Single-level Discectomy Research Articles

To study functional outcome of single level discectomy by fenestration method in lumber disc prolapse- A prospective study

: Low backache pain affects every population and is one of the most common clinical symptoms encountered in medical practice. Approximately 70 - 80% of people have experienced low back pain at some point of time in life. The annual prevalence of low back pain ranges from 15-45%. The major cause of low back pain leading to severe morbidity throughout the world that affects mainly the young working-class population is lumbar disc prolapsed. Various retrospective and some prospective reviews of fenestration disc surgeries orthopaedicvary greatly, with good results ranging from 46-97% and a reoperation rate of 09%. The present study was conducted to evaluate the results of single-level discectomy by fenestration method in Lumbar disc prolapse. Total thirty cases of lumber disc prolapsed treated with fenestration and discectomy satisfying inclusion and exclusion criteria treated in the Facility based tertiary care centre department of Orthopedics of Dr. S. N. Medical College and associated group of hospital, Jodhpur were studied.In our study,Out of 30 patients majority of 25 (83.3%) patients showed good outcomes, followed by 04 (13.33%) patients had fair outcomes, and 01(3.33%) patient had poor outcomes. Total complications are 4 (13.33%), and the most common complication is superficial wound infection 2 (6.67%). By considering all aspects, fenestration, and discectomy is a better technique with the advantage of less tissue injury, good spinal function, smooth patient recovery, improved working status with early rehabilitation and maintained clinical efficacy

Outcome of back pain and radiculopathy in patients with single level lumbar discectomy

Background: Surgery for lumbar disc herniation is one of the most commonly performed procedures in spine surgery. Questions remain if lumbar discectomy is the optimal treatment for patients with lumbar disc herniation who exhibit a substantial amount of preoperative back pain.
 Objective: To evaluate the outcome of improvement of back pain and radiculopathy between male and female patients with single-level discectomy and in relation to different indications for the surgery. 
 Patients and Methods: In this retrospective follow-up study, 80 patients (40males and 40 females) with symptoms of radiculopathy and back pain who underwent single-level open discectomy (small incision of 2-3 cm) were followed-up by discharge from the hospital between 2017 and 2019 in Erbil, Iraqi Kurdistan. The patients were included after having the symptoms of radiculopathy as confirmed on magnetic resonance imaging. In addition, patients who had undergone discectomy due to radiculopathy without response after 6 weeks of conservative treatment were included in this investigation.
 Results: The mean age of the patients was 45.1 (19-70 years old). The study showed that the level of back pain and radicular pain was significantly decreased from the initial step to 3, 6, and 12 months. The levels of back and radicular were not changed significantly from three to six months. The study showed that the prevalence of different levels of back and radicular pain was similar between male and female patients at different periods. The study did not find a significant difference in levels of back and radicular pains among patients with different indications in male and male patients.
 Conclusion: This study showed that single-level lumbar discectomy improved back and radicular pain by 12 months postoperatively in males and females, regardless of the indication for surgery.

Canadian Spine Society

# Abstract 57. Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments? {#article-title-2} Cobb angle measurement is the standard method for quantification of scoliosis in adolescent idiopathic scoliosis (AIS),

Getting it right first time: national survey of surgical site infection 2019.

Surgical site infections (SSIs) are associated with increased morbidity and mortality. Deep SSI, or prosthetic joint infection (PJI), is associated with revision surgery involving longer operative times with higher infection rates, longer length of stay (LoS) and high costs in addition to the catastrophic effect on the patient. The surveillance of SSI is important for patient decision making, identification of outliers for support and maximising focussed improvement. This paper reports the findings of the second Getting it Right First Time (GIRFT) national SSI survey for orthopaedic and spinal surgery. Data were submitted prospectively by 67 orthopaedic units and 22 spinal units between 1 May 2019 and 31 October 2019. For a patient to be included, they had to present with SSI within the study period and within 1 year of the index procedure. A total of 309 SSIs were reported from primary and revision, total hip, knee, shoulder, elbow and ankle replacements, and 58 SSIs were reported from lumbar spine single level discectomy or decompression, lumbar spine single-level instrumented posterior fusion, posterior cervical spine decompression and instrumented fusion and posterior correction of adolescent idiopathic scoliosis. SSIs rates have remained low compared with the 2017 survey. There were variations in SSI rates by procedure, with primary shoulder replacement reporting the lowest (0.4%) and revision shoulder replacement the highest (2.5%) rates. The authors recommend that the elective surgical restart following the COVID-19 pandemic provides a unique opportunity for all units to implement a full SSI prevention bundle to minimise the risk of infection and improve patient outcomes.

Comparative Study of the Outcomes of Unilateral Biportal Endoscopic Discectomy and Tubular Microdiscectomy Based on the Visual Analogue Scale, Oswestry Disability Index, and Short-form 36

Objective: Unilateral biportal endoscopic (UBE) discectomy and tubular microdiscectomy (TMD) are widely practiced methods for treatment of lumbar disc herniation. Good clinical outcomes of these methods are reported in many papers, but there are a few comparative studies. This study reports the clinical outcomes of UBE and TMD as minimally invasive surgery methods for lumbar disc herniations and discusses the effectiveness of UBE.Methods: Sixty-seven patients who had undergone single-level discectomy using one of two methods, UBE or TMD, underwent a prospective follow-up examination. Thirty-four of these patients underwent discectomy using UBE, and the remaining 33 patients underwent TMD. In addition to the traditional measures of outcome, the improvement of generic health-related quality of life and disease-specific measurements like Visual Analogue Scale (VAS) score, Short-form 36 (SF-36), and Oswestry Disability Index (ODI) were evaluated and compared.Results: Sixty-seven patients with more than 6 months of post-operative follow-up evaluations were included. The mean improvements in the VAS scores for back pain and leg pain and ODI were 2.0, 3.7, and 26.5 for the UBE group and 1.6, 3.0, and 19.4 for the TMD group. The SF-36 physical health component subscale score improved from 35.4 pre-operatively to 54.8 at the last follow-up in the UBE group, and the mental health score improved from 43.5 to 55.1 (TMD group: from 34.9 to 54.3 and 44.2 to 57.1, respectively). Conclusion: The clinical outcomes of the UBE group are comparable to those of the TMD group. The results indicate that UBE for lumbar disc herniation can be performed safely and effectively as a treatment modality.

Effectiveness of Lumbosacral Orthosis After Discectomy for Lumbar Disk Herniation: A Prospective Comparative Study.

A prospective comparative study. To investigate the benefits of postoperative application of lumbosacral orthosis after single-level discectomy for lumbar disk herniation (LDH). Although many surgeons use postoperative lumbosacral orthosis for patients with LDH, there is no clear evidence to support or deny its effectiveness. Ninety-nine consecutive patients who underwent the microscopic discectomy were included. They were divided into two groups: orthosis group and nonorthosis group, before surgery. The recurrence rate and reoperation rate were compared between the two groups at four-week, six-month, and one-year follow-up. Japanese Orthopaedic Association Score for lumbar spine (L-JOA score) at two-week and one-year follow-up, lower extremities and low back pain's visual analog scale (VAS) and Oswestry Disability Index (ODI) at six-month and one-year follow-up were compared. Forty-two patients in the orthosis group and 39 patients in the nonorthosis group were followed up for at least one-year after surgery. Recurrence occurred in three patients (7.1%) in the orthosis group and six (15.4%) in the nonorthosis group within one-year. Two patients (4.8%) in the orthosis group and two patients (5.1%) in the nonorthosis group underwent reoperation. There were no significant intergroup differences in the recurrence rate and in the reoperation rate. No significant difference was also observed between the two groups in L-JOA score, ODI, VAS of low back pain, and leg pain at one-year after surgery. Furthermore, at any other follow-up period, no significant differences were observed between the two groups in recurrence rate, reoperation rate, L-JOA score, VAS of low back/leg pain, or ODI. The use of a postoperative orthosis did not reduce recurrence or reoperation rates, nor did it improve postoperative clinical symptoms. The routine use of an orthosis may not be necessary after single-level lumbar discectomy.

Outcome of back pain and radiculopathy in patients with single level lumbar discectomy

Background: Surgery for lumbar disc herniation is one of the most commonly performed procedures in spine surgery. Questions remain if lumbar discectomy is the optimal treatment for patients with lumbar disc herniation who exhibit a substantial amount of preoperative back pain. Objective: To evaluate the outcome of improvement of back pain and radiculopathy between male and female patients with single-level discectomy and in relation to different indications for the surgery. Patients and Methods: In this retrospective follow-up study, 80 patients (40males and 40 females) with symptoms of radiculopathy and back pain who underwent single-level open discectomy (small incision of 2-3 cm) were followed-up by discharge from the hospital between 2017 and 2019 in Erbil, Iraqi Kurdistan. The patients were included after having the symptoms of radiculopathy as confirmed on magnetic resonance imaging. In addition, patients who had undergone discectomy due to radiculopathy without response after 6 weeks of conservative treatment were included in this investigation. Results: The mean age of the patients was 45.1 (19-70 years old). The study showed that the level of back pain and radicular pain was significantly decreased from the initial step to 3, 6, and 12 months. The levels of back and radicular were not changed significantly from three to six months. The study showed that the prevalence of different levels of back and radicular pain was similar between male and female patients at different periods. The study did not find a significant difference in levels of back and radicular pains among patients with different indications in male and male patients. Conclusion: This study showed that single-level lumbar discectomy improved back and radicular pain by 12 months postoperatively in males and females, regardless of the indication for surgery.

Relationship between fatty infiltration of paraspinal muscles and clinical outcome after lumbar discectomy

IntroductionCross sectional area (CSA) and fat infiltration (FI) are important parameters to assess paravertebral muscle atrophy. However, the relationship of muscular fat infiltration in patients with symptomatic lumbar disc herniation undergoing surgery remains unclear. Research questionDoes lumbar paravertebral muscle atrophy have prognostic value regarding the clinical outcome for patients with symptomatic lumbar disc herniation undergoing surgery? MethodsPatients over 18 years of age with lumbar disc herniation and radicular pain who underwent single-level discectomy were included. Multifidus, erector spinae and psoas cross-sectional area (CSA) and fatty infiltration (FI) were measured by ImageJ software at the levels of L3-L4, L4-L5 and L5-S1 from T2-weighted Magnetic Resonance axial images. Clinical status was assessed preoperatively and one-year after surgery with patient reported outcome measurements (PROMS), that included Numeric Rating Score for back and leg pain, Core Outcome Measurement Index (COMI), Oswestry Disability Index and EuroQoL-5D. Univariate and multiple linear regressions were performed. ResultsErector spinae FI was the only muscle-related factor that correlated to postoperative PROMS. Postoperative COMI was higher in patients with FI>30% (median: 4.4, IQR: 3.2) and lower when FI<15% (median: 1.2, IQR: 1.6) (Kruskal-Wallis, p ​< ​0.001). Male gender was associated with better outcome as well as erector spinae FI<15%, while FI >30% was related to worse postoperative status. ConclusionsIn the current study, increased fat infiltration of erector spinae muscles correlated to less favorable clinical outcomes following lumbar discectomies.

CT Osteoabsorptiometry Assessment of Subchondral Bone Density Predicts Intervertebral Implant Subsidence in a Human ACDF Cadaver Model.

Cadaveric biomechanics study. Subchondral bone mineral density (sBMD) reflects the long-term mineralization and distribution of stress on joints. The use of 3-dimensional (3-D) methods to evaluate sBMD, including computed tomography osteoabsorptiometry (CT-OAM), enables the assessment of density distribution with emphasis on subchondral bone. This study sought to measure the sBMD of cervical endplates using CT-OAM and correlate it to mechanical implant subsidence in a cadaveric model. Fourteen fresh human cadaveric cervical spines were subjected to dynamic testing after single level discectomy and instrumentation using a PEEK interbody spacer. Specimens were imaged with CT 3 times: 1st) whole intact cervical spine, 2nd) after implantation, and 3 rd) after testing. These images were used to assess sBMD distributions using CT-OAM directly underneath the spacer. Subsidence was defined as the displacement of the device into the endplates. The observed "failure mode" was consistently recorded as subsidence, with a mean of 0.45 ± 0.36 mm and 0.40 ± 0.18 mm for the C4-5 and C6-7 levels, respectively. There were no differences by level. The experimental cyclic test showed that denser endplates experienced less deformation under the same load. This study achieved its stated aim of validating the use of CT-OAM as a method to analyze the sBMD of the cervical endplates. Studies such as this are providing new information on available technology such as CT-OAM, providing new tools for clinicians treating spinal conditions in need of augmentation and stabilization via interbody devices.

Symposium 3: Motor neuron disease SY3.1. Monomelic amyotrophy – Experience from a large cohort

In 1959, Hirayama described the clinical entity of progressive atrophy of distal muscles of a single upper limb and called it Hirayama disease (HD). Later on Gourie-Devi from India coined the term Monomelic Amyotrophy. The other phenotypes described by us are: Distal Bimelic, Proximo-distal bimelic and unilateral/bilateral proximal amyotrophy. Illness has sporadic occurrence with male preponderance, but familial forms are also reported. Most cases are described from Asian countries. There is insidious onset and slowly progressive weakness and atrophy of intrinsic hand and forearm muscles, with oblique atrophy with sparing of Brachioradialis and reverse split hand syndrome. Typically, they have cold paresis. In the year 2000, HD was confirmed to occur secondary to dynamic compression of the lower Cervical Cord due to forward displacement of the tight cervical dural sac causing arterial/venous ischemic damage to anterior horn cells. Classically MRI at cervical level shows “eye of the snake” appearance, reverse lordosis, dural detachment with forward displacement and epidural venous congestion and enhancement. From our experience on 480 cases seen over 38 years, the mean age at onset is 19.5 years; range,15–25 years, with majority being in the progressive phase. Progression generally occurs over 5 years but even rapidly and slower in certain cases, and the disability is moderate to severe in the majority. Rarely patients experienced Lhermitte’s phenomenon and had spasticity of the lower limbs with sphincter disturbance. Over the last 4.5 years, 101 cases with HD have undergone anterior cervical decompressive surgery at our center. Predominantly C5-C6 single level discectomy and fusion was performed. Pre-operative and serial post-operative assessment included, Fugl Meyer and Jebsen Taylor hand function tests which demonstrated significant improvement in functions in the majority at 3,6,12 and 24 months follow-up. In the remaining patients the illness has stabilized. No major complications were encountered except for post-operative neck pain and restricted movements which improved in a few weeks. To conclude Hirayama disease is now confirmed to be a cervical compressive myelopathy due to dynamic neck flexion induced ischemic damage and surgery has a major role in stabilizing / improving the neurological deficits. The most appropriate term for this disease would be “CERVICAL FLEXION INDUCED MYELOPATHY”.

A comparison of the perioperative outcomes of anterior surgical techniques for the treatment of multilevel degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Multilevel ventral compressive pathology is routinely managed through anterior decompression and reconstruction, but there remains uncertainty regarding the relative safety and efficacy of multiple discectomies, multiple corpectomies, or hybrid corpectomy-discectomy. To that end, using a large national administrative healthcare data set, the authors sought to compare the perioperative outcomes of anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and hybrid corpectomy-discectomy for multilevel DCM. Patients with a primary diagnosis of DCM who underwent an elective anterior cervical decompression and reconstruction operation over 3 cervical spinal segments were identified from the 2012-2017 National Surgical Quality Improvement Program database. Patients were separated into those undergoing 3-level discectomy, 2-level corpectomy, or a hybrid procedure (single-level corpectomy plus additional single-level discectomy). Outcomes included 30-day mortality, major complication, reoperation, and readmission, as well as operative duration, length of stay (LOS), and routine discharge home. Outcomes were compared between treatment groups by multivariable regression, adjusting for age and comorbidities (modified Frailty Index). Effect sizes were reported by adjusted odds ratio (aOR) or mean difference (aMD) and associated 95% confidence interval. The study cohort consisted of 1298 patients; of these, 713 underwent 3-level ACDF, 314 2-level ACCF, and 271 hybrid corpectomy-discectomy. There was no difference in 30-day mortality, reoperation, or readmission among the 3 procedures. However, on both univariate and adjusted analyses, compared to 3-level ACDF, 2-level ACCF was associated with significantly greater risk of major complication (aOR 2.82, p = 0.005), longer hospital LOS (aMD 0.8 days, p = 0.002), and less frequent discharge home (aOR 0.59, p = 0.046). In contrast, hybrid corpectomy-discectomy had comparable outcomes to 3-level ACDF but was associated with significantly shorter operative duration (aMD -16.9 minutes, p = 0.002). The authors found multiple discectomies and hybrid corpectomy-discectomy to have a comparable safety profile in treating multilevel DCM. In contrast, multiple corpectomies were associated with a higher complication rate, longer hospital LOS, and lower likelihood of being discharged directly home from the hospital, and may therefore be a higher-risk operation.

94. Cost analysis of primary single-level lumbar discectomies

BACKGROUND CONTEXT Improving value in surgical care requires a detailed understanding of the true costs of surgical and operating room resources. PURPOSE In this study, we sought to identify predictors of health care costs and operating room resource use for patients undergoing initial single-level discectomies using a unique institutional cost dataset from the value driven outcomes (VDO) program developed by the University of Utah. STUDY DESIGN/SETTING A retrospective cost analysis of primary single-level lumbar discectomies. PATIENT SAMPLE A total of 622 patients undergoing initial single-level lumbar discectomy between January 2014 to April 2016 at the University of Utah Orthopaedic Center. OUTCOME MEASURES Health care costs, clinical length of stay, and operating room time. METHODS Univariate and multivariate generalized linear models (GLM) performed to identify predictors of health care costs, clinical length of stay (LOS, days) and operating room time (OR, minutes) using a unique costing tool. Modified park test procedure was implemented to determine GLM error distribution specifications and standard errors were clustered by provider. Cost outcomes were normalized using mean costs for a patient with normal body mass index (BMI) and a healthy American Society of Anesthesiologists (ASA) classification system. Average marginal effects in multivariate analysis were reported as percentage of normalized costs. RESULTS Advanced age, male gender, Hispanic, Black, unemployment, and being retired were significant positive predictors of costs in univariate analysis. Asian, Native American, outpatient procedures, and being a student were significant negative predictors of costs. Univariate analysis also showed that obesity, higher ASA class and insurance status were also positive and significant predictors of costs. In multivariate analysis, we found that obesity led to higher average marginal total direct (9%), total facility (15%), and facility OR costs (22%), as well as an average marginal effect of 24 more OR minutes per surgery. Conversely, being underweight was associated with lower average marginal total direct (-23%), total non-facility (-54%), total facility (-8%), facility OR costs (-15%), as well as lower clinical LOS (-.42 days), and 18 less OR minutes. While being overweight was not significantly associated with greater total direct costs, it was associated with higher total facility (8%), and facility OR costs (12%), with an average marginal effect of 11 more OR minutes per surgery. Age was associated with a longer LOS but not with OR costs in multivariate analysis. As expected, outpatient surgical costs, LOS and OR time were significantly lower than inpatient procedures. Patients with incapacitating disease ASA Class had the highest predicted OR time in GLM estimates with an average marginal effect of 28 minutes, while severe systematic disease was associated with greater total and nonfacility costs. In addition, Medicare patients had higher facility costs (14%) compared to privately insured patients. CONCLUSIONS Although many of our observed variables were significant predictors of costs in univariate analysis, multivariate GLM estimates showed that the main variables determining cost and operating room time and resource use were obesity (BMI), general health (ASA class), Medicare status and advanced age, and whether the surgery was an outpatient or inpatient procedure. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

185. Reoperation rates after single-level lumbar discectomy in the military health system

BACKGROUND CONTEXT Despite advances in surgical techniques, rates of recurrent lumbar disc herniation (LDH) range from 5-24%, representing the most common cause of surgical failure and subsequent reoperation. PURPOSE Our goal was to determine the reoperation rate, time to reoperation and type of revision procedures performed after single-level discectomy for LDH within the military health system. STUDY DESIGN/SETTING Restrospective. PATIENT SAMPLE Military health system. METHODS Using CPT codes to capture lumbar microdiscectomy procedures, 3,999 patients undergoing primary single-level microdiscectomy for lumbar disc herniation were identified between October 2012 and November 2017. Demographic data, as well as number and type of revision surgical intervention were investigated. Rates of subsequent procedures involving instrumented fusion and complications were recorded. RESULTS We identified 415 patients (10.3%) who required a revision surgery for a same-level reherniation. Of these patients requiring revision surgery at the same level of the index procedure, 9.3% required more than one revision surgery. The majority of first-time revision procedures consisted of revision microdiscectomy (290/415, 69.9%); however, 125 patients (30.1%) underwent single- or multi-level fusion for definitive treatment at time of first revision. Of the 40 patients requiring more than one revision, 21 (52.5%) eventually required a fusion procedure, which was significantly higher than patients having only one revision (p= CONCLUSIONS In our retrospective study of 3,999 patients undergoing single-level microdiscectomy for lumbar disc herniation, we identified 415 patients (10.4%) undergoing subsequent reoperation for a recurrent LDH at the same level. Within this group, 9.6% would require two or more reoperations, and 52.5% of these patients would ultimately undergo a lumbar arthrodesis at the same level as the initial disc herniation. Our findings characterize the lumbar disc reherniation population in the military, with major implications for the prognosis and treatment strategy of these commonly-treated injuries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The Presence of Thyroid Cartilage at the Surgical Level Reduces Early Dysphagia after Single-Level Anterior Cervical Surgery: A Retrospective Study

Background: Early dysphagia is a frequent complication of anterior cervical (AC) spine surgery. However, there are no reports that have discussed the correlation between early dysphagia and the positional relationship between thyroid cartilage and the surgical level.Methods: We retrospectively enrolled 82 patients in our hospital who underwent single-level AC discectomy performed by the same surgeon using the same internal fixation apparatus from 2015 to 2017. Swallowing difficulty was rated during the first five postoperative days using a 10-point scoring system. The positional relationship between the thyroid cartilage and the surgical level was defined as discectomy within the thyroid cartilage (IN group) or outside the thyroid cartilage (OUT group) using preoperative computed tomography (CT) images. The confounding factors such as gender, age, body mass index (BMI), hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, and blood loss were analyzed by a binomial logistic regression.Results: The thyroid cartilage was most commonly located above the C5 level (65.1%). Early dysphagia developed in 47.6% of the patients during the first five postoperative days. The IN and OUT groups each contained 41 cases. The difference in the cumulative postoperative early dysphagia score between the IN and OUT groups was statistically significant (p < .05). The factors of gender, age, BMI, hypertension, diabetes mellitus, drinking, smoking, operative level, operative time, blood loss did not significantly influence the incidence of postoperative early dysphagia.Conclusions: We found that early dysphagia, which is a self-limiting complication, was correlated with surgery performed at levels outside the thyroid cartilage region. Preoperative review of the positional relationship between the thyroid cartilage and the surgical level can predict the incidence of postoperative transient dysphagia.

The n-HA/PA66 Cage Versus the PEEK Cage in Anterior Cervical Fusion with Single-Level Discectomy During 7 Years of Follow-Up

The nano-hydroxyapatite/polyamide66 (n-HA/PA66) cage is a novel biomimetic nonmetal cage, whereas the polyetheretherketone (PEEK) cage has been widely used for decades with excellent clinical outcomes. However, there has been no long-term comparison of these 2 cages in anterior cervical reconstruction. This retrospective study included 98 patients who underwent single-level anterior cervical decompression and fusion (ACDF) from January 2009 to June 2011 with at least 7 years of follow-up; the PEEK cage was used in 51 patients (PEEK group), whereas the n-HA/PA66 cage was used in 47 (n-HA/PA66 group). The groups were compared regarding radiographic (cage subsidence, fusion status, cervical lordosis, and segmental sagittal alignment) and clinical (10-point visual analog scale and Japanese Orthopedic Association scores) parameters preoperatively, postoperatively, and at the final follow-up. The n-HA/PA66 and PEEK cages had similar fusion rates at the final follow-up (97.9% vs. 98.0%). The respective cage subsidence rates in the PEEK and n-HA/PA66 cage groups were 9.8% and 10.6%. There were no significant differences between the 2 groups in mean cervical lordosis, mean interbody height, segmental sagittal alignment, cervical lordosis, and 10-point visual analog scale and Japanese Orthopedic Association scores at the final follow-up. The n-HA/PA66 cages resulted in high fusion and low subsidence rates during long-term follow-up. After single-level ACDF, the n-HA/PA66 cage showed similar radiographic fusion, subsidence rate, and clinical results compared with the PEEK cage during 7years of follow-up. These results suggest that the n-HA/PA66 cage could be comparable with the PEEK cage for ACDF.

Incidence of Respiratory Complications Following Lumbar Spine Surgery.

The purpose of this study is to assess the incidence, risk factors for, and types of respiratory complications occurring in patients undergoing lumbar spine surgery. Patients undergoing various lumbar spine surgeries from 2007 to 2014 were identified using the PearlDiver patient record database from the nationwide insurance provider Humana Inc. Patient records were analyzed using International Classification of Diseases, Ninth Revision codes and Current Procedural Terminology codes to determine the incidence of pneumonia, pleural effusion, pulmonary collapse, and acute respiratory failure for each procedure type. The incidence of these complications in patients with the risk factors diabetes mellitus, chronic obstructive pulmonary disease (COPD), and smoking was also examined. A total of 64,891 patients (33,280 females; 31,611 males) within the Humana database underwent various lumbar procedures from 2007 to 2014. The overall incidence of respiratory complications in patients undergoing lumbar procedures was 5.7% (n = 3694) within 1 month of having the procedure. Pulmonary collapse was the most common complication with an incidence of 4.3% (n = 2792), followed by pneumonia 1.98% (n = 1285), acute respiratory failure 1.97% (n = 1279), and pleural effusion 1.6% (n = 1048). For each respiratory complication studied, single level discectomy had the lowest complication rate and multilevel anterior lumbar interbody fusion had the highest complication rate. The incidence of each individual respiratory complication was higher in patients who had a history of smoking, COPD, or diabetes mellitus than it was in patients with none of these 3 risk factors (P < .01). The results of this study show that patients who have a history of smoking, COPD, or diabetes mellitus are at a greater risk for respiratory complications following lumbar spine surgery. These findings are useful for patient selection, clinical decision-making, and preoperative counseling.

A comparative study of adjacent segment degeneration following discectomy and instrumented fusion in lumbar Spine

Adjacent segment degeneration following lumbar spine fusion and lumbar discectomy remains a widely known problem, but due to insufficient knowledge regarding the factors that contribute to its occurrence it is difficult to diagnose considering the fact that it has variable presentation in terms of the symptoms it produces, the time frame for its occurance and radiological changes. Our study shows that both in single level discectomy and post instrumented fusion and is marginally more in post single level discectomy without fusion. In both groups cephalic segment is more affected as compared to the caudad segment. There is a significant relationship between radiological degeneration and the clinical adjacent segment degeneration. It has been seen that there is a significant relation between degeneration and chronic smokers both radiologically and clinically. Since there is only marginally difference, we hold on to our hypothesis that the role of natural degeneration is more compared to the role of instrumented fusion causing adjacent segment degeneration. Thus we have to rule out natural and post surgical causes of adjacent segment degeneration leading to different clinical complaints of the patient and manage it accordingly.

Advantages of a Microsurgical Translaminar Approach (Keyhole Laminotomy) for Upper Lumbar Disc Herniation

To prevent risk of iatrogenic instability after surgery for upper lumbar disc herniation, we adapted a microsurgical translaminar approach (keyhole laminotomy), which allows less destructive laminotomy. We compared results of translaminar and interlaminar approaches. The study enrolled 48 patients who underwent single-level discectomy in the upper lumbar spine (L1-2 or L2-3). Patients were allocated to 2 groups: a translaminar group (n= 20) or an interlaminar group (n= 28). Mean patient age was 57.04 ± 12.77 years, and median follow-up duration was 3.5 years (range, 1.0-7.0 years). Clinical and radiologic data were retrospectively reviewed. Baseline characteristics, including age, sex, surgical level, and preoperative symptoms, were nonsignificantly different. At 1 year after surgery, improvement in leg pain as determined by visual analog scale was nonsignificantly different. Improvement in visual analog scale for back pain was significantly greater in the translaminar group compared with interlaminar group (mean 4.00 ± 1.56 vs. 2.45 ± 2.01, P < 0.001). Surgical outcome was not different between groups. Mean decrease in disc height at operated level was not significantly different between groups. Mean increase in segmental range of motion at surgical levels was significantly greater in the interlaminar group (-3.38 ± 4.03° vs. 1.10 ± 3.03°, P= 0.010), and mean recovery of total lumbar lordosis was significantly greater in the translaminar group (9.80 ± 5.96° vs. 0.43 ± 8.45°, P= 0.021). The translaminar approach provides a safe and effective alternative to the classic interlaminar approach for upper lumbar disc herniation.

Back pain improves significantly following discectomy for lumbar disc herniation

Background ContextAlthough lumbar disc herniation (LDH) classically presents with lower extremity radiculopathy, there are patients who have substantial associated back pain. PurposeThe present study aims to determine if patients with LDH with substantial back pain improve with decompression alone. Study DesignThis is a longitudinal observational cohort study. Patient SamplePatients enrolled in the Quality and Outcomes Database with LDH and a baseline back pain score of ≥5 of 10 who underwent single- or two-level lumbar discectomy only. Outcome MeasuresBack and leg pain scores (0–10), Oswestry Disability Index (ODI), and EuroQoL 5D were measured. MethodsStandard demographic and surgical variables were collected, as well as patient-reported outcomes at baseline and at 3 and 12 months postoperatively. ResultsThe mean age of the cohort was 49.8 years and 1,195 (52.8%) were male. Mean body mass index was 30.1 kg/m2. About half of the patients (1,103, 48.8%) underwent single-level discectomy and the other half (1,159, 51.2%) had two-level discectomy. Average blood loss was 44 cc. Most of the patients (2,217, 98%) were discharged home with routine postoperative care. The average length of stay was 0.53 days. At 3 and 12 months postoperatively, there were statistically significant (p<.000) improvements in back pain (from 7.7 to 2.9 to 3.2), leg pain (from 7.5 to 2.3 to 2.5), and ODI (from 26.2 to 11.6 to 11.2). Patients with a single-level discectomy, compared with patients with a two-level discectomy, had similar improvements in 3- and 12-month back pain, leg pain, and ODI scores. ConclusionsPatients with LDH who have substantial back pain can be counseled to expect improvement in their back pain scores 12 months after a discectomy.

Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis

BackgroundThe unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. A new endoscopic technique that uses a UBE approach has been applied to conventional arthroscopic systems for the treatment of spinal disease. In this study, we aimed to compare and evaluate the perioperative parameters and clinical outcomes, including recovery from surgery, pain and life quality modification, patient’s satisfaction, and complications, between UBE and open lumbar microdiscectomy (OLM) for single-level discectomy procedures.MethodsThis study included 141 patients with degenerative disc disease requiring discectomy at a single level from L2–L3 to L5–S1. A total of 60 and 81 patients underwent UBE and OLM, respectively. Analysis was based on comparison of perioperative metrics, operation time (OT); estimated blood loss (EBL); length of hospital stay (HS); clinical outcomes, including assessment using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI); patient satisfaction (the MacNab score); and the incidence of reoperation and complications.ResultsThe study cohort was 56.7% women, and the mean patient age was 50.98 ± 18.23 years. The mean VAS (the back and leg), MacNab score, and ODI improved significantly from the preoperative period to the last follow-up (12.92 ± 3.92) in both groups (p < 0.001). One week after operation, the back VAS score in the UBE group showed significantly more improvement than that in the OLM group. However, the 1-week, 3-month, and 12-month VAS (the back and leg), ODI improvement, modified MacNab score, and OT were not significantly different between the two groups. In the UBE group, EBL (34.67 ± 16.92) was smaller and HS (2.77 ± 1.2) was shorter than that of the OLM group (140.05 ± 57.8, 6.37 ± 1.39). However, OT (70.15 ± 22.0) was longer in the UBE group than in the OLM group (60.38 ± 15.5), and the difference was statistically significant. Meanwhile, the differences in the rate of surgical conversion and complications between the two groups were not statistically significant.ConclusionsThe UBE for single-level discectomy yielded similar clinical outcomes to OLM, including pain control, functional disability, and patient satisfaction, but incurred minimal EBL, HS, and postoperative back pain.Trial registrationNot applicable.