigation. Three repetitions of a 10 s unilateral stance test were performed on each leg. Postural sway was determined. Patients were divided into three age groups. In the eyes open condition, there was no significant difference between postural sway of pain-free lumbar discectomy patients and controls (P=0.68), whereas balance of patients with pain was significantly worse than in controls (P=0.003). In the eyes closed condition, the sway in both groups of lumbar discectomy patients was significantly worse than in controls (pain-free P=0.009/painful P<0.001). No significant differences were found in postural sway between patients with unilateral and bilateral disc resection. In unilateral stance on the leg of the operated side, centre of gravity sway was not significantly different in the eyes open condition compared to the eyes closed condition, whereas in stance on the leg of the non-operated side, postural sway was significantly lower in the eyes open condition compared to the eyes closed condition. In both conditions, postural sway in the age group of 50-65 years was significantly higher than in the age groups of 30-39 years (eyes open P=0.005; eyes closed P<0.001) and 40-49 years (eyes open P=0.002; eyes closed P=0.006). There was no significant difference between the age group of 30-39 years and the age group of 40-49 years (P=0.51). As for long-term following lumbar discectomy, there is no complete recovery of postural control. Patients seem to develop visual compensation mechanisms for underlying sensory-motor deficits, which are, however, sufficient in case of pain relief only. Further study is needed to determine the cause of the balance disturbances in lumbar discectomy patients.

Cost effectiveness evaluation of ADCONê-L adhesion control gel in lumbar surgery

Patientst physicians and third-party payers are becoming increasingly concerned with the economic burden resulting from advances in health care. Many economic health studies have focused on patients with sciatica and low back pain. An Economic Survey was conducted on lumbar discectomy patients who had been enrolled at least 12 months prior in a prospective randomized controlled clinical study of the adhesion control device AOCONê-L. The survey measured patient satisfactiont return to workt additional medical treatment and medications after surgery. In additiont the duration of any re-operations from patients in the clinical study was analyzed. The results of the Economic Survey and re-operation time analysis show significant advantages for lumbar discectomy patients who received AOCON, Y-L compared to control patients who did not. Patients who received AOCONê-L not only had less scarring and less back pain than control patients but also were more satisfied with their surgeries and were able to return to work more oftent as originally planned (p = 0.02). In additiont AOCONê-L patients returned to their original jobs an average of 3.6 days soonert changed jobs 50% less oftent did not seek additional medical treatment as oftent and took 20% less pain medication than did control patients (p = 0.01). In additiont patients receiving AOCONê-L who required subsequent re-operation at the same lumbar space (e.g. t reherniation) had a significantly shorter duration of secondary surgery (56.6 min vs. 130 mint p = 0.001) compared to patients who did not receive AOCONê-L at the first surgery. Overallt AOCONê-L patients demonstrated significant clinical and economic advantages over control patients. If all lumbar surgical patients in the US were to receive AOCONê-L annual savings to the health care system would exceed one half billion dollars. [Neural Res 1999; 21 Suppl 1: S67-S71]

Effect of Timing of Local Anesthetic Administration on Functional Outcome in Lumbar Discectomy Patients: A Prospective, Randomized, Controlled Trial

Effect of Timing of Local Anesthetic Administration on Functional Outcome in Lumbar Discectomy Patients: A Prospective, Randomized, Controlled Trial

Endoscopic Discectomy in Pediatric and Juvenile Lumbar Disc Herniations

Most herniated lumbar discs in children and adolescents respond to conservative treatment, but some young patients with persistent low back and neurological symptoms do not respond to noninvasive treatment and require operative treatment. Because the long-term results of disc surgery depend not only on the disc disease itself but also on the degree of surgical trauma, disc herniations in children and adolescents should be treated with minimally invasive procedures. We report our experience with four young patients aged 8-17 years with contained or small noncontained lumbar disc herniations who were treated by percutaneous endoscopic discectomy (PED). The clinical results were good to excellent in all four cases, with follow-up of 1 to 5 years. There were no complications, and the operation was tolerated well by the young patients. We recommend percutaneous endoscopic lumbar discectomy in patients with contained or small uncontained disc herniations who do not respond to conservative treatment.

The effects of aerobic exercise after lumbar microdiscectomy.

This study determined whether lumbar discectomy patients could endure an aerobic exercise program sufficient to achieve a training effect, and whether any functional advantages were derived. Trained volunteers (n = 19) were compared with untrained control subjects (n = 18) after a 12-week aerobic and rehabilitation exercise program. Subjects completed a maximal graded exercise test, a hydrostatic weighing test, and a battery of self-report inventories. Using a discriminant analysis, as a post hoc test, maximal oxygen consumption was found to be the factor responsible for the difference between the groups (P < 0.006). Oxygen consumption was more than three times as important as any other single variable in differentiating between the groups.

Erythrocyte sedimentation rate as a possible indicator of early disc space infection.

Clinical, radiographic and laboratory changes are defined in the syndrome of disc space inflammation, and a series of 25 patients is summarized. In the majority inflammation occurred following lumbar discectomy. Forty-nine routine lumbar discectomy patients are assessed acutely and chronically. Erythrocyte sedimentation rates (ESR) were found to be elevated in the post-discectomy patients, but dropped toward normal. In patients with disc space inflammation, the ESR remained high or increased with time. It is felt that by obtaining ESR in the post-discectomy patient, the clinician might be alterted to potential disc space inflammation and stimulate early diagnosis and treatment.