Surgery For Lumbar Disc Herniation Research Articles

Outpatient anterior cervical discectomy: A French study and literature review.

In France, surgery for lumbar disc herniation is now being done in the outpatient ambulatory setting at select facilities. However, surgery for the cervical spine in this setting is controversial because of the dangers of neck hematoma. We wanted to share our experience with performing ambulatory anterior cervical discectomy in 30 patients at our facility. Since 2014, 30 patients (16 men, 14 women; mean age of 47.2 years) with cervical radiculopathy due to single-level cervical disc disease (19 at C5-C6 and 11 at C6-C7) were operated at our ambulatory surgery center. After anterior cervical discectomy, cervical disc replacement was performed in 13 patients and fusion in 17 patients. The mean operative time was 38minutes and the mean duration of postoperative monitoring was 7hours 30minutes. The patients stayed at the healthcare facility for an average of 10hours 10minutes. One female patient (3%) was transferred to a standard hospital unit due to a neurological deficit requiring surgical revision with no cause identified. Two patients (7%) were rehospitalized on Day 1 due to dysphagia that resolved spontaneously. Thus the "ambulatory success rate" was 90% (27/30). There were no other complications and the overall satisfaction rate was excellent (9.6/10). Outpatient anterior cervical discectomy is now widely performed in the United States. Ours is the first study of French patients undergoing this procedure. The complication rate was very low (<2%) and even lower than patients treated in an inpatient hospital setting in comparative studies. Note that our patients were carefully selected for outpatient surgery as certain risk factors for complications have previously been identified (age, 3+levels, comorbidities/ASA>2). No deaths in the first 30 days postoperative have been reported in the literature. Wound hematoma leading to airway compromise is rare in the ambulatory setting (0.2%). The few cases that occurred were detected early and the hematoma drained before the patient was discharged. Dysphagia is actually the most common complication (8 to 30%). Cervical spine surgery can be performed in an ambulatory surgery center in carefully selected patients. Our criteria are patients less than 65 years of age, single-level disease, ASA<2, and standard cervical morphology. The complication and readmission rates are low. Careful hemostasis combined with close postoperative monitoring for at least 6hours helps to reduce the risk of neck hematoma. Prevention of postoperative dysphagia must be a focus of the care provided.

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.

Incidence of early postoperative complications requiring surgical revision for recurrent lumbar disc herniation after spinal surgery: a retrospective observational study of 9,310 patients from the German Spine Register

BackgroundThe recurrence rate in lumbar disc herniations (LDH) has been reported between 5 and 25%. There are only few data about this phenomenon that occurs within days of the initial operation. We analyse early recurrent LDH by analysis of data from the German Spine register.MethodsData from patients undergoing disc herniation surgery in the lumbar region were extracted from the German Spine Registry between 1st January 2012 and 31st December 2016. Patients with early recurrent LDH within days of initial surgery were separately analysed.ResultsA total of 9310 surgeries for LDH were documented in the German Spine Register. From these patients 115 (1.2%) presented an early recurrent disc surgeries within days of the initial surgery. The mean age was 70 ± 2.50 years. Most affected segment was L4/5 (47 cases, 41%), followed by L3/4 (45 cases, 39%). The most of our patients showed a normal or overweight Body Mass Index. Surgery for early recurrent LDH was associated with a high rate of incidental durotomies (20 cases, 17.6%). In 3 cases (2.6%) therapy with a lumbar drain was necessary.ConclusionsThe rate of early recurrent LDH within days of surgery is 1.2%. Age seems to be an important factor in early recurrent LDH while obesity does not. The data of the German Spine Register seems to have a reliable data collection system that can perform multicentre data analysis. The databases from this Register could be used in the future for various purposes, such as the evaluation of multicentre surgical techniques, results in patients with various surgical procedures and basic research in spine surgery.

Surgery versus conservative management for lumbar disc herniation with radiculopathy: A systematic review and meta-analysis

Introduction: Lumbar Disk Herniation with Radiculopathy (LDHR) appears to be a large and costly problem. The paradigm regarding the best treatment for LDHR has being between surgery and conservative management. The aim of this study was to compare and summarize evidence regarding the effectiveness of surgery and conservative treatment for individuals with sciatica due to lumbar disc herniation.&#x0D; Methods: This study reviewed all literatures published on individuals with LDHR, who were managed either via surgery or conservative method. Pain and functional disability were the main outcome measures analyzed. A comprehensive search of PubMed, TRIP, PEDro and CINAHL was conducted from October, 2011 to June 2017. Two independent researchers selected the studies, and extracted the data. Methodological quality was assessed using the PEDro scale. Meta-analysis was carried out where suitable.&#x0D; Results: Eight studies involving (n=1,507) were included in the review. Meta-analysis was conducted for only 4 studies (n=784). The meta-analysis showed significant benefit for early surgery than conservative care -8.01(95% CI, -9.27 to -6.72) in the short-term effect -0.49 (95% CI, -0.7 to -0.28). However, the result for long-term effect did not show any significant difference between surgery and conservative care 1.60 (95% CI, -6.85 to 10.05).&#x0D; Conclusion: This current evidence suggest that early surgery for individuals with lumbar disc herniation with radiculopathy is better than conservative care in the short-term without any long-term difference. The results of this review should be interpreted with caution as the populations of the included studies were largely heterogeneous.

Comparing the Extent of Tissue Damage between Lumbar Microendoscopic Discectomy (MED) and Microscopic Discectomy (MD) Using Biochemical Markers

Background Data: Discectomy through a limited laminotomy has remained the “gold standard” for lumbar disc surgery. Surgery for lumbar disc herniation can be classified into two broad categories;open (conventional) versus minimally invasive surgery, where the last category classified into microscopic, endoscopic and percutaneous procedures.Microendoscopic discectomy (MED) is unique in that it combines open surgical principles with endoscopic technology.Purpose: To evaluate extent of tissue damage and pain relief after microendoscopic (MED) and microscopic lumbar discectomy (MD). Study Design: A prospective randomized controlled study.Patients and Methods: The study included 40 patients having lumbar disc prolapse, operated in Alexandria Main University Hospital. Twenty of them underwent MED (Group A) and the other twenty underwent MD (Group B). Clinical (VAS, ODI) and radiological and biochemical markers (CRP, CPK) for tissue inflammation data were collected preoperatively and postoperatively for comparison. Patients were followed up for 6 months.Results: 26 patients were males and 14 were females. The mean age for group A was 40.8±1.34 years and for group B was 40.2±1.06 years. Clinically all patients had low back pain and radicular leg pain. There was no statistically significant difference between the duration of surgery in both groups. The length of hospital stay was significantly less in MED group. The length of the skin wound was significantly less in MED group. Reduction of back pain VAS immediate and 1 month postoperative was reported in both groups and was statistically significantly better in MED group, however, after 6 monthsthere was no difference between both groups. There was significant improvement with no difference between both groups regarding radicular VAS and ODI all through the follow up. Postoperative CRP and CPK was statistically significantly higher in MD group (P<0.001). Conclusion: Both techniques gave comparable clinical outcomes although early backpain score and tissue markers were in favor of MED technique. (2018ESJ153)

Is There a Correlation Between Clinical Improvement and Return to Work in Patients, Civil Servants, Who Underwent Surgery for Lumbar Disc Herniation?

Objective. To analyze the rate of return to work in patients, civil servants, who underwent urgery for lumbar disc herniation. Methods. Thirty patients were included in the study. The level of pain was accessed by Visual Analogue Scale preoperatively and at 3 months postoperatively, when also evaluated the situation of working using the Denis Work Scale. We compared the pain level pre and postoperatively, and the clinical improvement and return to work. Results. The mean age was 47.42 years, females accounted for 54%. The mean preoperative pain was 9.11 and postoperatively was 3.11. Seventy-seven percent of patients returned to previous work. There was moderate correlation between postoperative pain and return to work. Conclusion. There was a correlation between clinical improvement and return to work.

Lumbar disc herniation surgery with microdiscectomy plus interspinous stabilization: Good clinical results, but failure to lower the incidence of re-operation

BackgroundDiscectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system (IDSS) in association with disc excision to prevent pain and re-operation, remains controversial. MethodsPatients (age 18–50 years) presenting with lumbago/sciatica (ICD-10-CM M54.3, M54.4) due to voluminous lumbar disc herniation were eligible for participation. Patients underwent microdiscectomy plus IDSS. The primary outcome measure was the clinical efficacy using Owestry disability index(ODI) and visual analogue pain scale (VAS). We also evaluated several other outcome parameters including: length of stay and costs during hospital admission, 90-day complication rate, and 1-year re-operation rate. This prospective observational study was carried out from January 2015 to August 2016. ResultsA total of 30 patients whose mean age was 38.6(±9.2) years were included. ODI score dropped from 62.93(±16.45) to 13.50(±16.67), representing 78.54% (95% C.I 68.07–88.66%) improvement of the baseline score after one year (p < 0.001). Patients had 90 day re-admission and 1 year re-operation rates of 4/30(13.3%) and 3/30(10%) respectively. Length of stay was 2.1 ± 1.2 days. In-Hospital cost was 1069.8 ± 288.4 € (not including 1500€ of the implant). Implant related complications were common 12/30(40%), although they did not have any clinical consequences. ConclusionOur short-term experience indicates that microdiscectomy plus interspinous device is safe and it shows good clinical results, although the clinical improvement seems to be due to microdiscectomy, without the implant adding any extra benefit. The addition of IDSS did not protect against re-operation, and it increased the surgical expenses.

Comparison of the biochemical and radiological criteria for lumbar disc degeneration

BackgroundThe relationship between radiological degeneration criteria on lumbar magnetic resonance imaging (MRI) and both the keratan sulfate (KS) and chondroitin sulfate (ChS) levels was examined in disc material taken from patients undergoing lumbar disc herniation (LDH) surgery. To examine whether the biochemical and radiological degeneration criteria testing the reliability of radiological degeneration findings agreed and to evaluate the contribution of the KS/ChS ratio to disc form (protruding or extruding). MethodsThis was a prospective experimental cohort study. Using enzyme-linked immunosorbent assay, KS and ChS levels were measured in the degenerate nucleus pulposus taken from 71 patients with a diagnosis of LDH who underwent surgery. The degeneration levels and disc form (protruding or extruding) were determined according to the Pfirrmann five-stage grading system on preoperative T2-weighted lumbar MRIs. According to the Pfirrmann system, 28 patients were grade III and 43 were grade IV. The relationship between radiological criteria and the KS/ChS ratio was statistically evaluated. ResultsThe KS levels (p=0.046) and the KS/ChS ratio (p=0.001) were significantly higher in grade IV patients than in grade III patients. However, there was no difference between the KS and ChS levels and the KS/ChS ratio when patients were classified as protruding or extruding according to their disc structure. Disc structure and biochemical degeneration indicators were not correlated. ConclusionsThe KS level and the KS/ChS ratio were high in patients with marked radiological degeneration on lumbar MRI, demonstrating the sensitivity and reliability of the Pfirrmann five-stage grading system for showing radiological degeneration.

Is Eighty the New Sixty? Outcomes and Complications after Lumbar Decompression Surgery in Elderly Patients over 80 Years of Age.

An increasing demographic aging of the general population results in a rising incidence of octogenarians and nonagenarians with spine disease. Patients older than 65 years represent the majority of patients with degenerative lumbar spine disease in our daily clinical routine. Surgical treatment is undertaken reluctantly because of an increased rate of comorbidities. We therefore assessed complication rates of lumbar decompression in regard to neurological outcome and medical conditions in patients age 80 years or older in a retrospective single-center series. Data for 244 patients (124 female, 120 male; mean age, 83.1 ± 3 years; age range, 80-95 years) who underwent decompressive surgery for lumbar spinal stenosis or disc herniation between April 2007 and February 2016 were assessed retrospectively. Age at surgery, neurologic deficits (preoperative and postoperative), relevant medical comorbidities and previous lumbar decompression, intraoperative and postoperative complications (e.g., surgery-related, medical), duration of surgery, length of hospital stay, and rate of revision surgeries were recorded. Surgery was performed for lumbar stenosis (184 patients; 75.4%), lumbar disc herniation (13 patients; 5.3%) or both (47 patients; 19.3%). Seventy-six patients (31.3%) patients experienced preoperative neurologic deficits; 48 (63.2%) of these patients improved, 28 (36.8%) of them were unchanged after surgery, and none deteriorated. New transient, postoperative, neurologic deficits occurred in 6 patients (2.5%). All 55 (22.5%) intraoperative complications were mild to moderate, and no severe surgical complications occurred. Two hundred fifteen patients (88%) had relevant medical disorders. Nineteen (7.7%) postoperative medical complications were reported in 17 patients (7%), of which 14 (73.7%) were severe and 5 (26.3%) were mild (4 pulmonary embolisms, 6 pneumonias, 3 myocardial infarctions, 1 postoperative renal failure, 5 urinary tract infections). Medical complications that necessitated intensive care unit treatment and resulted in lethal outcome were seen in 2 patients (0.8%). Despite their age, the vast majority of octogenarians and nonagenarians benefited from lumbar decompression surgery. Mild to moderate intraoperative complications were relatively frequent, whereas severe intraoperative complications did not occur. The majority of medical complications was severe, but the incidence was acceptable, and the postoperative outcome was still favorable in most patients.

Assessment of the correlation between histological degeneration and radiological and clinical parameters in a series of patients who underwent lumbar disc herniation surgery

Background and objectiveThe use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters. Patients and methodRetrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa. ResultsNo statistically significant correlation was found between histological variables (histological degeneration score, inflammatory infiltrates or neovascularization) and clinical or radiological variables. Interobserver agreement for radiological scores resulted in a kappa of 0.79 for the Pfirrmann scale and 0.65 for the Modic scale, both statistically significant. ConclusionsIn our series of patients, we could not demonstrate any correlation between the degree of histological degeneration or the presence of inflammatory infiltrates when compared with radiological degeneration scales or clinical variables such as the patient's age or duration of symptoms.

Clinical effect of polylactic acid membrane in the surgery of lumbar disc herniation

Objective To investigate whether the polylactic acid (PLA) membrane can reduce the scar size and or improve the clinical outcome of the patients after lumbar disc herniation surgery, and the association between peridural scarring and recurrent pain after lumbar disc herniation surgery. Methods Seventy-two patients treated with lumbar disc herniation surgery were collected and randomly divided into two groups, including 38 cases were treated with PLA membrane, and 34 cases as the control group.All patients underwent MRI at 12 months after surgery for grading the size, location and development of the scar.NRS was used to assess the severity of lower limb pain before and 12 months after surgery.The modified Macnab scale was used to assess the clinical outcomes of the patients. Results For 9 cases(23.7%) in the PLA membrane group, the scar tissue had an effect on the nerve root, while 16 cases(47.1%) in the control group experienced the same, the difference was statistically sigificant (χ2=4.326, P=0.038). There was significant difference in scar score between the two groups (Z=2.340, P=0.019), but there was no significant difference in leg pain degree between the two groups (t=0.687, 1.014, 0.426, 0.000, P=0.532, 0.324, 0.675, 1.000). There was no significant difference between the two groups in modified Macnab classification grading (χ2=1.202, P=0.273). Conclusion PLA membranes used in lumbar disc herniation surgery could reduce peridural scar formation, but it does not significantly improve the clinical results. Key words: Anti-adhesion membrane; Lumbar disc herniation; Peridural scar

Percutaneous Endoscopic Lumbar Spine Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis: Emphasizing on Clinical Outcomes of Transforaminal Technique

Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.

Lumbar Disc Herniation in Pediatric

Lumbar disc herniation is a common complaint among adults with degenerated lumbar intervertebral discs, however its incidence in childhood and adolescence is abundant. Findings recommended that pediatric lumbar disc herniation is dissimilar in numerous way from that in adults. It was confirmed that pediatric patients respond to conventional management less than adults, also the consequence of the operation continued to be acceptable for at least 10 years after the first surgery even though it seems to decline somewhat. This retrospective study was undertaken to determine the clinical outcome and the feature of lumbar disc prolapse in pediatric patients. 12 patients younger than 18 years were operated for lumbar disc prolapse in the period from 2012-2016. Patients preoperative data and radiological imaging, operative and postoperative follow up were reviewed. 12 patients were included in this study, 10 were male and 2 females, the average age was 15 years (ranging between 12 - 18 years). The average duration of the symptoms was 11 months. The average follow up was 14 months. All patients had a sciatica prior to surgery, 35% had motor deficit, and 60% had parasthesia. Conservative treatment failed in all patients. After surgery and follow up, improvement occurs in about 80% of patients, ranging from excellent to good, and 20% of patients with fair outcome. According to Pain Visual Analogue Scale, leg pain reduced from 90 - 30 and back pain from 80 - 35. Conclusion: Pediatric lumbar disc herniation is an uncommon object leading to hospitalization. About 0.1% - 0.2% of children and adolescence surgery for lumbar disc herniation in pediatric does not lead to chronic back pain or interfere with physical activity and is related to the excellent short consequence.

Outcomes of N-butyl cyanoacrylate use in cases where incidental durotomy developed in lumbar disc herniation surgery

Outcomes of N-butyl cyanoacrylate use in cases where incidental durotomy developed in lumbar disc herniation surgery

Evaluation of thoracolumbar interfascial plane block for postoperative analgesia after herniated lumbar disc surgery: A randomized clinical trial.

Background:Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3rd lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves.Objective:The objective of this study was to evaluate the analgesic effects gained after performing TLIP block (analogous to the transversus abdominis plane [TAP] block, but intended for the back) in patients undergoing lumbar discectomy.Methodology:This was a prospective, randomized, double-blinded, controlled clinical trial. Computer-generated randomization numbers were used to allocate patients into two groups. A total of 102 patients scheduled for lumbar discectomy were considered eligible, of these 70 patients were randomly included in the analysis: 35 patients (control group) received the standard general anesthetic technique and 35 patients (TLIP group) received TLIP block with 20 ml mixture of 0.25% bupivacaine and 1% lidocaine on each side. The primary outcome was to compare the two groups with regard to pain scores, whereas the secondary outcomes included the time to first analgesic (TFA), 24-h morphine consumption, and side effects associated with morphine such as nausea, vomiting, and sedation.Results:TLIP group compared with the control group showed a significant reduction in the postoperative Visual Analog Scale for pain score both on rest and movement, with no statistically significant difference at 24 h during movement. TFA was significantly shorter in the control group compared to the TLIP group (82.00 ± 69.01 vs. 442.7 ± 126.47 min, P < 0.001). TLIP group had lower cumulative morphine consumption than control group of statistically significant difference (9.7 ± 6.38 vs. 25.88 ± 5.17 mg, P < 0.001). TLIP block group compared with the control group showed a significant reduction of nausea and a lower incidence of sedation.Conclusion:TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy.

Recurrence Is Associated With Body Mass Index in Patients Undergoing a Single-Level Lumbar Disc Herniation Surgery.

BackgroundThe aim of the study was to assess the body mass index (BMI) and other risk factors associated with lumbar disc herniation (LDH) and clinical outcomes, in patients who undergo surgery for single-level LDH.MethodsThis was a retrospective cohort study, affecting patients that underwent surgery for single-level LDH attending our hospital between July 2009 and January 2016. The mean follow-up period was 3.5 years (1 - 8 years). To maintain adequately sized groups for analysis, level L2-L3 and L3-L4 herniations were grouped as upper disc levels (group A) and level L4-L5 (group B) and L5-S1 (group C) herniations were analyzed individually. Disk herniation was graded on T2-weighted sagittal magnetic resonance images by using a five-point scale. Pain assessment was made using the visual analog scale (VAS).ResultsTwo hundred fifty-six (256) patients met study inclusion criteria. There were 138 males (53.9%) with a mean age of 55.3 ± 12.9 years (range, 30 - 77). The association between A, B and C groups was analyzed, based on criteria such as age, sex, BMI, surgical techniques, diabetes, size of herniated disc, preoperative VAS, length of hospital stay, drop foot on admission, smoking, family history and history of injury to the lumbar spine, location of herniated disc (far lateral) and use of steroids. We found a statistically significant factor between groups in BMI (P = 0.006), family history (P = 0.001), location (far lateral) (P = 0.003) and history of injury to the lumbar spine (P = 0.003).ConclusionsThere may be an association between severity of disc degeneration and BMI (overweight and obese adults). Furthermore, spine and neurosurgeons should be aware that BMI might be related to patients’ outcome.

The effect of multimedia-based nursing visit on preoperative anxiety and vital signs in patients undergoing lumbar disc herniation surgery: A randomised clinical trial.

This study was a randomised clinical trial on 60 candidates undergoing lumbar disc herniation surgery. Anxiety rate and vital signs were measured before and after the intervention. There was a statistically significant difference between the two groups in terms of the preoperative anxiety, systolic and diastolic blood pressure, pulse and respiratory rate (P = 0.0001). Neurosurgery perioperative nurses can make use of multimedia in preoperative nursing visit based on the needs of patients.

Risk Factors Analysis for Foot Drop Associated with Lumbar Disc Herniation: An Analysis of 236 Patients

To identify the risk factors for foot drop in patients with lumbar disc herniation (LDH). Two hundred thirty-six patients who underwent surgery for LDH were retrospectively reviewed. Foot drop was defined as tibialis anterior muscle strength of lower than grade 4 by the manual muscle test. Possible risk factors, including demographic and radiographic parameters, were evaluated by multivariate logistic regression analysis. Fifty-two patients (22.9%) suffered from foot drop. Multivariate logistic regression analysis revealed that diabetes mellitus, disc calcification, patients who had an acute episode or acute-on-chronic episode, and patients who presented with lateral recess or extraforaminal type of disc herniation were at greater risk of foot drop. Notably, patients who had a canal occupancy rate of more than 50% were at greater risk of foot drop compared with patients who had a canal occupy rate of less than 25%. With a 1.0-mm increase in anteroposterior diameter of the index spinal canal, the risk of developing foot drop decreased to 51.8% in these patients (P < 0.05). The following factors may affect the development of foot drop in patients with LDH: 1) diabetes mellitus; 2) patients with an acute episode or acute-on-chronic episode; 3) patients with lateral recess or foraminal type of herniation; 4) disc calcification; 5) canal occupancy rate greater than 50%; and 6) the anteroposterior diameter of canal. Surgical treatments for patients with those risk factors should be implemented positively during the follow-up period to reduce possible adverse outcomes.

Length of stay, costs, and complications in lumbar disc herniation surgery by standard PLIF versus a new dynamic interspinous stabilization technique

BackgroundThe number of lumbar spine surgeries has been increasing during the last 20 years, which also leads to an increase in hospital costs and complications related to surgery. Therefore, there is a greater concern about the costs and safety of the techniques and implants used.MethodsPatients (aged from 18 to 50 years) presenting with lumbago /sciatica (ICD-10-CM M54.3, M54.4) due to lumbar disc herniation lasting more than 12 weeks, were included. Patients with disc herniation larger than size-2 or size-3 according to the MSU Classification were eligible for participation. Intervention was divided in two groups. In Group 1, patients underwent microdiscectomy and Interspinous Dynamic Stabilization System (IDSS). Meanwhile, in Group 2, patients received discectomy and posterior lumbar interbody fusion (PLIF). The primary outcome measure was the length of stay and costs during hospital admission. We also evaluated several other outcome parameters, including 90- day readmission rate, 90-day complication rate, and re-operations rate. The study was an observational prospective cohort study carried out from January 2015 to August 2016 in which two surgical techniques were compared. Our hypothesis was that a less aggressive procedure, such as discectomy and DSS, will decrease the length of stay and costs, and that it will also reduce the rate of complications with respect to PLIF.ResultsA total of 67 patients (mean age 39.8 ± 8.4 years) were included. Patients in the PLIF group had a length of stay increase of 109% (4.52 ± 1.76 days vs 2.16 ± 1.18 days p < 0.001) and an in-hospital cost increase of 71% (1821.97 ± 460.41€ vs. 1066.20 ± 284.34€ p < 0.001). The reduction of one day of stay is equivalent to a reduction of total in-hospital costs of 12.5%. Patients in the IDSS cohort had no significant differences regarding PLIF cohort in the 90-day readmission rate (12.9% vs 11.1% € p > 0.999, respectively), 90-day re-operation rate (12.9% vs 11.1% € p > 0.999) and 90-day complication rates (35.5% vs 52.8% € p > 0.156). Dural tear and urinary tract infection rates were higher in the PLIF cohort (13.9% vs 3.2%. p = 0.205 and 11.1% vs 0% p = 0.118, respectively). Implant related complications were the most frequent in both IDSS and PLIF groups (32.3% vs 38.9% p = 0.572).ConclusionsPatients who underwent IDSS had a significant decrease of the length of stay and costs in relation to PLIF group. No significant differences were found in 90-day readmission and reintervention rates for both groups. Although differences were not significant, dural tear and urinary tract infection rates were lower in the interspinous group. IDSS or PLIF after discectomy, did not protect against subsequent 90-day re-operation or readmission compared to discectomy alone.

Preliminary results of lumbar disk herniation surgery by Endoscopic Destandau Method

BackgroundThe incidence of Disc herniation is about 2–3% of population. Each year 300,000 procedures performed in USA. The aim of this paper is to describe the utility of endoscopic procedure in treatment of lumbar disc herniation. MethodsWe operated 359 patients from September 2013 to December 2016 for lumbar disk herniation by Endoscopic DESTANDAU method (EDM). The average length of surgery was 47min. We operated 211 male and 148 female patients. In average, patients had pain for 4.3 months before surgery. Results310 patients became pain free in six weeks and 332 after 3 months. We had 7 recurrent herniation. Among these patients 4 have been operated for the second time with success. Three patients refused to be operated. And had infiltration. We had 1 deep infection and 3 cutaneous infections. We have 7 two SCF fluid leak. Among them 3 needed second operation. ConclusionsThe patients are admitted the day of surgery and are discharged the day after surgery. EDM is a good alternative surgery for lumbar disk herniation in comparison with classical surgery. The duration of hospitalization is shorter and recovery is faster.