Surgery For Lumbar Disc Herniation Research Articles

Gender differences in patients scheduled for lumbar disc herniation surgery: a National Register Study including 15,631 operations.

Previous studies have shown gender differences in preoperative status and outcome of spine surgery. This study explores whether gender differences in preoperative demographics exist in patients scheduled for lumbar disc herniation (LDH) surgery. This study includes the preoperative data of the 15,631 patients operated for LDH between years 2000 and 2010, registered in the national Swedish spine register (SweSpine). We analysed preoperative gender differences in age, smoking habits, walking distance, consumption of analgesics, back and leg pain (Visual Analogue Scale; VAS), quality of life (EuroQol; EQ 5D and Short Form-36 Questionnaire; SF-36) and disability (Oswestry Disability Index; ODI). 44 % of the patients were women (mean age 45 ± 13) and 56 % men (mean age 44 ± 13). More women than men were smokers (26 versus 21 %, p < 0.001). Women also reported inferior walking ability (less than 100 metre walking ability 37 vs 30 %; p < 0.001), consumed more analgesics (92 versus 84 %; p < 0.001), reported higher level of pain (mean difference VAS leg 6 (95 % CI 5-7)), had inferior health-related quality of life (mean difference EQ 5D 0.07 (95 % CI 0.05-0.08)) and had higher disability (mean difference ODI 6 (95 % CI 5-6)). Women scheduled for LDH surgery report inferior clinical status than men scheduled for the same operation. We have in the literature found no evidence-based data that support such a difference, and the reason for the discrepancy is unclear.

Synthesis of the 19th ArgoSpine Symposium.

After a short introduction of the meeting by the President 2015, Wilco Peul, the opening lecture was delivered by Bart Koes, who dealt with Health Technology Assessment and Guidelines. Then, it was the turn of Carmen Vleggert to show whether there was any Evidence for the Use of Implants in Spinal Stenosis. The final presentation of this session was delivered by Björn Strömqvist who dealt with Surgery for Lumbar Disc Herniation, patients' selection and outcomes. Developing the subject of "Do Not's", Jeremy Fairbank described the UK experience for Low Back Pain. Yves Coppens then took over and further elaborated on "Lucy's legacy". Prof. Coppens recalled that Lucy is a partial skeleton of a pre-human found in Ethiopia among other remains. Prof. Alan Crockard offered what he called "a whimsical view" of his practice of Craniocervical Surgery. Wafa Skalli was asked to speak about Finite Element Analysis of the Spine and Arts et Métiers Paris Tech where there is a long tradition of close collaboration between engineers and clinicians. Rune Hedlund, who will serve as 2016 Symposium President, further elaborated on Scoliosis with a focus on Unsolved Issues in Adolescent Idiopathic Scoliosis Treatment.

Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation. A prospective study on 177 patients

The role of inflammation and fibrinolysis for the development of back pain and sciatica has been discussed. The aim of this study was to assess the relationship between markers of inflammation and fibrinolysis, to predict the outcome after surgery for lumbar disc herniation. 177 patients were recruited. High sensitive C-reactive protein (hsCRP), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, and D-dimer were analyzed preoperatively. Visual analogue scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and EuroQol 5 Dimensions (EQ-5D) were assessed preoperatively and at 6 weeks, 6-, 12-, and 24- months postoperatively. Dichotomization was made at the median for the laboratory analyses, and between the worst quartile and the other three quartiles for the outcome variables. Logistic regression was used to determine the odds ratios (OR) and 95 % confidence intervals (CI). The associations between PAI-1 and outcome seemed to be most prominent at the 6 and 12-month follow-up. When being in the upper half of PAI-1, the OR for being in the worst quartile of VAS back pain 12 months postoperatively was 3.33 (1.56-7.10). The corresponding OR for VAS leg pain was 2.46 (1.18-5.10), for ODI 2.83 (1.35-5.94) and for EQ-5D 2.73 (1.30-5.75). The OR for hsCRP was 2.10 (1.03-4.29) for being in the worst quartile of VAS back pain. Fibrinogen or D-dimer was not associated with any outcome variable. High PAI-1, a marker of fibrinolysis, was fairly consistently associated with poor outcome, while hsCRP, fibrinogen, and D-dimer were not.

When Would a Spine Surgeon Have Surgery for a Herniated Disc?

Introduction Surgical indications are not always clear cut and patients need to participate in the process of making an informed decision, weighing the potential risks, and benefits to have surgery or not. This decision is likely heavily influenced based on their pain level, work, and activity limitations. There is much information available on the outcomes and complications of surgery for lumbar disc herniation. The purpose of this study was to determine for which indications spine surgeons would have surgery themselves. Materials and Methods A survey was designed using Survey Monkey, which ensures responses are anonymous. The survey was sent to the ISASS surgeon membership. The survey collected basic demographics. The scenario for seeking treatment was that if you had sciatica with a 5 mm disc herniation identified on MRI and pain at the confirmed level, when would you consider some form of direct decompressive surgery? The second set of questions addressed if in the same circumstances and having failed nonoperative care, separately assessed pain level, work limitation level, and nonwork activity limitation level for which the surgeon would have spine surgery to treat the herniated disc. Results There were 67 responses to the survey. The majority of those completing the survey were in the age ranges of 45 to 54 years (40.3%) and 55 to 64 years (35.8%). The most frequent response selected to the question about the number of years in practice was 21 to 30 years (43.3%). More than half selected one of the two categories indicating performing between 100 and 300 spine surgeries a year. The majority of responses came from members in the United States, but there were participants from Canada, Australia, Europe, and Asia. Responses to the question about having surgery for a 5 mm herniation indicated that 75.8% of surgeons would have surgery if they had buttock and leg pain below the knee that limited work activities 2 of 5 days so that on those 2 days you had to stop after half day of work. Less than 20% would have surgery if symptoms interfered with nonwork activities, but not work. Of note, 18.2% indicated that they would not have surgery for the herniated disc regardless of the symptoms experienced. The second series of questions separately assessed pain, work, and nonwork activities. With respect to pain intensity, on a 0 to 10 scale, 63.6% would have surgery for scores of 7 to 10. With respect to work, 39.4% indicated they would have surgery if experiencing continual pain at work, 34.8% would have surgery if able to work only half days, and 19.7% would have surgery only if they were unable to work at all. Partial limitation of activities would lead 28.4% of respondents to have surgery, while 68.7% would have surgery if their activities were severely limited. Discussion The results of this survey found that many spine surgeons would have surgery if the pain was 7 or greater on a scale of 10, they continually experienced pain during work or had severely limited activities. Interestingly, 18.2% indicated they would not have surgery regardless of symptoms.

Relevance of Signs and Symptoms in the Prognosis of Patients with Lumbar Disc Herniation

Introduction Lumbar disc herniation (LDH) is currently a prevalent pathology which leads to physical, psychological, and social limitations for the patient. The most frequent signs and symptoms are lumbocyatalgia, motor and sensitive disorders, and Lasègue sign. In patients with LDH refractory to medical treatment, discectomy is the standard procedure to improve the symptoms. The objective of this study is to study the prognostic relevance of signs and symptoms in patients with LDH refractory to medical treatment. Materials and Methods a systematic review was performed in the main biomedical databases, searching for articles that studied the percentage of improvement and prognostic value of the preoperative signs and symptoms of patients with LDH. The signs and symptoms evaluated were lumbar pain, leg pain, motor and sensitive disorders and Lasègue sign. Results Some authors found that the preoperative low back pain was a negative predictor of outcome after LDH surgery whereas others did not find a correlation with prognosis. The more intense the leg pain the better were the results as the duration of the symptoms was less than a mean time of 6 months. The sensitive deficit in the leg and Laségue sign were usually reported as positive prognostic factors. The different study designs and instruments to assess the outcome explained some disagreement observed in the literature. Conclusion The literature shows that the success rate in surgery of patients with LDH refractory to medical treatment is correlated with the absence of lumbalgia, the presence of cyatalgia over up to 6 months, the sensitive deficit present alone or associated with MD, and the presence of a positive Lasègue sign during the preoperative period.

Economic Evaluation of Lumbar Disc Herniation Surgery in Brazilian Health

Introduction Lumbar discectomy is one of the most common surgical procedures, with success rates greater than 80%. To better understand the meaning of a good outcome in lumbar disc herniation treatment, it is important to know how much the health care system or the patient need to pay to achieve a good result. The cost–utility studies are useful to evaluate the value of health care interventions. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life years (QALY) gained in Brazil. Patients and Methods Costs of medical treatment were recorded in 143 consecutive patients who underwent open discectomy for lumbar disc herniation. Direct medical costs comprised medical reimbursement and costs of hospitalization. Indirect costs were considered the disability losses. Utilities were estimated using SF-6D–derived utilities from a 12-month variation in SF-36. A 4-year horizon with 3% discounting was applied to health utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and American Dollars ($), at an exchange rate of 2.4:1. Results Direct and indirect costs of open discectomy were estimated at an average of R$ 3.426,72 ($ 1,427.80) and R$ 2.027,67 ($ 844.86), respectively. The mean total cost of treatment was estimated at R$ 5.454,40 ($ 2,272.66) (± R$ 2.709,17/$ 1,128.82) The SF-6D utility gain was 0.0456 (95% CI: 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$ 30.828,35 ($ 12,845.14) per QALY gained. The sensitivity analysis showed a range of R$ 25.690,29 ($ 10,714.28)–R$ 38.535,44 ($ 16,056.43) per QALY gained. Conclusion Open discectomy is associated with a significant improvement in health utilities as measured by SF-6D. Open discectomy performed in the Brazilian Supplementary Health System provides a cost–utility ratio of R$ 30.828,35 ($ 12,845.14) per 1 quality-adjusted life year.

Surgical Excision of Upper Lumbar Disc Herniations

Background Data: Disc herniations at the L1/2 and L2/3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgical outcome. Spinal canals are narrower than those of lower levels, which may compromise multiple spinal nerve roots or conus medullaris. Purpose: The aim of this study to evaluate the clinical features and surgical outcomes of upper lumbar disc herniations. Study Design: A prospective descriptive clinical case study. Patients and Methods: Thirty patients underwent surgeries for single fresh lumbar disc herniation at the L1/L2 or L2/3 levels. They were operated between 2011 and 2014. Participants were evaluated pre-operatively and post-operatively at 3, 6, 9, and 12 month intervals. Pain was scored by a VAS for both lower limb and back pain. Theclinical outcomes were compared using the Prolo economic and functional rating scale. Results: The affected levels were L1/2 in 9 patients and L2/3 in 21 patients. The mean age of patients was 52.5 years and (Range=29-67). The mean follow-up period was 13.6 months. Most patients complained of back and buttock pain (27 patients, 90%),and radiating pain in areas such as the anterior or anterolateral aspect of the thigh (23 patients, 77%). Weakness of lower extremities was observed in 12 patients (39%) and sensory disturbance was presented in 15 patients (50%). Only 4 patients (13%) had undergone previous lumbar disc surgery (One patient at L1-2 and the other 3 patients at L4-5 level). Discectomy was performed in all patients. The mean values of preoperative back pain by VAS were 7.7±0.3. The mean values of radicular pain were 8.3±1.4. The mean values of preoperative Prolo Scale were 5.1±0.7. At 1 year follow upthe mean back pain on VAS decreased significantly to 2.6±0.4 (P<0.01) and the mean lower limb pain on VAS also decreased significantly to 2.5 ±0.5 (P<0.01). When the outcome was evaluated by the Prolo scale, 23% (7 of 30) of all the patients experienced excellent results, 50% (15 of 30) had good results, 23% (7 of 30) had fair results, and3% (1 of 30) had poor results. By 12 months follow up period, 73% of the study group expressed clinical success.Conclusion: Clinical features of disc herniations at the L1/2 and L2/3 levels were variable, and localized sensory change or pain was rarely demonstrated. In most cases, the discectomy was performed successfully by conventional posterior laminectomy. (2015ESJ088)

An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register

Background contextDisc-related sciatica has a prevalence of about 2% in adults, but is rare in adolescents. If conservative treatment is unsuccessful, surgery is an option. PurposeThe aim of this study was to compare the outcomes of surgery for lumbar disc herniation in adolescents with adults in the Swedish Spine Register. Study design/settingThis is a prospective observational study: National Quality Register. Patient sampleThis study included 151 patients, 18 years or younger, 4,386 patients, 19–39 years, and 6,078 patients, 40 years or older, followed for 1–2 years after surgery. Outcome measuresThe primary outcomes were patient satisfaction and global assessment of leg and back pain. Secondary outcomes were Visual Analog Scale (VAS) leg pain, VAS back pain, Oswestry disability index (ODI), and EuroQol-5 dimensions (EQ-5D). MethodsStatistical analyses were performed with the Welch F test, the chi-square test, and the Wilcoxon signed-rank test. ResultsAt follow-up, 86% of the adolescents were satisfied compared with 78% in the younger adults and 76% in the older adults group (p<.001). According to the global assessment, significantly decreased leg pain was experienced by 87% of the adolescents, 78% of the younger adults, and 71% of the older adults (p<.001). Corresponding figures for back pain were 88%, 73%, and 70%, respectively (p<.001). All groups experienced significant postoperative improvement of VAS leg pain, VAS back pain, ODI, and EQ-5D (all p<.001). ConclusionsThe adolescent age group was more satisfied with the treatment than the adult groups. There was a significant improvement in all age groups after surgery.

Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of over 39,000 Patients

Objective: To determine the long-term follow-up of the various operations for lumbar disc herniation in a large patient population. Subjects and Methods: Patients who had operations for lumbar disc herniation (microdiscectomy, endoscopic microdiscectomy and the ‘classical operation', i.e. laminectomy/laminotomy with discectomy) were collected from the world literature. Patients who had follow-ups for at least 2 years were analyzed relative to the outcome. The outcome was graded by the patients themselves, and the operative groups were compared to one another. Results: 39,048 patients collected from the world literature had had lumbar disc operations for disc herniations. The mean follow-up period was 6.1 years, and 30,809 (78.9%) patients reported good/excellent results. Microdiscectomy was performed on 3,400 (8.7%) patients. The mean follow-up was 4.1 years with 2,866 (84.3%) good/excellent results, while 1,101 (3.6%) patients had endoscopic microdiscectomy. There, the mean follow-up was 2.9 years with 845 (79.5%) good/excellent results. The classical operation was performed on 34,547 (88.5%) patients with a mean follow-up period of 6.3 years, and 27,050 (78.3%) patients had good/excellent results. These results mirror those with discectomy and the placement of prosthetic discs. Conclusions: The analysis of 39,048 patients with various operations for lumbar disc herniation revealed the same pattern of long-term results. Patients who had microdiscectomy, endoscopic microdiscectomy or the classical operation (laminectomy/laminotomy with discectomy) all had approximately 79% good/excellent results. None of the operative procedures gave a different outcome.

The Age Significance of Lumbar Disc Extrusion or Sequestration: A Systematic Review of the Literature

BACKGROUND CONTEXT : Surgery of lumbar disc extrusion or sequestration is usually reported in young adult. The significance of age has been underscored when one considers that lumbar disc herniation is the most common reason of spine surgery. Even if the procedure is non-life – threatening, a low risk of expected consequence would be far more devastating as a crisis occurring in this middle period of life. PURPOSE : To review the recent evidence for the significance of age at the time of surgery. STUDY DESIGN : Systematic review PATIENT SAMPLE: Patients who were performed surgery for lumbar disc herniation. OUTCOME MEASURES: Age of patients at the time performedt surgery for lumbar disc herniation. METHOD : A search of Medline, Embase, Cochrane database and cross references from 1980 to 2014 was conducted to identify the mean age of patients who underwent lumbar disc surgery. Two reviewers independently evaluated and extracted English published articles that contained keywords of lumbar disc herniation, extrusion and sequestration. Quality of evidence was classified into 3 levels. All of authors have no conflict of interest. RESULTS : There were totally 134 papers, 49 were excluded. Of all the 11,803 patients, 7,021 were male (59.48%) and 4,782 were female (40.52%) respectively with mean age of 41.75 years, age ranged from 18 to 96 years. All 85 articles were classified as 19 randomized controlled none concealed trials - level I, 34 prospective comparative studies - level II and 32 retrospective – level III evidence. CONCLUSION : Patients with proven damaged disc(s) are at greater risk to have lumbar discectomy at the age of 41.75 years.

Initial Discectomy Associated with Aging Leading to Adjacent Disc Disease and Recurrence.

Failure of surgery for lumbar disc herniation (LDH) can be commonly caused by recurrence. There are many debates regarding the risk factors of recurrent LDH (rLDH) and it is very difficult to define them because many clinical and complicated biomechanical parameters are involved. The purpose of study was to evaluate the long term result of re-discectomy for LDH at the same level and adjacent segments. Between 1999 and 2009, 1898 cases were operated and 142 (6.4%) patients underwent re-discectomy following initial operation. The study included 65 patients who were operated for single level discectomy, and their charts were analyzed retrospectively. There were 33 (50.8%) women and mean age was 45.5 years (24-73 years). rLDH was diagnosed at the initial level in 40 (61.5%) but adjacent and/or opposite level herniation (with or without the first level) was found in the remaining 25 cases (39.1%). Recurrence at the same level (SLG) and adjacent level groups (ALG) were similar according to the clinical outcomes in follow-up (mean 34.1 months). Admission period after initial operation was also parallel in SLG and ALG (54.7 and 53.1 months, respectively). However, the mean age of ALG (49.4 years) was significantly higher (p≤0.05) than SLG (42.8 years). After discectomy, collapsed discs are biomechanically more stable than those with preserved disc heights, and responses to axial compression on intervertebral disc pressure produced deformations of adjacent levels despite limitations. Altered biomechanical loading next to a fusion resulted in ongoing degeneration with aging at the affected entire lumbar spine.

Spontaneous Regression of Lumbar Disc Herniation After Weight Loss: Case Report.

Diagnosis, treatment, and surgery for lumbar disc herniations have existed for over a century. However, during the last three decades, there have been many new developments in imaging techniques, surgical procedures, physical medicine, and rehabilitation. In light of this, the most effective and appropriate treatment is controversial. Spontaneous regression of sequestrated, extruded, or protruded disc herniation has often been reported in the literature, although it is still a rare phenomenon. After a thorough review of the literature, we did not find any case report about this phenomenon after weight loss. In this report, though, we present a recent case about spontaneous regression of extruded disc herniation following weight loss.

Everyday memory in microsurgically treated patients after subarachnoid hemorrhage.

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

CSM 2015 Sports Physical Therapy Section Platform Presentations (Abstracts SPL1–SPL67)

CSM 2015 Sports Physical Therapy Section Platform Presentations (Abstracts SPL1–SPL67)

Four-year follow-up results of transforaminal lumbar interbody fusion as revision surgery for recurrent lumbar disc herniation after conventional discectomy

This study investigated the safety, effectiveness, and clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) for recurrent lumbar disc herniation (rLDH) following previous lumbar spine surgery. Seventy-three consecutive patients treated for rLDH between June 2005 and May 2012 were included in the study. The previous surgical procedures included percutaneous discectomy, discectomy with laminotomy, discectomy with unilateral laminectomy, and discectomy with bilateral laminectomy. The level of rLDH was L4–L5 in 51 patients, L5–S1 in 19 patients, and L3–L4 in three patients. All patients underwent reoperation using the TLIF technique. Outcomes were evaluated using the Oswestry disability index (ODI), visual analogue scale (VAS) scores for low back pain and leg pain, and the Japanese Orthopaedic Association (JOA) score, based on the results of physical examinations and questionnaires. The range of motion and disc height index of the operative segment were compared between preoperative and postoperative radiographs. The mean follow-up period was 4.1years. The VAS scores for low back pain and leg pain, ODI, and JOA score improved significantly between the preoperative and final follow-up evaluations. The mean recovery rate of the JOA score was 89.0%. The disc space height and stability at the fused level were significantly improved after surgery. The fusion rate at the final follow-up was 93.2%. There were no major complications. These results indicate that TLIF can be considered an effective, reliable, and safe alternative procedure for the treatment of rLDH.

Gender-Related Demographic Differences among Patients Scheduled for Lumbar Disc Herniation Surgery

Gender-Related Demographic Differences among Patients Scheduled for Lumbar Disc Herniation Surgery

Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5–S1 level

The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5–S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5–S1 microdiscectomy with or without implantation of an ISD. Group 1 consisted of 47 patients, with mild (n=22), moderate (n=14) or severe (n=11) degenerative disc changes who had microdiscectomy alone. Group 2 comprised 45 patients with similar types of disc changes who underwent microdiscectomy with an ISD implant. The Visual Analogue Scale (VAS) was used to grade low-back pain and postoperative clinical status was rated according to the modified MacNab criteria. Mean VAS score for low-back pain improved significantly at 1year follow-up from 7.3 at baseline to 2.75 (p<0.001) in Group 1 and from 6.7 to 1.5 (p=0.001) in Group 2. VAS score at 1year showed significant improvements in 21 Group 1 patients versus 30 Group 2 patients (p=0.001). Forty four percent of Group 1 patients and 80% of Group 2 patients showed improvement using the modified MacNab criteria. Patients in both groups reported significant improvement in sciatic pain and disability after microdiscectomy with or without an ISD implant. Patients with mild degenerative disc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion.

Lumbar disk herniation surgery: outcome and predictors.

Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery. Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation. Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power.

The impact of generalized joint laxity on the occurrence and disease course of primary lumbar disc herniation

Background contextGeneralized joint laxity (GJL) has been associated with spine-related disorders such as low back pain, accelerated disc degeneration, and recurrence after discectomy surgery for primary lumbar disc herniation (p-LDH). Generalized joint laxity might be a causative factor of p-LDH, but this relationship is poorly understood. In addition, the impact of GJL on outcomes after the treatment for p-LDH has not been reported. PurposeTo explore relationship between GJL and p-LDH and to compare clinical and radiological outcomes post-therapy in p-LDH patients with or without GJL. Study designA retrospective comparative study. Patient sampleThe study group included 203 males, and the control group included 362 males who were matched for age, race, and body mass index with the study group. Outcome measuresThe primary outcome was the presence or absence of GJL according to the Beighton scale. The secondary outcome measures included the clinical outcome according to a visual analog scale and the Oswestry disability index and the radiological outcome. MethodsWe compared baseline data between groups, and we evaluated the impact of GJL on outcomes after different types of several treatment for LDH. ResultsThe prevalence of GJL was significantly higher in the study group (10.8%) than in the matched control group (4.4%) (p=.003). In multivariate logistic regression analysis, GJL was the only significant predictor (p=.012). For all treatment methods, patients with GJL had worse clinical outcomes than did patients without GJL. In the patients treated with lumbar discectomy surgery, the differential Cobb value at the last follow-up was higher in the GJL patients than in the non-GJL patients (p=.001). ConclusionsGeneralized joint laxity was closely related to p-LDH and may be a causative factor. In addition, patients with GJL had worse clinical and radiological outcomes than patients without GJL. Consequently, GJL should be evaluated preoperatively, and this information should be communicated to p-LDH patients with GJL.

Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial

Objectives:The roles of gabapentin and pregabalin are well established in the management of chronic neuropathic pain. Here, we investigated the effectiveness of pregabalin and gabapentin for treating acute neuropathic pain following lumbar discectomy.Methods:This prospective, non-randomized, and observational study included 54 patients who experienced acute neuropathic pain after lumbar discectomy. The assessments included the Leeds assessment of neuropathic symptoms and signs scale (LANSS), the Oswestry disability index (ODI), and the visual analog scale (VAS) pre-operatively and at 3 days, 6 months, and 1 year after surgery. The LANSS scores ≧12 suggest the presence of neuropathic pain. Those patients who reported neuropathic pain were randomly treated with gabapentin or pregabalin.Results:In the gabapentin group, the LANSS scores increased to 14 at 3 days after surgery. The patients improved neurologically and on the LANSS, which decreased to 10 points 6 months after surgery and to 4 points at 1 year (P < 0·001). In the pregabalin group, the LANSS scores increased from 12 to 16 points on post-operative day 3 and then decreased to 12 and 5 at the 6-month and 1-year follow-ups, respectively (both P < 0·001). The ODI and VAS scores significantly improved in both groups (P < 0·001).Discussion:Many patients may suffer from neuropathic pain in the early post-surgical period after lumbar discectomy. Gabapentin and pregabalin are anticonvulsant agents that may decrease perioperative central sensitization and early post-surgical neuropathic pain. Gabapentin and pregabalin effectively relieved neuropathic pain and prevented the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy.