Microdiscectomy Surgery Research Articles

Musical Odyssey: From Pain to Recovery

Psychiatric rehabilitation aims to promote health recovery from significant losses, both physical and psychological, that have derailed the lives of adults and young adults diagnosed with a serious mental illness (SMI) so that they can actively participate in rebuilding and recreating themselves. The population faces premature morbidity and experiences higher than average rates of chronic and life-threatening disorders. When participants join the BU Center for Psychiatric Rehabilitation services’ programs, they take on the role of student, increasing their knowledge, skills, and supports to further their personal goals and recovery journeys. The submission, Musical Odyssey: From Pain to Recovery, is an original poem informed by the values and practices of my work in the field of psychiatric rehabilitation as well as my recent medical experience as a patient. The poem was inspired primarily by my four-month experience of having to navigate through the primary care system and advocate for myself to get services for two herniated discs while working. During this period I was teaching three courses: Empowering Ourselves through Song, Buddhist Psychology’s Path of Recovery, and Mindfulness: The Practice of Buddhist Psychology.In the 2018 fall semester, I was role modeling recovery-oriented rehabilitation for my students, a Certified Peer Support Specialist, and three interns (two from BU School of Social Work and one from Tufts University). Despite excruciating pain from two herniated discs, I taught almost all the classes before and after a micro-discectomy and hemi-laminectomy surgery at the Beth Israel Deaconess Medical Center and prepared detailed lesson plans for my interns who had the opportunity to develop their clinical and teachings skills while receiving my support. My suffering and sharing of daily meditation, music listening, and singing helped grow everyone’s awareness, compassion, and commitment to mindfulness practice.

Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation: A Retrospective Analysis of Three Hundred Twenty-One Cases.

Retrospective clinical series. To investigate the clinical features and the risk factors for recurrent lumbar disc herniation (rLDH) in China. rLDH is a common cause of poor outcomes after lumbar microdiscectomy surgery. Risk factors for rLDH are increasingly being investigated. However, results in these previous studies were not always consistent. Between June 2005 and July 2012, 321 consecutive patients with single-level LDH, who underwent surgery, were enrolled in this study. We divided the patients into the recurrent group (R group) and the nonrecurrent group (N group) and compared their clinical parameters and preoperative radiologic parameters. The relationships between the variables and rLDH were evaluated by univariate analysis and multiple logistic regression analysis. There was significant difference between groups in sex (P = 0.003), age (P = 0.003), current smoking (P = 0.004), body mass index (BMI) (P = 0.04), occupational lifting (P < 0.001), trauma history (P = 0.04), procedures (P = 0.04), herniation type (P = 0.006), disc height index (DUI) (P = 0.04), facet orientation (FO) (P = 0.04), facet tropism (FT) (P = 0.04), and sagittal range of motion (from) (P = 0.04). By putting these differences in logistic regression analysis, it showed that being male, young age, current smoking, higher BMI, herniation type (transligamentous extrusion), surgical procedures (bilateral laminectomy or total laminectomy), heavy works, undergoing a traumatic event, a large from, a high DUI, a large FT, and a small FO significantly related with rLDH. Based on our data, sex, age, current smoking, BMI, occupational lifting, trauma, surgical procedures, herniation type, DUI, FO, FT, and from showed a significant correlation with the incidence of rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. 3.

Clinical Outcomes after Microdiscectomy for Recurrent Lumbar Disk Herniation: A Single-Center Study.

Revision discectomy is the principal procedure for recurrent lumbar disk herniation (RLDH). The clinical outcomes after this procedure are as good as or slightly poorer than those produced by primary discectomy. In this study, the clinical outcomes of patients treated with microsurgical discectomy for RLDH were analyzed. We examined 179 patients undergoing lumbar microdiscectomy surgery for RLDH. The visual analogue scale (VAS), Prolo scoring system, and Oswestry Disability Index (ODI) were used for evaluating the improvement of symptoms and functional outcomes. Among 179 patients, 101 (56%) obtained good and excellent Prolo scores (group 1), while 78 (44%) obtained fair or poor results (group 2). There was no significant difference between the groups regarding age (P=0.515), gender (P=0.545), body mass index (P=0.523), diabetes mellitus (P=0.074), smoking (P=0.100), interval between primary and revision surgeries (P=0.749), and surgical outcomes (P=0. 749). However, significant improvements were achieved in VAS scores for back (P=0.197) and radicular pain (P=0.606), as well as ODI scores (P= 0.000). Based on the findings, only ODI scores showed a significant inter-group difference in the 12-month follow-up (P=0.038). Limited microsurgical discectomy could be considered as the main surgical method in patients with RLDH without overt instabilities.

An Analysis of the Cost-Effectiveness of Spinal Versus General Anesthesia for Lumbar Spine Surgery in Various Hospital Settings.

Study Design:Retrospective chart review.Objective:To determine the relative cost-effectiveness of spinal anesthesia and general anesthesia for lumbar laminectomy and microdiscectomy surgery performed in an academic versus private practice hospital setting.Methods:The authors retrospectively reviewed charts of 188 consecutive patients who underwent lumbar laminectomy or microdiscectomy by a single surgeon from 2012 to 2016 at either an academic or a private practice hospital setting. Intraoperative and postoperative outcomes were recorded and direct variable costs were calculated.Results:At the academic institution, the direct cost of a lumbar laminectomy or microdiscectomy surgery under general anesthesia was determined to be 9.93% greater than with spinal anesthesia (P = .040). The greatest difference was seen with operating room costs, in which general anesthesia was associated with 18.74% greater costs than spinal anesthesia (P = .016). There was no significant difference in cost at the private practice hospital setting.Conclusions:We conclude that use of spinal anesthesia for lumbar laminectomy leads to less operating room, postanesthesia care unit, and anesthesia times, lower levels of postoperative pain, and no increased rate of other complications compared with general anesthesia at an academic institution as compared to a private practice setting. Spinal anesthesia is 9.93% less expensive than general anesthesia, indicating substantial cost-saving potential. With no sacrifice of patient outcomes and the added benefit of less pain and recovery time, Spinal anesthesia represents a more cost-effective alternative to general anesthesia in lumbar spine surgery in the academic hospital setting.

A Prospective Detailed Time Analysis Study of 18 Patients Undergoing Elective Single-Level Open Lumbar Microdiscectomy Spinal Surgery Compared with Centers for Medicare and Medicaid Services Reimbursement Guidelines

Single-level open lumbar microdiscectomy surgery is one of the most straightforward and effective spinal surgeries performed by spinal surgeons today to treat disk herniation. Although a common operation, little in the literature is reported on the exact overall time, cost, and effort associated with the performance of this surgery. The consistency of this operation across institutions and disciplines makes it a good starting point to accurately track the total time and effort of all phases of the surgical intervention. Eighteen patients undergoing elective single-level open lumbar microdiscectomy surgery were prospectively enrolled in this study. The time spent interacting with each patient by every member of the surgical team was tracked and recorded along will every phone call and e-mail. All perioperative times associated with the surgery were tracked and analyzed. Each patient was followed from their first interaction through surgery and for the first 3 months postoperatively. The advanced practice providers spent the most time with the patient both pre- and postoperatively followed by the surgeon and resident. A total of 2.98 hours was spent with the patient preoperatively in clinic and 1.69 hours postoperatively. The total time commitment of an institution treating this condition was 12.56 hours. Comparing our results with the Centers for Medicare and Medicaid Services data, a significant discrepancy and underestimation was observed. As such, we hope our results enable health care providers to more accurately allocate resources for the provision of high-quality medical care to patients with this increasingly common condition.

Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: optimizing lumbar disc surgery: 218. Patients undergoing revision microdiscectomy for recurrent lumbar disc herniation experience worse clinical outcomes and more reoperations compared to patients undergoing a primary microdiscectomy

BACKGROUND CONTEXT When conservative measures fail, lumbar disc herniation has been shown to be successfully treated by a microdiscectomy surgery. The percentage of patients that necessitate revision surgery within 2years varies between 0.5% and 24% in literature, with recurrent herniation being the most common presentation.However, in the setting of a revision discectomy surgery for a recurrent disc herniation, outcomes can be more difficult to predict. Some studies with smaller patient populations and diverse outcome protocols have not found significant clinical outcome differences between these two patient populations. Other studies have begun to elucidate differences at 1 year after surgery. PURPOSE The goal of this study is the compare the demographics and outcomes of patients undergoing primary lumbar microdiscectomy surgery for a disc herniation and those undergoing a revision microdiscectomy surgery for a recurrent disc herniation. STUDY DESIGN/SETTING Retrospectivec cohort series. PATIENT SAMPLE We performed a retrospective analysis of patients who underwent a primary or revision lumbar microdiscectomy between 2009 and 2015 by one of two senior orthopaedic spine surgeons. Patients were excluded from analysis if they had any previous lumbar surgery (other than a microdiscectomy at the recurrent disc herniation level), were under 18 years of age at the time of surgery, or had postoperative follow up less than 3 months. Patients were divided into two groups: those undergoing a primary surgery for a lumbar disc herniation (primary) and those undergoing a revision procedure for a recurrent disc herniation (recurrent). OUTCOME MEASURES Patient reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and the Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. Patients were also surveyed about their expectations and satisfactions following surgery. METHODS Baseline patient characteristics were compared using chi-squared analysis and independent sample t-tests for categorical and continuous data, respectively. Bivariate and multivariate regressions were subsequently used to compare clinical outcomes between procedure groups. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS Overall, 296 consecutive patients who fulfilled our inclusion criteria were assessed. The patients in the recurrent group were significantly younger than those in the primary group (44.6±12.7 vs. 53.2±16.2 years; p CONCLUSIONS Patients who presented with symptoms related to a recurrent lumbar disc herniation underwent surgery significantly sooner than those patients who underwent a primary lumbar microdiscectomy for a disc herniation. At 2 years following surgery, patients that underwent a revision lumbar microdiscectomy for a recurrent disc herniation reported significantly worse patient outcomes following surgery. These patients that underwent revision surgery were also significantly less satisfied and felt as though their results did not exceed nor meet their expectations of the procedure. Revision rates were also significantly higher in patients undergoing a revision lumbar microdiscectomy. Although three-quarters or patients will not require a repeat operation following a revision microdiscectomy, preoperative educations should be clearly communicated regarding the elevated risk of a subsequent reherniation and/or worse back pain as well as expectations following this revision procedure.

Hypericum perforatum to improve post-operative Pain Outcome after monosegmental Spinal microdiscectomy (HYPOS): a study protocol for a randomised, double-blind, placebo-controlled trial

BackgroundSpinal disc herniation is a frequently occurring degenerative disease of the spine. Many patients undergoing surgery suffer from radicular pain, known as memory pain, beginning from the third post-operative day. This results in the prescription of high-dose opioid medications. In homeopathy, Hypericum perforatum is known as a remedy for unbearable, shooting or jabbing pain especially when neural damage is involved. Reduction of pain after application of H. perforatum has been observed in previous studies. This study is aimed to investigate whether homeopathic H. perforatum in a potentisation of C200 leads to the reduction of post-operative pain and a decrease of pain medication compared to placebo.Methods/designThis is a monocentric, double-blind, randomised placebo-controlled trial conducted at the Department of Neurosurgery at the Community Hospital Herdecke, Germany. One hundred study participants are being recruited from inpatients undergoing elective, monosegmental, lumbar microdiscectomy surgery. Patients are randomly allocated to receive homeopathic treatment or placebo in addition to usual pain management after surgery. The primary clinical outcome is pain reduction after 3 days of inpatient care as measured by pain reduction of subjective pain on a 100-mm Visual Analogue Scale (VAS) at the third post-operative day. Statistical analysis will be carried out by means of a covariance model with adjustment for baseline values and patient expectation for all randomised patients.DiscussionThis study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic H. perforatum after monosegmental spinal microdiscectomy. We intend to clarify the potential of homoeopathic H. perforatum to reduce surgery-associated pain.Trial registrationGerman Clinical Trials Register, ID: DRKS00007913. Registered on 17 October 2014.EudraCT – Nr: 2013–001383-31.Data sets from the German Clinical Trials Register (DRKS, Deutsches Register Klinischer Studien) are updated every 4 weeks automatically to the International Clinical Trials Registry Platform of World Health Organisation: http://apps.who.int/trialsearch/.ResponsibilitiesSponsor:Witten/Herdecke UniversityAlfred-Herrhausen-Straße 5058,448 WittenDeputy of the sponsor:Dr. Wolfgang Eglmeier (Head of Centre for Clinical Trials Witten/Herdecke)Alfred-Herrhausen-Straße 5058,448 WittenE-mail: wolfgang.eglmeier@uni-wh.dePrincipal investigator:Prof. Dr. med. Wolfram ScharbrodtCommunity Hospital HerdeckeDepartment for NeurosurgeryGerhard-Kienle-Weg 458,313 Herdeckew.scharbrodt@gemeinschaftskrankenhaus.deProject coordination:Christa RaakFaculty for Health (Department for Integrative and Anthroposophic Medicine)University Witten/Herdecke gGmbhGerhard-Kienle-Weg 458,313 Herdeckechrista.raak@uni-wh.deProject manager/data analysis/biometry:Prof. Dr. Thomas OstermannFaculty for Health (Department for Psychology and Psychotherapy)University Witten/Herdecke gGmbhAlfred-Herrhausen-Straße 5058,448 Wittenthomas.ostermann@uni-wh.de

Evaluation of pain status and quality of life in patients with lumbar disc hernia who underwent microdiscectomy

The objective of this study was to evaluate the emotional state, pain status, and quality of life in patients with lumbar disc herniation using preoperative Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and 1- and 3-months postoperative VAS scores. Between December 2017 and March 2018, 49 patients with lumbar disc herniation, who were admitted to our neurosurgery department, were enrolled in this retrospective study. According to the ODI questionnaire, pre- and postmicrodiscectomy analysis revealed a statistically significant improvement in all the parameters (for all parameters, p < 0.001). VAS scores of the patients showed a significant gradual decrease in the severity of pain at 1 and 3 months following the operation (p < 0.001). It was observed that lower back pain and quality of life in patients improved following microdiscectomy surgery. Microdiscectomy surgery is still an important option in lumbar disc herniation treatment.

Cryopreserved Amniotic Membrane Improves Clinical Outcomes Following Microdiscectomy.

Prospective, randomized controlled trial. To compare pain, physical/mental functional recovery and recurrent herniation for patients following lumbar microdiscectomy with and without the use of a cryopreserved amniotic tissue graft. Although microdiscectomy procedures are routinely successful for patients with lumbar radiculopathy due to herniated disc disease, residual low back pain, and recurrent herniation remain unsolved clinical problems. Following Investigated Review Board approval, 80 subjects were randomized in a 1:1 ratio to either receive cryopreserved amniotic (cAM) tissue or no tissue following elective lumbar microdiscectomy surgery. cAM grafts were applied to the annular defect at the conclusion of the procedure. Patients provided preoperative and postoperative clinical assessment data out to 24 months using the Oswestry Disability Index (ODI), Short Form-12 (SF-12) Health Survey, and Visual Analog Pain Scale for back and leg pain. Patients with symptomatic recurrent disc herniation were recorded. In total, 48 males and 32 females with an average age of 47.2 years were included. Mean ODI scores for subjects treated with cAM graft demonstrated statistically greater improvement at 6 weeks (14.49 vs. 21.82; P=0.05) and 24 months (6.62 vs. 14.40; P=0.02) compared with controls. Similarly, SF-12 Physical Component Scores demonstrated statistically greater gains in the cAM group at both the 6 weeks and 24 months. None of the subjects in the cAM graft group sustained a recurrent herniation at the same surgical level, whereas 3 patients in the control group sustained a recurrent herniation at the same surgical level, with 2 requiring fusion to manage persistent pain. The data demonstrate statistically superior clinical outcomes following lumbar microdiscectomy as measured by ODI and SF-12 (physical composite scale) and a lower rate of recurrent herniation with the use of a cAM tissue graft compared with traditional microdiscectomy.

Physiotherapy for Patients with Sciatica Awaiting Lumbar Micro-discectomy Surgery: A Nested, Qualitative Study of Patients' Views and Experiences.

Background and PurposeSciatica is a common clinical condition that can be extremely painful, disabling and life‐changing. Whether conservative or surgical treatment for sciatica secondary to an intervertebral disc prolapse is most effective is still much debated. An important component of conservative treatment is physiotherapy, which aims to promote physical and psychological health for the patient, whilst resorption of the disc takes place. This paper reports a qualitative study of patients' views and experiences of a bespoke physiotherapy intervention for the treatment of sciatica.MethodsA qualitative study nested within a pilot randomized controlled trial of bespoke physiotherapy for the treatment of patients with sciatica awaiting lumbar microdiscectomy surgery. Patients randomized to receive bespoke physiotherapy in the intervention arm of the trial were invited to take part in semi‐structured interviews. Twenty‐one in‐depth, semi‐structured interviews took place. All interviews were recorded, fully transcribed and thematically analysed.ResultsMost patients in the sample found the physiotherapy valuable, appreciating the individual nature of the approach, the exercises to reduce pain and discomfort, techniques for improving functional spinal movement, walking and dynamic posture, and manual therapy and cardiovascular exercise. A small number did not find the physiotherapy of benefit. Sixteen patients in the sample went on to proceed with surgery, but most of these found value in having had the physiotherapy first.DiscussionMany patients with sciatica appreciate the value of physiotherapy prior to surgery. Future research should examine patients' experiences of bespoke physiotherapy delivered within primary care. Copyright © 2016 The Authors Physiotherapy Research International published by John Wiley & Sons Ltd.

Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis

BackgroundLumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically...

Everyday memory in microsurgically treated patients after subarachnoid hemorrhage.

BackgroundMemory declines measured by traditional tests in patients after subarachnoid hemorrhage (SAH) are well documented. Classic examinations of memory problems sometimes do not significantly correlate with memory functions in everyday life. The objective of the study was to assess the specific type of everyday memory loss in patients after microsurgical treatment of ruptured intracranial aneurysm causing SAH.MethodsThe prospective controlled, randomized study was conducted using the specific tests for everyday memory measure with high ecological validity. All patients were operated on by the same neurosurgeon (KD). Preoperatively, patients were in a good grade (Hunt-Hess I or II), with no neurological deficit and no hydrocephalus postoperatively. Patients were tested at two phases: 15 and 45 days after microsurgery with the Rivermead behavioral memory test (RBMT) and the cognitive failure questionnaire (CFQ).ResultsWe compared the results of the tests administered in subjects that underwent microdiscectomy surgery for SAH to a control group that underwent surgery for lumbar disc herniation (DH).ConclusionNeuropsychological assessment of operated patients who sustained SAH showed a decline, compared to the DH group, in everyday memory function. Also, we found failures in perception and motor function in operated SAH patients with a trend of cognitive recovery as time progresses.

Technique of Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.

Post anesthesia recovery rate evaluated by using White fast tracking scoring system

Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025) finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046). In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008). Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

Cognitive function recovery rate in early postoperative period: comparison of propofol, sevoflurane and isoflurane anesthesia

Introduction: There is no simple answer to the question as to when the brain function is back to normal after anaesthesia. Research done so far has identified different factors influencing the rate of cognitive function recovery and type of anaesthetic as one of those factors.Methods: This study encountered 90 patients hospitalized in neurosurgical department of University Clinical Centre Tuzla in period from October 2011 to may 2012 year. Aim of the study was to compare influence of three different anesthetics (propofol, isofl urane and sevofl urane) on recovery rate of cognitive performance 1, 5 and 10 minutes following extubation. Assessment of cognitive functions was preformed using the short Orientation-Memory-Concentration (OMC) Test. All patients included in the study underwent lumbar microdiscectomy surgery and were allocated to one of three groups: propofol, sevoflurane and isoflurane.Results: Trough comparison of OMC test values there is obvious superiority in recovery of cognitive functions between propofol group and inhaled anesthetic group, after 1 minute (p = 0.008) and after 5 minutes (p =0.009). Comparison of propofol and isoflurane anesthesia shows significantly faster recovery of cognitive performance in propofol group (after 1 minute p = 0.002, 5 minutes p = 0.004, 10 minutes p = 0.038). Faster recovery of cognitive function is present in sevoflurane compared to isoflurane group only 1 minute after extubation p = 0.049.Conclusions: Fastest recovery of cognitive performance appears after propofol anesthesia, than follows sevofl urane based anesthesia and after that isoflurane anesthesia.

A randomized, controlled trial of a clinical pharmacist intervention in microdiscectomy surgery – Low dose intravenous ketamine as an adjunct to standard therapy

AimThe hypothesis that postoperative pain would be reduced by using 1μg/kg/min of ketamine, both intra- and post-operatively, for lumbar microdiscectomy surgery was assessed by measuring morphine consumption. Patient side effects were reported. MethodsForty-five patients undergoing microdiscectomy surgery were randomized under double-blind conditions into three groups: Group1 (G1) received normal saline, Group 2 (G2) ketamine (1μg/kg/min) intra-operatively and Group 3 (G3) ketamine (1μg/kg/min) both intra- and post-operatively. Morphine consumption, pain scores, nausea and vomiting, CNS disorders were recorded for 24h post surgery. This study was conducted by applying the concept of a clinical pharmacist intervention. ResultsThe time for the first analgesia demand dose was significantly shorter (P<0.05) in G117±1.7min than for G2 and G3. In G3 morphine consumption 6, 12, and 24h after surgery was 3±2.26, 9.2±2.11 and 26.9±2.71mg. Total morphine consumption was significantly lower for G3 than for G1 or G2 (P<0.05). The visual analog scale score (VAS) values were significantly lower in G3 (P<0.05) than for the other groups during the first 24h. The rate of nausea and vomiting was significantly higher in G1 vs G3 (P<0.05). No difference in drug induced CNS disturbances was observed among the groups. ConclusionsUsing 1μg/kg/min of ketamine hydrochloride intra- and post-operatively for microdiscectomy surgery could be an adjunct therapy to reduce postoperative morphine consumption minimizing its side effects.Collaborative clinical pharmacy practice on the basis of pharmacology had an effective role in improving the general outcome of microdiscectomy surgery.

Conservative Management of Lumbar Disc Herniation With Associated Radiculopathy

A systematic review of randomized controlled trials. To determine the efficacy and adverse effects of conservative treatments for people who have lumbar disc herniation with associated radiculopathy (LDHR). Although conservative management is commonly used for people who have LDHR, the efficacy and adverse effects of conservative treatments for this condition are unclear. We searched 10 computer databases for trials published in English between 1971 and 2008. Trials focusing on people with referred leg symptoms and radiologic confirmation of a lumbar disc herniation were included if at least 1 group received a conservative and noninjection treatment. Eighteen trials involving 1671 participants were included. Seven (39%) trials were considered of high quality. Meta-analysis on 2 high-quality trials revealed that advice is less effective than microdiscectomy surgery at short-term follow-up, but equally effective at long-term follow-up. Individual high-quality trials provided moderate evidence that stabilization exercises are more effective than no treatment, that manipulation is more effective than sham manipulation for people with acute symptoms and an intact anulus, and that no difference exists among traction, laser, and ultrasound. One trial showed some additional benefit from adding mechanical traction to medication and electrotherapy methods. Adverse events were associated with traction (pain, anxiety, lower limb weakness, and fainting) and ibuprofen (gastrointestinal events). Advice is less effective than microdiscectomy in the short term but equally effective in the long term for people who have LDHR. Moderate evidence favors stabilization exercises over no treatment, manipulation over sham manipulation, and the addition of mechanical traction to medication and electrotherapy. There was no difference among traction, laser, and ultrasound. Adverse events were associated with traction and ibuprofen. Additional high-quality trials would allow firmer conclusions regarding adverse effects and efficacy.

Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report

Objective To discuss management of postsurgical lumbar disc herniation using a program of chiropractic manipulation and an active rehabilitation program. Clinical Features The patient was a 54-year-old Caucasian male with a history of acute low back pain and left sciatic pain down the left posterior thigh and lateral calf and numbness in the dorsum of the left foot. Prior medical intervention included treatment with steroid anti-inflammatory drugs and lumbar microdiscectomy surgery, with incomplete resolution of his symptoms. The patient was unable to walk without pain or return to normal activities of daily living. He was antalgic in flexion. His lumbar range of motion was restricted in flexion and extension. He exhibited a positive straight leg raise and exhibited foot drop on the left. Intervention and Outcome The treatment plan and intervention consisted of patient education on proper posture and proper bending and lifting techniques. Rehabilitative exercise began in the office and progressed to home based therapy and exercises. He noticed a decrease in his signs and symptoms after seven visits. Active rehabilitation was continued with the goal of returning lumbar spinal extensor strength. He was released to home therapy and supportive chiropractic care with continued positive response. Conclusion Management of postsurgical lumbar disc herniation with chiropractic and active rehabilitation is discussed. Spinal deconditioning and a weakness of the lumbar spinal extensor muscles appeared to be related to the patient's symptoms. Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.

Lumbar microdiscectomy in rats.

An operative method for lumbar microdiscectomy in rats is described in general terms so that it may be adapted to any microsurgical laboratory. The operation may be used as an advanced exercise in microsurgery, or to prepare surgeons for clinical lumbar microdiscectomy surgery.