Surgery For Lumbar Disc Herniation Research Articles

Evaluation of Treatment of Recurrent Lumbar Disc Prolapse: Fusion Versus Non Fusion

Background Recurrent lumbar disc herniation is one of the most common spinal disorders. The management of recurrent lumbar disc herniation remains somewhat controversial. Surgical treatment for recurrent disc herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion. Objective The aim of the work is the evaluation of management of recurrent lumbar disc prolapse: fusion versus non fusion aiming to reach ideal method of treatment. Matients and Methods: This is a prospective, randomized, comparative study on 30 patients (19 M, 11 F) with recurrent lumbar disc herniation at Assiut University Hospitals from January 2015 to January 2016 (minimum 12-months follow-up) with an average age of 47.2 years (range: 30–67 years). The patients were classified into 2 groups: Group A (15 patients); who had revision discectomy alone, group B (15 patients); who had revision discectomy with fusion. The clinical and radiographic results were compared between the two groups. Clinical outcome was assessed using the Modified MacNab’s Criteria and radiological outcome was assessed using Lenke classification. Results: Regarding postoperative Modified MacNab’s Criteria, there is no significant difference (P=0.7826) between group A which was excellent in 7 cases (7/15, 46.7%), good in 6 cases (6/15, 40%) and fair in 2 cases (2/15, 13.3%) and group B which was excellent in 6 cases (6/15, 40%), good in 6 cases (6/15, 40%), fair in 2 cases (2/15, 13.3%) and poor in 1 case (1/15, 6.7%). In group A: 1 of 15 patients (6.7%) had dural tear while in group B: 3 of 15 patients (33.3%) have dural tear (P=0.6171) and no infection occur in group A while 2 patients (13.3%) have infection in group B. The intraoperative blood loss and length of operation were significantly less in group A. The post-surgery hospital stay was significantly different between the 2 groups, being least in group A and highest in group B. Conclusion: Surgery for recurrent lumbar disc herniation can be very successful and may approach the success rate for initial operations (80% in our study) provided proper patient selection, good and thorough examination and investigations and proper surgical technique.

Treatment of Recurrent Lumbar Disc Herniation With or Without Fusion in Workers' Compensation Subjects.

Retrospective cohort study. To determine outcomes after reoperation discectomy with or without fusion surgery for recurrent lumbar disc herniation (RLDH) in the workers' compensation (WC) population. RLDH is estimated to occur in 7% to 24% of patients after discectomy. There are two main surgical options after reherniation: a revision discectomy (RD), or an RD combined with fusion (RDF). A total of 10,592 patients received lost-work compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005 and 2012. Patients with lumbar spine comorbidities, a smoking history, or multilevel surgery were excluded. One hundred two patients had RD alone for RLDH and 196 had RDF procedures. The primary outcome was whether subjects returned to work (RTW). A total of 298 WC patients met our study criteria, including 230 (77.2%) men and 68 (22.8%) women with an average age of 39.4 years (range 19-66). The RDF group had lower rates of RTW than the RD group (27.0% vs 40.2%; P = 0.03). Multivariate regression analysis showed that reoperation with discectomy and fusion (P = 0.04; odds ratio [OR] = 0.56), psychiatric illness (P < 0.01; OR = 0.19), and opioid analgesic use within 1 month of reoperation (P < 0.01; OR = 0.44) were independent negative predictors of RTW. RDF patients were supplied with opioids for 252.3 days longer (P < 0.01) and incurred $34,914 (31.8%) higher medical costs (P < 0.01) than the RD alone group. We analyzed outcomes after operative management of RLDH in the WC population. WC patients receiving RDF had lower RTW rates, higher costs, and a longer duration of postoperative opioid use than those receiving RD alone. This information allows for informed patient management decisions and suggests that fusion should be reserved for patients with clear indications for its use. We are unable to conclude what treatment method is best, but rather we provide a baseline for future studies. 3.

Criteria for failure and worsening after surgery for lumbar disc herniation: a multicenter observational study based on data from the Norwegian Registry for Spine Surgery

PurposeIn clinical decision-making, it is crucial to discuss the probability of adverse outcomes with the patient. A large proportion of the outcomes are difficult to classify as either failure or success. Consequently, cutoff values in patient-reported outcome measures (PROMs) for “failure” and “worsening” are likely to be different from those of “non-success”. The aim of this study was to identify dichotomous cutoffs for failure and worsening, 12 months after surgical treatment for lumbar disc herniation, in a large registry cohort.MethodsA total of 6840 patients with lumbar disc herniation were operated and followed for 12 months, according to the standard protocol of the Norwegian Registry for Spine Surgery (NORspine). Patients reporting to be unchanged or worse on the Global Perceived Effectiveness (GPE) scale at 12-month follow-up were classified as “failure”, and those considering themselves “worse” or “worse than ever” after surgery were classified as “worsening”. These two dichotomous outcomes were used as anchors in analyses of receiver operating characteristics (ROC) to define cutoffs for failure and worsening on commonly used PROMs, namely, the Oswestry Disability Index (ODI), the EuroQuol 5D (EQ-5D), and Numerical Rating Scales (NRS) for back pain and leg pain.Results“Failure” after 12 months for each PROM, as an insufficient improvement from baseline, was (sensitivity and specificity): ODI change <13 (0.82, 0.82), ODI% change <33% (0.86, 0.86), ODI final raw score >25 (0.89, 0.81), NRS back-pain change <1.5 (0.74, 0.86), NRS back-pain % change <24 (0.85, 0.81), NRS back-pain final raw score >5.5 (0.81, 0.87), NRS leg-pain change <1.5 (0.81, 0.76), NRS leg-pain % change <39 (0.86, 0.81), NRS leg-pain final raw score >4.5 (0.91, 0.85), EQ-5D change <0.10 (0.76, 0.83), and EQ-5D final raw score >0.63 (0.81, 0.85). Both a final raw score >48 for the ODI and an NRS >7.5 were indicators for “worsening” after 12 months, with acceptable accuracy.ConclusionThe criteria with the highest accuracy for defining failure and worsening after surgery for lumbar disc herniation were an ODI percentage change score <33% for failure and a 12-month ODI raw score >48. These cutoffs can facilitate shared decision-making among doctors and patients, and improve quality assessment and comparison of clinical outcomes across surgical units. In addition to clinically relevant improvements, we propose that rates of failure and worsening should be included in reporting from clinical trials.

Risk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based study.

There are no previous studies evaluating risk factors for surgical site infections (SSIs) and the effectiveness of prophylactic antibiotic treatment (PAT), specifically for patients operated on for lumbar disc herniation. This observational multicentre study comprises a cohort of 1,772 consecutive patients operated on for lumbar disc herniation without laminectomy or fusion at 23 different surgical units in Norway. The patients were interviewed about SSIs according to a standardised questionnaire at 3 months' follow-up. Three months after surgery, 2.3% of the patients had an SSI. Only no PAT (OR = 5.3, 95% CI = 2.2-12.7, p< 0.001) and longer duration of surgery than the mean time (68 min) (OR = 2.8, 95% CI = 1.2-6.6, p = 0.02) were identified as independent risk factors for SSI. Numbers needed to have PAT to avoid one SSI was 43. In summary, this study clearly lends support to the use of PAT in surgery for lumbar disc herniation. Senior surgeons assisting inexperienced colleagues to avoid prolonged duration of surgery could also reduce the occurrence of SSI.

Predictors of improvement in low back pain after lumbar decompression surgery: Prospective study of 140 patients.

Lumbar decompression surgery is often used to treat neurological symptoms of the lower extremity as a result of lumbar disease. However, this method also leads to the improvement of the accompanying low back pain (LBP). We studied the extent of LBP improvement after lumbar decompression surgery without fusion and the associated preoperative factors. Patients (n=140) with lumbar spinal stenosis (n=90) or lumbar disc herniation (n=50) were included. To evaluate the change in LBP, VAS scores and the Oswestry disability index scores were measured before surgery and 2 weeks, 3 months, and 6 months after surgery. The predictors of residual LBP were investigated using logistic regression analyses. In total, 140 patients were examined. The VAS scores for LBP before surgery and 2 weeks, 3 months, and 6 months after surgery were 4.4±3.0 (mean±standard deviation), 1.1±1.5, 1.3±1.8, and 1.9±2.2, respectively. LBP significantly improved 2 weeks after surgery (P<0.001), stabilized between 2 weeks and 3 months after surgery, but was significantly aggravated 3-6 months after surgery (P<0.001). At 6 months after surgery, 67 (47.9%) patients had a VAS score of >1. The predictors of residual LBP included severe preoperative LBP, degenerative scoliosis and the size of the Cobb angle. The independent predictors, determined by multivariate analysis were degenerative scoliosis and the size of the Cobb angle. LBP was alleviated at 2 weeks after lumbar decompression surgery for lumbar disc herniation and lumbar spinal stenosis. The predictors of residual LBP after decompression included more severe LBP at baseline, degenerative scoliosis and the size of Cobb angle. Level 3.

Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors.

Minimally invasive spine (MIS) surgery utilizing tubular retractors has become an increasingly popular approach for decompression in the lumbar spine. However, a better understanding of appropriate indications, efficacious surgical techniques, limitations, and complication management is required to effectively teach the procedure and to facilitate the learning curve. To describe our experience and recommendations regarding tubular surgery for lumbar disc herniations, foraminal compression with unilateral radiculopathy, lumbar spinal stenosis, synovial cysts, and dural repair. We reviewed our experience between 2008 and 2014 to develop a step-by-step description of the surgical techniques and complication management, including dural repair through tubes, for the 4 lumbar pathologies of highest frequency. We provide additional supplementary videos for dural tear repair, laminotomy for bilateral decompression, and synovial cyst resection. Our overview and complementary materials document the key technical details to maximize the success of the 4 MIS surgical techniques. The review of our experience in 331 patients reveals technical feasibility as well as satisfying clinical results, with no postoperative complications associated with cerebrospinal fluid leaks, 1 infection, and 17 instances (5.1%) of delayed fusion. MIS surgery through tubular retractors is a safe and effective alternative to traditional open or microsurgical techniques for the treatment of lumbar degenerative disease. Adherence to strict microsurgical techniques will allow the surgeon to effectively address bilateral pathology while preserving stability and minimizing complications.

Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us?

Background:Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined.Methods:A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion.Results:A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy.Conclusion:The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery, particularly in the current advertising climate greatly favoring MIS.

Surgical treatment of lumbar disc herniation in different ages—evaluation of 11,237 patients

Background ContextSurgical treatment of lumbar disc herniation (LDH) may lead to different outcomes in young, middle-aged, and elderly patients. However, no study has, by the same data ascertainment, evaluated referral pattern, improvement, and outcome in different age strata. PurposeThis study aimed to evaluate referral pattern and outcome in patients of different ages surgically treated because of LDH. Study DesignThis is a register study of prospectively collected data. Patient SampleIn SweSpine, the national Swedish register for spinal surgery, we identified 11,237 patients who between 2000 and 2010 had their outcome of LDH surgery registered in pre-, per-, and 1-year postoperative evaluations. Outcome MeasuresThe data collected included age, gender, smoking habits, walking distance, preoperative duration and degree of back and leg pain, consumption of analgesics, quality of life in the patient-reported outcome measure (PROM) Short-Form 36 (SF-36) and EuroQol 5 dimensions (EQ5D), disability in the Oswestry Disability Index, operated level, type of surgery, and complications. MethodsWe compared the outcome in patients within different 10-year age strata. IBM SPSS Statistics 22 was used in the statistical calculations. No funding was obtained for this study. The authors have no conflicts of interest to declare. ResultsPatients in all ages referred to surgery had inferior PROM data compared with published normative age-matched PROM data. Referral to LDH surgery demanded of each 10-year strata statistically significantly more pain, lower quality of life, and more disability (all p<.001). Surgery markedly improved quality of life and reduced disability in all age groups (all p<.001), but with statistically significantly less PROM improvement with each older 10-year strata (all p<.001). This resulted in statistically significantly inferior PROM values for pain, quality of life, and disability postoperatively for each 10-year strata (all p<.001). There were also more complications (p<.001) with each 10-year older strata. ConclusionsIn general, older patients referred to LDH surgery have statistically significantly inferior PROM scores, improve less, and reach inferior PROM scores postoperatively. The clinical relevance must however be questioned because most patients reach, independent of age group, the defined level for a successful outcome, and the patient satisfaction rate is high.

REOPERATION AFTER HERNIATED DISC REMOVAL IN PATIENTS WITH LUMBAR DEGENERATIVE DISC DISEASE

Objective. To analyze the reasons for and to evaluate the results of repeated surgery in patients with lumbar degenerative disc disease after the removal of herniated discs. Material and Methods . The results of surgical treatment in 186 patients (mean age 48.7 years) treated between 2013 and 2014 at the Federal Center for Neurosurgery in Novosibirsk were analyzed. All patients previously underwent surgery for lumbar disc herniation in different hospitals. Primary intervention at one level was performed in 171 patients (92.0 %), and at two levels - in 15 patients (8.0 %). Results . Progression of degeneration at the operated segment was detected in 155 patients (83.3 %). Out of them, recurrent disk herniation was diagnosed in 92 patients (49.5 %) and instability at the operated level was found in 63 patients (33.8 %). Adjacent segment degeneration was diagnosed in 31 patients (16.7 %). After surgery, positive results in pain regression were achieved in 87.1 % of cases, and unsatisfactory results with preserved pain intensity were observed in 12.9 %. Conclusion : The main causes of reoperation after primary microdiscectomy were recurrent disc herniation and instability of the operated segment. In 16.7 % of cases, repeated surgery was performed for the adjacent segment degeneration, which must be regarded as a sequela of primary disease. The use of differential surgical treatment strategy based on the identification of the dominant clinical and neurological syndrome provides good and satisfactory results in patients undergoing reoperation after primary microdiscectomy.

Surgery for Lumbar Disc Herniation : Demographic Data and Analysis of Complications at King Hussein Medical City

Surgery for Lumbar Disc Herniation : Demographic Data and Analysis of Complications at King Hussein Medical City

Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation.

Background Outcome of lumbar disc herniation are influenced by various clinical, socioeconomic and psychological factors. In the absence of provision of medical insurances, worker's compensation and sick leave, predictors for outcome after lumbar disc herniation surgery will be different in Nepalese population. Objective To evaluate different clinical variables that can affect outcome after lumbar disc herniation surgery. Method Among 88 patients who underwent microdisectomy for lumbar disc herniation, 63 patients (43 male, 20 female) with follow up at least six months were retrospectively evaluated for clinical variables which can affect Oswestry disability index (ODI) score, its interpretation and Mcnab classification of post operative outcome. Result Average age of patients was 42.54±8.60 years. Mean follow up period was 34.89±23.80 months (range 6 -111 months). Thirty four patients had follow up period > 24 months. Mean ODI score before surgery and at final follow up was 37.87±8.76 vs 7.78±7.7; (p=0.00). Success rate was 90.47% (change in ODI score at least by 10), 93.65% (ODI score interpretation <40%), and 85.71%. (Mcnab outcome excellent and good). Significant correlation was found between age and ODI at final follow up but not with duration of symptoms. Male, non alcoholic, low level of education, numbness as a predominant symptom, disc at L4-L5 were significantly associated with better ODI at final follow up. For ODI score interpretation, gender, smoking habit, presence of leg pain as a predominant symptom were statistically significant factors whereas smoking and drinking habit, level of education, occupation, back pain and numbness as predominant pre-operative symptom, types of disc in MRI were significantly related to Mcnab outcome. There was 9.5% peri- or post-operative complications and recurrence in seven patients. Conclusion Age, gender, smoking and drinking habit, level of education, occupation, types of disc in MRI are important variables for ODI score, ODI score interpretation and Mcnab outcome.

Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases

BackgroundWe designed an easy posterolateral transforaminal endoscopic decompression technique, termed PTES, for radiculopathy secondary to lumbar disc herniation. The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications.MethodsPTES was performed to treat 209 cases of intracanal or extracanal herniations with or without extruding or sequestrated fragment, high iliac crest, scoliosis, calcification, or cauda equina syndrome including recurrent herniation after previous surgical intervention at the index level or adjacent disc herniation after decompression and fusion. Preoperative and postoperative leg pain was evaluated using the 10-point visual analog scale (VAS) and the results were determined to be excellent, good, fair, or poor according to the MacNab classification at 2-year follow-up.ResultsThe patients were followed for an average of 26.3 ± 2.3 months. The VAS score of leg pain significantly dropped from 9 (6–10) before operation to 1 (0–3) (P < 0.001) immediately after the operation and to 0 (0–3) (P < 0.001) 2 years after operation. At 2-year follow-up, 95.7% (200/209) of the patients showed excellent or good outcomes, 2.9% (6/209) fair and 1.4% (3/209) poor. No patients had any form of permanent iatrogenic nerve damage and a major complication, although there were one case of infection and one case of recurrence.ConclusionsPTES for lumbar disc herniation is an effective and safe method with simple orientation, easy puncture, reduced steps, and little X-ray exposure, which can be applied in almost all kinds of lumbar disc herniation, including L5/S1 level with high iliac crest, herniation with scoliosis or calcification, recurrent herniation, and adjacent disc herniation after decompression and fusion. The learning curve is no longer steep for surgeons.

Immediate post-discectomy percutaneous facet nerve continuous and nerve root pulsed radiofrequency and intraluminal injection of steroid with hyaluronidase improved outcome of surgery for lumbar disk herniation

ObjectivesEvaluation of effects of postoperative (PO) facet nerve continuous thermal radiofrequency neurotomy (CTRFN), nerve root pulsed RF (PRF) and triamcinolone with hyaluronidase injection on outcome of patients undergoing open lumber discectomy.Patients & methodsSeventy patients were allocated into the following groups: Group S underwent open discectomy alone and Group M underwent open discectomy followed by the three adjuvant procedures. Low back pain (LBP) severity was assessed using numeric rating scale (NRS) and disability was assessed using the Oswestry Disability Index (ODI). Primary outcome measure was at least 50% improvement of NRS and ODI. Secondary outcome involved scoring of pain medication requirements, Odom's criteria for improvement of preoperative abnormal findings and patients' satisfaction.ResultsThroughout 12-m follow-up, mean NRS and ODI scores of all patients were significantly lower than preoperative scores with significantly lower scores in group M than in group S. Frequency of patients had ⩾50% improvement which was significantly higher in group M than in group S. Patients of both groups showed significant reduction of scoring of consumed analgesics with significantly less consumption of PO analgesics in group M than in group S. Odom's scoring, resumption of activity and overall satisfaction scoring were significantly higher in group M than in group S.ConclusionOpen discectomy provided significant improvement of LBP and disability secondary to LDH. Discectomy with adjuvant therapy including PRF, CTRFN and triamcinolone and hyaluronidase intraluminar injection significantly improved outcome compared to discectomy alone.

Effect of traditional Chinese medicine-based nursing intervention on gastrointestinal function, psychological mood, and pain in patients after surgery for lumbar disc herniation

Effect of traditional Chinese medicine-based nursing intervention on gastrointestinal function, psychological mood, and pain in patients after surgery for lumbar disc herniation

Perspective of Lumbar Segmental Instability for Surgical Evalua tion of Lumbar Disc Herniation

Surgery of lumbar disc herniation is most common procedure in neurosurgical practice. However poor outcomes, recurrent disc herniation and recurrence of low back and leg pain which affect quality of life, are still challenging. Lumbar spine instability develops as a result of a gradual degenerative process and lumbar segmental instability is one of main reason of failed back surgery. Presence of lumbar segmental instability or potential secondary instability after surgery should not be overlooked. Accurate preoperative evaluation of patients with lumbar disc herniation needs to understand biomechanics of spinal stability and predict possible result of postoperative instability. Thus failure of treatment modalities can be avoided.

Clinical and surgical outcomes of upper lumbar disc herniations: a retrospective study

Background/aim: Upper lumbar disc herniation (LDH), generally involving L1?L2 and L2?L3 level herniation, is less common than lower LDH and, in this retrospective study, the clinical and radiological findings of patients who suffered from upper LDH and were operated on due to this pathology were reviewed. Materials and methods: Data regarding neurological and radiological findings of patients operated on between January 2005 and December 2013 were retrospectively collected. During this period, 3494 patients had surgery for LDH, and 129 of these patients had disc herniation at the upper levels. Seventy-eight patients with proper follow-up and data were included in the study. Results: There were 39 males and 39 females enrolled in the study. Twenty-one patients (0.6%) were operated on due to L1?L2 disc herniation and 45 (1.2%) had L2?L3 disc herniation. Twelve (0.3%) patients had disc pathologies at both levels. The mean age of the population was 59.9 years old, and this was significantly higher than lower LDH averages previously described in the literature (42 years old). Cauda equina signs and urinary disturbances were frequently seen, in addition to symptoms related to back and leg pain, neurologic claudication, and weakness in lower extremities. Conclusion: Upper LDHs requiring surgical therapy are extremely rare, more so than other LDHs. They are more frequent among older patients and are often present along with signs of cauda equina and urinary dysfunction.

Is there a relationship between blood lipids and lumbar disc herniation in young Turkish adults?

IntroductionAtherosclerosis might diminish the nutrient supply to intervertebral discs (IVD), leading to disc herniation. Therefore, there is interest in determining the possible association between the blood lipid profile and lumbar disc herniation (LDH). We aimed to evaluate the association between blood lipids and LDH in a homogeneous group of patients, controlling for age- and sex-specific effects.Material and methodsThis is a case-control study which consisted of 100 individuals (mean age: 41.25 ±9.09; 50 men and 50 women), classified into two groups, as follows. Group I (G-I) consisted of 50 patients who underwent surgery for symptomatic LDH, while group II (G-II) consisted of 50 patients with nonspecific complaints of a headache, but with no previous history of back and/or leg pain, recruited among patients admitted to the outpatient clinic at the time of the study, and whose age and sex were matched to the study group. Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, and hemoglobin A1c levels were measured. The TC/HDL-C ratio was calculated. Blood pressure, waist circumference, body mass index, and the history of smoking were included in the analysis.ResultsThe mean values of the TC, TG, LDL-C, HDL-C levels and TC/HDL-C ratio were 198.38, 132.76, 131.9, 40.38 mg/dl and 5.09, respectively. No statistically significant relationship between the blood lipid profile and LDH was identified in this population.ConclusionsBlood lipid levels in this young adult Turkish population did not predict LDH, and may not be a leading cause of IVD ischemia and IVD degeneration.

The Significance of Foraminotomy in Lumbar Herniated Disc Surgery

Introduction: Spinal column represents a strong and flexible body axis. It is consisted of vertebrae which are connected by the intervertebral disk and solid fibrous joints. Aim of the Study: To ascertain whether or not and to what extent foraminotomy affects the final outcome of lumbar herniated disc surgery. Patients and Methods: This retrospective study analyzed 71 patients who were operated at the Clinic of Neurosurgery in Banja Luka, in the period from 2009 to 2016. Extirpation of disc was performed in 41 respondents, while in 30 patients, a nerve root was further alleviated, along with the extirpation of disc. All patients were operated under the same conditions. Results: There was no statistically significant difference in the age of women and men who underwent classical discectomy and foraminotomy. There was a statistically significant difference in the disc protrusion and extrusion in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was no statistically significant difference in diagnosis in respondents who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was statistically significant difference in the severity of pain in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was a statistically significant difference in clinical recovery, where the findings were in favor of the respondents who underwent foraminotomy, compared to the respondents who did not. Discussion: The treatment of this syndrome is complex, multidisciplinary and with problematic success, and in cases when the operation is performed, the results are not as good as in the primary operation. Conclusion: The results of this study show that the patients who underwent foraminotomy during the operation of prolapsed lumbar disc have a clinically better result.

Recurrent Lumbar Disc Herniation: Conventional Re-discectomy Versus TLIF with Unilateral Fixation

Background Data: Recurrent lumbar disc herniation is reported from 5 to 11%. Optimal surgical approach for recurrent disc prolapse is controversial. Some authors believe that repeat discectomy is the treatment of choice, with similar clinical results compared to the primary procedure. Some spine surgeons believe that fusion is necessary for treating disc reherniation. Purpose: Our aim is to compare the clinical outcome in patients with recurrent lumbar disc herniation operated by conventional rediscetomy versus those operated by TLIF with unilateral pedicle screw fixation.Study Design: A descriptive controlled, non-randomized, retrospective, clinical study. Patients and Methods: Forty patients underwent surgery for recurrent lumbar disc herniation. They were divided into two groups; re-discectomy group and TLIF with unilateral fixation group. Each group included 20 patients. They were operated between 2008 and 2016. Participants were evaluated pre-operatively and post-operatively every three months. Operative time, hospital stay and complications were assessed. Pain was scored by a VAS for both lower limbs and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale. In addition fusion was looked for radiologically. Results: The two groups of patients were fairly homogeneous and comparable. TLIF group showed better clinical outcome parameters including better VAS for low back pain and better Prolo economic, functional rating scale. In comparison the re-discectomy group showed significantly higher complications and reoperation during the follow up period. Conclusion: Patients with recurrent lumbar disc herniation operated by TLIF with unilateral spinal fixation reported less pain & lower disability scores all over the follow up period. This technique is preferable to conventional re-discectomy because it avoids the possibility of recurrence and has less postoperative complications. (2016ESJ124)

P160 - Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us?

Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined. Methods: A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion. Results: A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy. Conclusion: The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery, particularly in the current advertising climate greatly favoring MIS.