Posterior Lumbar Discectomy Research Articles

Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy.

One-hole Split Endoscopy (OSE) is a newer surgical modality that can be applied to posterior cervical foraminotomy (PCF), lumbar discectomy, laminectomy, and decompression. It incorporates intervertebral foraminotomy, open surgery, and other lumboendoscopic techniques with a wide observation field, free space, and compatibility with various spinal surgical techniques and instruments. This study investigated the clinical efficacy of minimally invasive posterior cervical nucleus pulposus removal for cervical spondylotic radiculopathy (CSR) by OSE-Keyhole technique. This was a retrospective study of 63 patients treated with OSE keyhole treatment for CSR between May 2021 and September 2023 at Qilu Hospital of Shandong University, Qilu Hospital of Shandong University (Qingdao, China), and Second Hospital of Shandong University, respectively. Clinical outcomes included patients' preoperative and postoperative visual analogue scale (VAS) - arm and neck, Japanese Orthopaedic Association Assessment Treatment Score (JOA) - cervical spine, which were collected at baseline, two days postoperatively, one month postoperatively, and three months postoperatively after the last follow-up visit for evaluation, and perioperative indicators, including intraoperative bleeding, length of hospital stay, postoperative complications, and reoperations, which were also collected. Statistical analyses were performed for the baseline data and follow-up results of 63 patients. Compared to the preoperative baseline values, the follow-up results two days, one month and three months after surgery showed significant improvements in vas-arm, neck and JOA scores in the operated patients (P<0.05) as well as a reduction in all perioperative-related indices. In the treatment of cervical pain and disability due to radiculopathy, OSE keyhole removal of the posterior cervical nucleus pulposus is a better clinical option as it is less invasive and recovers better postoperatively.

Uniportal Dual Mode Dry-Saline Endoscopy for Lumbar Disc Herniation

Objective: Posterior dry medium endoscopic lumbar discectomy techniques have been successfully used to treat lumbar disc prolapse. A drawback of these techniques is repeated blood staining of the scope tip while working close to the surgical target. To address this drawback, we modified the design of the previous Arthrospine system and made it compatible for use in air and saline medium to treat lumbar, cervical, and thoracic disc prolapse. Herein, we describe the operative technique and results of lumbar discectomy in a dual (air/saline) medium using this system.Methods: Eighty patients underwent endoscopic discectomy using the Arthrospine Duo system for lumbar disc prolapse. The procedure was conducted through a muscle dilatation approach using 5-mm and 10-mm dilators. The Arthrospine Duo tube was passed over a 10-mm dilator, the working insert was adjusted over the tube in a press-fit manner, and endoscopic discectomy was performed using a 30° arthroscope and conventional microdiscectomy instruments in an air or saline medium.Results: As per the modified MacNab criteria, 80% (n=64) of patients had excellent, 12.5% (n=10) good, 6.25% (n=5) fair, and 1.25 patients (n=1) had poor results. The leg pain visual analogue scale improved from 7.87±0.68 to 1.3±0.67 at 2 years of follow-up. As complications, dural tears and transient paraesthesia occurred in 4 patients (5%) each, nerve root injury in 1 patient (1.25%), and superficial wound infection in 5 patients (6.25%).Conclusion: The uniportal Arthrospine Duo system can be used in air/saline medium and is an excellent minimally invasive option for lumbar discectomy.

Retrolaminar block for opioid-free anaesthesia and enhanced recovery after posterior lumbar discectomy: A randomised controlled study.

Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy. The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). P values < 0.05 were considered statistically significant. The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group (P < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group (P < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group (P < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group (P < 0.001). Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.

Histopathological spectrum of lumbar disc changes in obesity: analysis of intervertebral discs in lumbar hernia patients in Zenica-Doboj Canton, Bosnia and Herzegovina

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods &amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt;The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI&amp;amp;ge;25 and control group with BMI&amp;amp;lt;25.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Among 69 patients with herniated IVD, 26 (37.7%) were with BMI&amp;amp;ge;25 (study group), and 43 (62.3%) were with BMI&amp;amp;lt;25&amp;lt;br /&amp;gt;(controls). The study group displayed substantial increase in height, 1.80&amp;amp;plusmn;0.06 m compared to controls, 1.74&amp;amp;plusmn;0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60&amp;amp;plusmn;10.22 vs. 67.37&amp;amp;plusmn;9.20 kg, BMI: 28&amp;amp;plusmn;2 vs. 22&amp;amp;plusmn;2; p&amp;amp;lt;0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p&amp;amp;lt;0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p&amp;amp;lt;0.05), and positive correlations were found between BMI and&amp;lt;br /&amp;gt;these alterations found in the herniated discs (p&amp;amp;lt;0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p&amp;amp;lt;0.001) and weight (R=0.696; p&amp;amp;lt;0.001).&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;The study&amp;#039;s findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the&amp;lt;br /&amp;gt;importance of weight management in preventing disc degeneration.&amp;lt;/p&amp;gt;

The effect of annulus fibrosus incision and foraminoplasty on lumbar biomechanics in percutaneous endoscopic lumbar discectomy: a finite element analysis

The objective of this study was to analyze the effects of annulus fibrosus incision and foraminoplasty on lumbar biomechanics during posterior lateral approach translaminar percutaneous endoscopic lumbar discectomy (PELD) using a lumbar 4/5 segment model and three-dimensional finite element analysis (FEA). We created a model of the L4 to L5 segment and performed simulated foraminoplasty, annulus fibrosus incision, and a combined operation. The models were tested under six working conditions, and we recorded the deformation and equivalent strain/stress of each group. Results showed that foraminoplasty can affect the stability and rotation axis of the segment during rotation without significantly impacting discal stress. Conversely, annulus fibrosus incision significantly increases discal stress except for when the patient is doing a forward flexion movement. We recommend that surgical maneuvers minimize the removal and destruction of the annulus fibrosus and that rotation movements are avoided during the short-term recovery period following PELD surgery.

The Effect of Topical Tranexamic Acid on Intraoperative Blood Loss in Patients Undergoing Posterior Lumbar Laminectomy and Discectomy: A Randomized, Double-Blind, Controlled Trial Study.

Randomized, double-blind, controlled trial study. This study aimed to evaluate the safety and efficacy of topical tranexamic acid (TXA) on intraoperative blood loss (IBL) in patients that have degenerative lumbar canal stenosis and undergo posterior lumbar laminectomy and discectomy. The volume of IBL is directly proportional to potential surgical complications. Recent reports have shown that the topical use of antifibrinolytic drugs, such as TXA, during surgery might decrease IBL and improve patient outcomes. A total of 104 patients with lumbar canal stenosis were enrolled in this randomized, double blinded clinical trial. Participants were randomized and divided into two groups: TXA (54 cases) and control (50 cases). In the TXA group, a TXA solution was used for washing and soaking, whereas, in the control group, irrigation of wound was with normal saline. IBL, pre- and postoperative coagulative studies, operation time, conventional hemostatic agent usage, systemic complications, and length of hospitalization were consecutively recorded. All participants were followed for an additional two months to gather data on their recovery status and time to return to work (RTW). At baseline, there was no difference in clinical or lab findings, between the groups. IBL and use of hemostatic agents were significantly decreased in TXA group, as compared to the control group (p=0.001 and p=0.011, respectively). Systemic complications, length of hospitalization, and RTW were not significantly different between groups (p=0.47, p=0.38, and p=0.08, respectively). This study showed that topical use of TXA during surgery may decrease IBL and minimize the use of hemostatic materials during posterior midline-approach laminectomy and discectomy, without increasing the potential for complications seen with intravenous TXA usage.

P.735 Emotion recognition processing as a predictor of clinical response to SSRI treatment in first episode versus recurrent depression

Surgical scalpel broken is rarely reported in posterior lumbar discectomy or fusion surgeries, but when it happens and even the broken part is deeply located in the disk space, there is no guideline to remove it during the initial surgery.A 56-year-old female with L3-L4 and L4-L5 disk herniation and stenosis underwent 2-level transforaminal lumbar diskectomy and fusion. The knife blade was broken in the L4-L5 disk space during the annulus resection. Despite a 1.5-hour trial for removal with fluoroscopy, the broken part gradually migrated to the anterior border of the disk space. Eventually, arthroscopy was used for retrieval, the blade tip was clearly recognized in the arthroscopic view, which improved the accuracy of the subsequent operation. The blade fragment was removed successfully within 30 minutes.Arthroscopic retrieval of a broken scalpel deeply located in the intradiskal space is recommended as an alternative method when conventional effort is unable to remove it, especially when the broken blade migrates anteriorly, which may provoke catastrophic consequences.

Functional outcome of Destandau technique of endoscopic discectomy for symptomatic lumbar disc herniation

Functional outcome of Destandau technique of endoscopic discectomy for symptomatic lumbar disc herniation - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.044, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Percutaneous Endoscopic Transforaminal Discectomy versus Conventional Open Lumbar Discectomy for Upper Lumbar Disc Herniation: A Comparative Cohort Study

Background Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (Conclusions PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.

Impact of medical student involvement on outcomes following spine surgery: A single center analysis of 6485 patients

Medical student (MS) observation and assistance in the operating room (OR) is a critical component of medical education. Though participation in the operating room has many benefits to the medical student, the potential cost of these experiences to the patients must be taken into account. Other studies have shown differences in outcomes with resident involvement, but the effect of medical students in the OR has been poorly understood. The objective of this study was to understand how medical students and residents impacted surgical outcomes in posterior spinal fusions, anterior cervical discectomy and fusions (ACDFs), and lumbar discectomies. We conducted a retrospective study of patients undergoing posterior spinal fusions, ACDFs, and lumbar discectomies over 15 years. There were 6485 patients met the inclusion criteria of either undergoing a posterior fusion, ACDF or lumbar discectomy (1250 posterior fusion, 1381 ACDF, 3854 lumbar discectomies). Overall, little difference was observed when a medical student was present for surgical outcomes including length of stay, infection, and readmission. For ACDFs, having a medical student present had a significantly longer procedure durations (OR = 1.612, p = 0.001) than cases without. Besides slightly longer operative time (in posterior fusions), there were no major differences in outcomes when a medical student was present in the OR.

Wallis Interspinous Spacer for Treatment of Primary Lumbar Disc Herniation: Three-Year Results of a Randomized Controlled Trial

Limited data have been reported showing whether the second-generation Wallis interspinous spacer improves function after lumbar spine decompression or discectomy. We evaluated Wallis interspinous spacer placement in patients with low back pain or sciatica secondary to a confirmed diagnosis of primary lumbar disc herniation. The patients were treated from July 2008 to July 2011 at 1 institution. Of the 77 patients, 40 allocated to undergo posterior lumbar discectomy with Wallis implantation and 37 without Wallis implantation. The primary outcomes were the visual analog scale score, Japanese Orthopedics Association score, and Oswestry Disability Index. The secondary outcomes were the intervertebral disc height, range of motion of the operated segments, complications, and operating time. At 3 years, the improvements in the primary outcomes were not different between the 2 groups (P>0.05). The disc height was significantly greater in the Wallis group than in the control group (P < 0.001). Two patients in the Wallis group and three patients in the control group underwent further surgery to treat repeated prolapse of the index segment or an adjacent segment. No significant difference was found in the complication rate between the 2 groups (P > 0.05). We found that discectomy combined with Wallis implantation was not beneficial for pain relief or lumbar function improvement compared with lumbar discectomy alone. Although the Wallis implant was associated with maintenance of the intervertebral disc height and limited range of motion of the spine, it is probably incapable of preventing recurrent herniation or adjacent segment degeneration.

Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1-2 to L4-5 (range 2.7-3.8 mm and 2.9-4.5 mm for right and left side, respectively) and slightly decreased at L5-S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3-11.6 mm and 8.2-10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3-4 to L5-S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root-to-disc angle gradually decreased from L-3 to S-1 (range 105°-110.6° and 99°-108°). Disc heights gradually increased from L1-2 to L5-S1 (range 11.3-17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels. To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.

Surgical Mystery

Case report. We report the unusual case of a patient who was referred to our institution after she sustained an intraoperative injury to the common iliac vein during posterior lumbar discectomy at L5-S1 with a pituitary rongeur. There was only minimal bleeding with spontaneous hemostasis and no hemodynamic instability. Subsequently, the referring surgeon noted that the pituitary rongeur tip was missing. Vascular injury during lumbar discectomy is a rare, but potentially devastating complication. Rapid diagnosis and treatment is traditionally targeted toward hemodynamic stabilization and repair of compromised structures. Intraoperative fluoroscopy confirmed the presence of the tip anterior to the L3 vertebral body, indicating a possible intravascular migration of the foreign body. After completion of the surgical procedure, an abdominal computed tomography scan failed to confirm the metallic object within the abdominal cavity. Subsequent imaging studies demonstrated the presence of the rongeur tip in the left ventricle. Transthoracic echocardiogram and cardiac catheterization confirmed the presence of a patent foramen ovale and localized the rongeur tip within the papillary cords of the left ventricle, in close proximity of the mitral valve leaflets. After failure to retrieve the foreign object during cardiac catheterization, the patient underwent sternotomy, removal of foreign metallic object, and closure of patent foramen ovale. Close multidisciplinary collaboration allowed for proper diagnosis and the safe retrieval of the missing rongeur tip from the left ventricle.

Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations

Background The observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher rate of recurrent disc herniation and sciatica was observed in all 3 groups in comparison to patients with type I (fragment-fissure) disc hernia. Methods In total, 40 single-level lumbar disc herniation cases were treated with limited posterior lumbar microdiscectomy and posterior dynamic stabilization. The mean follow-up period was 32.75 months. Cases were selected after preoperative magnetic resonance imaging and intraoperative observation. We used the Carragee classification system in this study and excluded Carragee type I (fragment-fissure) disc herniations. Clinical results were evaluated with visual analog scale scores and Oswestry scores. Patients' reherniation rates and clinical results were evaluated and recorded at 3, 12, and 24 months postoperatively. Results The most common herniation type in our study was type III (fragment-contained), with 45% frequency. The frequency of fragment-defects was 25%, and the frequency of no fragment-contained defects was 30%. The perioperative complications observed were as follows: 1 patient had bladder retention that required catheterization, 1 patient had a superficial wound infection, and 1 patient had a malpositioned transpedicular screw. The malpositioned screw was corrected with a second operation, performed 1 month after the first. Recurrent disc herniation was not observed during the follow-up period. Conclusions We observed that performing discectomy with posterior dynamic stabilization decreased the risk of recurrent disc herniations in Carragee type II, III, and IV groups, which had increased reherniation and persistent/continuous sciatica after limited lumbar microdiscectomy. Moreover, after 2 years' follow-up, we obtained improved clinical results.

Neurophysiological Monitoring of S1 Root Function During Microsurgical Posterior Discectomy Using H-Reflex and Spinal Nerve Root Potentials

Tibial H-reflex and epidural recordings of the spinal nerve root potentials (SRP) of the S1 root were performed intermittently during microsurgical posterior discectomy. To obtain reversible conduction dysfunction of dynamically retracted spinal nerve root S1 in an on-line manner to control the surgical manipulation and prevent iatrogenic root injury. Excessive force and duration of nerve root retraction during posterior lumbar discectomy may result in additional nerve root injury and battered root syndrome. The S1 root was exposed by fenestration and the epidural electrodes were placed along the root above and below the compression site in 12 patients. H wave and SRP changes were recorded intermittently during discectomy and related to different manipulative phases of surgery. The desynchronisation index of SRP was computed off-line as a ratio between a/b, where a represents the positive deflection of the signal from the zero line and b represents peak-to-peak amplitude. The reflex muscle evoked potential from the soleus muscle (H wave), SRP1 (ascendant) and SRP2 (descendant volley) paralleled the surgical manipulation. The amplitude of the H wave significantly decreased and the desychronisation index of SRP1 (later evaluated in 8/12 patients) significantly increased after mobilization of the root with a dissector and in the late phase of intervertebral disc evacuation (P < 0.001), indicating conduction dysfunction related to surgical manipulation of the root. A good surgical outcome as shown by preserved Achilles tendon and H reflexes was related to the immediate return of H wave and SRP on stopping the harmful manipulation, and preservation of the H wave and SRP at the end of surgery.SRP monitoring brings up additional information concerning initial root injury and cumulative manipulative effects. The technique of dynamic nerve root retraction in posterior lumbar discectomy can therefore be made safer.

Iatrogenic Left Internal Iliac Artery Perforation During Lumbar Discectomy

Iatrogenic intra-abdominal vascular injury can result from lumbar discectomy via the posterior approach. Although it is well known and documented in the literature, few anesthesiologists have personal experience with this life-threatening incident. Here, we report a patient who sustained perforation of the left internal iliac artery at the L(4-5) level during posterior lumbar discectomy. The patient experienced refractory hypotension with tachycardia at the end of surgery, even with prompt fluid resuscitation and medical treatment. Abdominal distension and tenderness of the left lower abdominal quadrant were also noted. Emergency laparotomy was performed by the consulting vascular surgeon and revealed perforation of the left internal iliac artery. The vascular injury was successfully repaired. It is important that, as anesthesiologists, we must be aware of this potentially fatal complication. Prompt diagnosis and immediate laparotomy to control hemorrhage can result in favorable outcomes.

Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials

The authors undertook this meta-analysis to assess the efficacy and safety of nonsteroidal antiinflammatory drugs (NSAIDs) in addition to opioid analgesics on perioperative pain management in lumbar spine surgery. The authors searched MEDLINE, Excerpta Medica (EMBASE), The Cochrane Library, CINAHL, PsycINFO, Allied and Complementary Medicine (AMED), and Science Citation Index Expanded databases. In addition, they manually searched key journals and their references. They included randomized trials comparing the use of NSAIDs in addition to opioid analgesics versus opioid analgesics alone after posterior lumbar discectomy, laminectomy, or spinal fusion. Two independent reviewers performed an assessment of the quality of the methods. Seventeen studies comprising 400 patients who received NSAIDs in addition to opioid analgesics and 389 patients receiving opioid analgesics alone were included. Patients receiving NSAIDs in addition to opioid analgesics had lower pain scores and consumed fewer opioids than the group receiving opioid analgesics alone. There was no difference in the incidence of adverse effects. This meta-analysis provides evidence that the addition of NSAIDs to opioid analgesics in lumbar spine surgery provided better pain control than opioid analgesics alone.

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations.

The focus of this study was to examine the safety and effectiveness of three different discectomy techniques using a posterior approach for the treatment of herniated lumbar discs. There are only a small number of prospective randomised studies comparing posterior lumbar discectomy techniques, and no recent systematic review has been published on this matter. Using the Cochrane Collaboration guidelines, all randomised or "quasi-randomised" clinical trials, comparing classic, microsurgical, and endoscopic lumbar discectomies using a posterior approach were systematically reviewed. No statistically significant differences were found between these techniques regarding improvement in pain, sensory deficits, motor strength, reflexes, and patient satisfaction. Current data suggest that the microsurgical and endoscopic techniques are superior to the classic technique for the treatment of single level lumbar disc herniations with respect to volume of blood loss, systemic repercussions, and duration of hospital stay. All three surgical techniques were found to be effective for the treatment of single level lumbar disc herniations in patients without degenerative vertebral deformities. No conclusions could be drawn from the clinical randomised studies reviewed regarding the safety of the three techniques studied due to insufficient data on postoperative complications.

Effect of Parecoxib on Postoperative Pain After Lumbar Spine Surgery

A bicenter randomized, patients, healthcare providers, and data collectors blind placebo-controlled trial in multimodal analgesia for postoperative lumbar spine surgery was conducted. To assess the efficacy and safety of parecoxib on postoperative pain management after posterior lumbar spine surgery. Systematic reviews suggest that cyclo-oxygenase-2 inhibitors are an effective treatment for acute postoperative pain. However, previous trials on lumbar spine surgery showed equivocal efficacy of cyclo-oxygenase-2 inhibitors for postoperative pain relief. In this study, 120 patients undergoing posterior lumbar discectomy, spinal decompression, or spinal fusion were stratified based on the surgical procedure to 3 groups (n = 40) and randomly allocated to receive multidoses of parecoxib 40 mg/dose or placebo. Efficacy was assessed by total morphine used from patient-controlled analgesic pump, pain intensity, pain relief, and the patient's subjective rating of the medication. Parecoxib 40 mg reduced the total amount of morphine required over 48 hours by 39% relative morphine reduction compared with placebo (P = 0.0001). Pain at rest was reduced by 30% (P = 0.0001). Ninety percent of patients given parecoxib experienced at least 50% maximum total pain relief compared with 58% treated with placebo. The number-needed-to-treat for 1 patient to have at least half pain relief was 3.1 (2.0-4.6). Patients' subjective rating of the medication was described as "excellent, good, and fair" by 48%, 43%, and 8% in the parecoxib group, respectively, compared with 21%, 50%, and 28% of placebo patients (P = 0.004). Overall adverse effects of patients receiving parecoxib and morphine were comparable to those receiving morphine alone. The present study demonstrates that the perioperative administration of parecoxib with patient-controlled analgesic morphine after lumber spine surgery resulted in significantly improved postoperative analgesic management as defined by reduction in opioid requirement, lower pain scores, and higher patients' subjective rating of the medication.

Peridural Methylprednisolone and Wound Infiltration With Bupivacaine for Postoperative Pain Control After Posterior Lumbar Spine Surgery

A randomized, double-blind placebo controlled trial in multimodal analgesia for postoperative pain was conducted. To examine whether combination of corticosteroid and bupivacaine administered in patients undergoing posterior lumbosacral spine surgery reduces postoperative morphine consumption, back and leg pain relief, and improves functional disability and general health status. Patients with lumbar spine surgery had moderate to severe postoperative pain. Administration of corticosteroid or injection of local anesthetic agent has been additive treatment methods for opioid drugs. There is uncertainty as to whether corticosteroid and bupivacaine combination improves outcomes in lumbosacral spine surgery. A total of 103 patients who were scheduled to undergo elective posterior lumbar discectomy, decompressive laminectomy with or without instrumented fusion for degenerative spinal diseases, received either methylprednisolone locally applied to the affected nerve roots (and bupivacaine was infiltrated into the wound) or injected placebo. Morphine consumption and pain scores were recorded at 1, 2, 3, 6, 12, 24, and 48 hours after surgery. Oswestry Index and Short Form SF-36 scores were recorded before surgery and at 1 and 3 months later. Demographic data between the 2 groups were comparable. The cumulative morphine dose and postoperative pain was significantly lower in the study group than in the placebo group (P = 0.01 and P = 0.001, respectively). When performing subgroup analyses, the beneficial effects were found in all groups of surgery but could not demonstrated statistically significant difference for all subgroup comparisons. There was no significant difference between the 2 groups with regard to pain on cough, Oswestry Index, and SF-36 scores. No complications were associated with the perioperative use of methylprednisolone or bupivacaine. Administration of methylprednisolone-bupivacaine provided a favorable effect immediately after posterior lumbosacral spine surgery for discectomy, decompression, and/or spinal fusion without complication.