Surgery For Lumbar Disc Herniation Research Articles

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis.

The pooled data were analyzed using RevMan 5.2 software. The aim was to compare the efficacy of minimally invasive and conventional surgery for lumbar disc herniation (LDH) in Chinese Han population. China. An electronic search up to November 2013 was performed to retrieve all relevant articles. The overall standardized mean difference (SMD) for continuous outcomes and odds ratio (OR) for dichotomous variables as well as their 95% confidence intervals (CIs) were calculated to compare the efficacy of minimally invasive and conventional surgery. A total of 23 studies involving 1913 patients treated by minimally invasive surgery and 2295 patients treated by conversational surgery were included in this meta-analysis. The overall estimate indicated that minimally invasive surgery could significantly decrease the hospitalization time (SMD = -2.03, 95% CI, -2.49 to 1.56, P < 0.0001), blood loss (SMD = -2.65, 95% CI -3.33 to 1.97, P < 0.0001), incision length (SMD = -3.57, 95% CI, -4.39 to 2.75, P < 0.0001), recurrence rate (odds ratio (OR) = 0.22, 95 CI: 0.08-0.60, P = 0.003) and complications (OR = 0.47, 95% CI: 0.25-0.92, P = 0.03) and increase the postoperative excellent rate (OR = 1.82, 95% CI, 1.44-2.31, P < 0.0001) compared with conventional surgery. In addition, the pooled data showed that there was no statistically significant difference in the operative time (SMD = -0.58, 95% CI, -1.32 to 0.15, P = 0.12) between LDH patients treated by minimally invasive and conventional surgery. In conclusion, minimally invasive surgery was a more safe and effective treatment for treating LDH in Chinese Han population when compared with conventional surgery.

Does the Fusion of a Lumbar Disk Herniation Improve the Clinical Outcome? An Investigation With a Minimum 10-Year Follow-up

A retrospective long-term (minimum 10 y) follow-up and comparative study. To compare the clinical outcome of surgically treated primary lumbar disk herniation (LDH) by conventional discectomy alone and discectomy with posterolateral fusion without instrumentation. Primary LDH is usually treated by discectomy alone. The long-term outcome of discectomy alone is generally satisfactory. However, the superiority of a discectomy alone in comparison with a discectomy with fusion for primary LDH has yet to be determined. Conventional discectomy without fusion was performed in 39 patients in hospital A (without-fusion group) and conventional discectomy with posterolateral fusion without instrumentation was performed in 109 patients in hospital B (with-fusion group). The subjective symptoms (analgesic use, continuing gait time, 4-grade modified outcome criteria, numerical rating scale of pain and satisfaction with the operation, and the Japanese version of the Roland-Morris Disability Questionnaire) and objective symptoms (straight leg raising test, manual muscle test, and sensory disturbance) were assessed. There were no differences detected in the subjective and objective symptoms between the without-fusion and with-fusion group. Routine fusion surgery for a primary LDH was therefore found to have no apparent benefit even in the long-term outcome.

CORR Insights®: Recurrent Versus Primary Lumbar Disc Herniation Surgery: Patient-reported Outcomes in the Swedish Spine Register Swespine

CORR Insights®: Recurrent Versus Primary Lumbar Disc Herniation Surgery: Patient-reported Outcomes in the Swedish Spine Register Swespine

Operative Management of Lumbar Disc Herniation with End Plate Modic Changes Necessitates More Definite Procedures

Introduction Nucleotomy through interlaminar fenestration has been the standard operation for lumbar disc herniation, but it does not always work well in clinical practice. End plate Modic changes are strongly linked with lower back pain, and Modic changes in the end plates of the herniation level may be one reason for the unpredictable result of nucleotomy alone. Studies on more definite surgical procedures for lumbar disc herniation with end plate Modic changes are still rare. To compare the clinical outcomes between two surgical options, nucleotomy alone and nucleotomy with additional posterolateral lumbar interbody fusion (PLIF), for lumbar disc herniation patients with end plate Modic changes, and to testify the hypothesis that end plate Modic change is an indication of interbody fusion for operative management of lumbar disc herniation. Materials and Methods A total of 91 patients who complained about both lower extremity radicular pain and lower back pain (lower back pain more severe than leg pain) were included, and all of them were of single segment disc herniation with Modic changes in the corresponding lumbar degenerative end plates. Of the 91 patients, 47 were treated with nucleotomy alone and 44 were treated with posterolateral lumbar interbody fusion (PLIF) in addition to nucleotomy. They were followed up for at least 2 years. Clinical outcomes were evaluated according to the Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) for lower back pain and VAS for lower extremity radicular pain before operation and at each follow-up, and the results before surgery and at 18 months after operation were statistically compared. Results In both the groups, the JOA scores, as well as VAS, for lower back pain significantly improved 18 months after surgery. The improvement rate of JOA score and power of improvement of VAS for lower back pain also showed significant difference between the two groups, being better in nucleotomy with PLIF procedure than in nucleotomy alone procedure. On the contrary, the mean VAS of lower extremity radicular pain showed a significant reduction in both groups at the follow-up of 18 months after operation. However, a significant difference of the power of this improvement between both the groups was not found. Conclusion Operative management of lumbar disc herniation with end plate Modic changes necessitates more definite procedures in addition to nucleotomy. PLIF is a good and reliable option. Disclosure of Interest None declared

Influence of smoking status at time of surgery for herniated lumbar disk on postoperative pain and health-related quality of life

BackgroundIt is well established that smoking has a myriad of negative effects on varies aspects of bodily health. The aim of this study was to examine the effects of the smoking status at time of surgery on the postoperative subjective pain course and health related quality of life (HRQoL) until 1 year after surgery for lumbar disc herniation (LDH). MethodThis prospective cohort study included patients ≥18 and ≤90 years of age with a symptomatic and radiological verified LDH. The current smoking patient collective (smoking 1 or more cigarettes a day) was compared with the nonsmoking collective (previous smokers without cigarette consumption for >2 months and never smokers) in respect of subjective pain sensation (measured with the visual analogue scale (VAS)) and HRQoL using the short-form (SF-12) questionnaire preoperatively, before discharge, as well as after 4 weeks and 1 year postoperatively. The primary outcome measures were the 1-year SF-12 scores (MCS and PCS) categorized into responders and non-responders. ResultsA total of 102 patients were enrolled in the study. Thirty-eight patients were current smokers (37.2%), whereas 43 (42.2%) and 21 (20.6%) patients were never-smokers and previous smokers, respectively. Four weeks and one year after surgery, both smokers and nonsmokers reported increase in the HRQoL as compared to preoperative values – the MCS increased more than the PCS. From a univariate and multivariate perspective, smoking status at time of surgery did not predict responder status. ConclusionsThe present study results could not confirm the hypothesis that smoking at time of surgery was associated with worse outcome after surgery for LDH.

Recurrent Versus Primary Lumbar Disc Herniation Surgery: Patient-reported Outcomes in the Swedish Spine Register Swespine

BackgroundLumbar disc herniation (LDH) is a common indication for lumbar spine surgery. The proportion of patients having a second surgery within 2 years varies in the literature between 0.5% and 24%, with recurrent herniation being the most common cause. Several studies have not found any relevant outcome differences between patients undergoing surgery for primary LDH and patients undergoing reoperation for a recurrent LDH, but these studies have limitations, including small sample size and retrospective design.Questions/purposesWe (1) compared patient-reported outcomes between patients operated on for primary LDH and patients reoperated on for recurrent LDH within 1 year after index surgery and (2) determined risk factors for worse outcomes.MethodsWe obtained data from the Swedish National Spine Register, Swespine, where patient-reported outcomes are collected using mailed protocols at 1, 2, 5, and 10 years after surgery. Of the 13,562 patients identified who underwent LDH between January 2000 and May 2011, 13,305 (98%) underwent primary surgery for LDH and 257 (2%) underwent reoperation for a recurrent LDH within the first year. Patient-reported outcomes at 1 to 2 years were available for 8497 patients (63%), 8350 of 13,305 (63%) in the primary LDH group and 147 of 257 (57%) in the recurrent LDH group (p = 0.068). We compared leg and back pain (VAS: 0–100), function (Oswestry Disability Index [ODI]: 0–100), quality of life (EQ-5D: −0.59 to 1.0), patient satisfaction, and global assessment of leg pain between groups. We also analyzed rsik factors for worse global assessment and satisfaction.ResultsMean (95% CI) differences in improvement between groups favoring patients with primary LDH were VAS leg pain 9 (4–14), ODI 6 (3–9), and EQ-5D 0.09 (0.04–0.15). While statistically significant, these effect sizes may be lower than the minimal clinically important differences often referred to. Percentage of satisfied patients was 79% and 58% in the primary and recurrent LDH groups, respectively (p < 0.001), and percentage of patients with no or better leg pain (global assessment) was 74% and 65%, respectively (p = 0.008). Reoperation for recurrent LDH represented the largest independent risk for dissatisfaction; this factor and smoking represented similar risks for less improvement in leg pain.ConclusionsRepeat surgery for a recurrent LDH was performed with good probability for improvement, although not as good as for primary LDH surgery, and patients undergoing repeated surgery were less satisfied. Studies on risk factors for recurrence are warranted.Level of EvidenceLevel II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Clinical Outcome of Fusion in Recurrent Herniated Lumbar Disc

Background Data: Discectomy in recurrent lumbar disc herniation may not be an efficient treatment without fusion especially with prominent low back pain after primary surgery; therefore discectomy with fusion may be a good solution inrecurrent lumbar disc herniation. Purpose: The goal of this study was to focus on the efficacy of fusion in recurrentlumbar disc surgery. Study design: This study was carried out at different hospitals and the data was collected prospectively and retrospectively. Patients and methods: 50 patients (30 males and 20 females) underwent revisionsurgery following primary lumbar discectomy between 2009 and 2013. This study includes (50) patients with clinically and radiologically documented recurrentlumbar disc herniation scheduled for surgery. This includes (30) males and (20)females. All patients had a discectomy and postero-lateral fusion in re-operation. Patients’ age ranged from 25 years to 45 years with mean age 30 years. All patients in this study were presented with low back pain and recurrent radicular pain with mean duration of 21 months. Peri-operative assessments were carried using “Japanese Orthopedic Associationscore” (JOAs), and radiographic follow-up. Results: Follow-up ranged from 12-36 months with a mean follow-up 22.9 months; 25 patients had an excellent outcome, 20 patients had a good outcome, 3 patients had a fair outcome, and 2 patients had a poor outcome. Conclusion: Fusion surgery for recurrent lumbar disc herniation is effective and beneficial procedure. (2014ESJ062)

腰椎椎間板ヘルニアに対する低侵襲手術 — MD法, MED法, micro-Love法の比較 —

腰椎椎間板ヘルニアに対する低侵襲手術 — MD法, MED法, micro-Love法の比較 —

Early surgical education of residents is safe for microscopic lumbar disc surgery

It is a well-established dogma that many surgeons do not reach a quintessential level of their technical operative skills until successful completion of their training program. The aim of this study was to test the hypothesis that early introduction of supervised residents to non-complex spinal surgical procedures within a structured and supervised educational program does not harm the patient in terms of higher complication rates or worse pain- and health-related quality of life (HrQOL) outcomes. A prospective study on 102 patients undergoing surgery for lumbar disc herniation (LDH) was performed. The procedures were dichotomized into two groups according to the surgeon's level of experience: teaching cases (neurosurgical residents in the 1st to 4th year of training) and non-teaching cases (experienced board-certified faculty neurosurgeons). Pain levels (VAS) and the HrQOL using the 12-item short-form health survey (SF-12) were measured at baseline, at 4 weeks and as a survey at 1 year postoperatively. In addition, data concerning the operation and the postoperative course including common complications were assessed. Intraoperative blood loss, length of surgery, as well as intra- and postoperative complications were similar between the study groups. Patients in both groups achieved equal results in terms of pain reduction after 4 weeks [mean VAS change -3.8 (teaching cases) vs. -3.1 (non-teaching cases), p = 0.25] and 1 year postoperatively [mean change in VAS -3.5 (teaching cases) vs. -3.37 (non-teaching cases), p = 0.84]. Teaching cases were 100 % (odds ratio of 1.00) as likely as non-teaching cases to achieve a favorable HrQOL response to surgery (p = 0.99). Early introduction of resident surgeons to lumbar microdiscectomy can be conducted safely within a structured and supervised educational program as it neither harms the patient nor leads to worse 1-year results. Surgical resident education may thus be implemented safely in times of rigorous working laws. However, a structured education program in which the senior surgeon gives advice, guidance and communicates cautions during each resident surgery is of paramount importance to provide high-quality patient care.

Obesity as a Risk Factor for Sciatica: A Meta-Analysis

The aim of this study was to assess the associations of overweight and obesity with lumbar radicular pain and sciatica using a meta-analysis. We searched the PubMed, Embase, Scopus, and Web of Science databases from 1966 to July 2013. We performed a random-effects meta-analysis and assessed publication bias. We included 26 (8 cross-sectional, 7 case-control, and 11 cohort) studies. Both overweight (pooled odds ratio (OR) = 1.23, 95% confidence interval (CI): 1.14, 1.33; n = 19,165) and obesity (OR = 1.40, 95% CI: 1.27, 1.55; n = 19,165) were associated with lumbar radicular pain. The pooled odds ratio for physician-diagnosed sciatica was 1.12 (95% CI: 1.04, 1.20; n = 109,724) for overweight and 1.31 (95% CI: 1.07, 1.62; n = 115,661) for obesity. Overweight (OR = 1.16, 95% CI: 1.09, 1.24; n = 358,328) and obesity (OR = 1.38, 95% CI: 1.23, 1.54; n = 358,328) were associated with increased risk of hospitalization for sciatica, and overweight/obesity was associated with increased risk of surgery for lumbar disc herniation (OR = 1.89, 95% CI: 1.25, 2.86; n = 73,982). Associations were similar for men and women and were independent of the design and quality of included studies. There was no evidence of publication bias. Our findings consistently showed that both overweight and obesity are risk factors for lumbar radicular pain and sciatica in men and women, with a dose-response relationship.

Minimally invasive surgery for lumbar disc herniation: a systematic review and meta-analysis

Assessing the benefits of surgical treatments for sciatica is critical for clinical and policy decision-making. To compare minimally invasive (MI) and conventional microdiscectomy (MD) for patients with sciatica due to lumbar disc herniation. A systematic review and meta-analysis of controlled clinical trials including patients with sciatica due to lumbar disc herniation. Conventional microdiscectomy was compared separately with: (1) Interlaminar MI discectomy (ILMI vs. MD); (2) Transforaminal MI discectomy (TFMI vs. MD). Back pain, leg pain, function, improvement, work status, operative time, blood loss, length of hospital stay, complications, reoperations, analgesics and cost outcomes were extracted and risk of bias assessed. Pooled effect estimates were calculated using random effect meta-analysis. Twenty-nine studies, 16 RCTs and 13 non-randomised studies (n=4,472), were included. Clinical outcomes were not different between the surgery types. There is low quality evidence that ILMI takes 11min longer, results in 52ml less blood loss and reduces mean length of hospital stay by 1.5days. There were no differences in complications or reoperations. The main limitations were high risk of bias, low number of studies and small sample sizes comparing TF with MD. There is moderate to low quality evidence of no differences in clinical outcomes between MI surgery and conventional microdiscectomy for patients with sciatica due to lumbar disc herniation. Studies comparing transforaminal MI with conventional surgery with sufficient sample size and methodological robustness are lacking.

A Survey on the Exercise Program after Surgery for the Herniated Lumbar Disc in the Hospital Websites

Study Design: Exercise therapy after lumbar disc herniation surgery which is presented through hospital website was studied. Objectives: To assess the efficacy of exercise therapy after lumbar disc herniation surgery; the methods of evaluation are identified through the participating hospital’s web site and exercise therapy that is presented on reference is compared. Summary of Literature Review: Exercise therapy after lumbar disc herniation surgery is effective; however, patient training is needed to ensure compliance. Materials and Methods: After searching on five different portals using the term ‘spine surgery,’ 230 websites were retrieved. The performance of lumbar disc herniation surgery and presentation of postoperative exercise therapy was discovered and the presentation of exercise therapy for surgery type and departments difference were investigated. Exercise therapy were classified according to purposes and method for reference and the number of each exercise therapy was investigated. Exercises which were divided by postoperative period were also investigated. Results: In 230 websites were retrieved; there were a total of 103 hospitals performing lumbar disc herniation surgery: 23 websites (22%) proposed exercise therapy after surgery is 23(22%), and 2(9%) of websites proposed exercise therapy for the type of surgery. The number of exercise therapy proposed by the website was 15; of the exercises mentioned, deep abdominal muscle contractions was the most commonly mentioned, using the treadmill was least. There were 5 websites that proposed exercise therapy divided by postoperative period. Conclusions: Only 22% of hospitals with websites that performed lumbar disc herniation surgery proposed postoperative exercise therapy. Although th common trends seem biased, postoperative exercise therapy needs more attention and the construction of websites for patient access is necessary to provide better rehabilitation for patients.

Use of Annular Closure Device (Barricaid®) for Preventing Lumbar Disc Reherniation: One-Year Results of Three Cases

Although lumbar discectomy is an effective treatment for lumbar disc herniation, complications exist, including postoperative disc height loss, facet joint degeneration, and recurrent disc herniation. To solve these problems, annular closure devices have been utilized in other countries, producing satisfactory results, but there has been no report of annular closure device use in our country. Here, we demonstrate the preliminary reports of Barricaid® insertion in 3 patients who underwent surgery for lumbar disc herniation.

Lumbosacral Transition Vertebra: Prevalence and Its Significance

Study DesignRetrospective analysis of radiological images.PurposeTo determine the prevalence of lumbosacral transition vertebra (LSTV) and to study its significance with respect to clinically significant spinal symptoms, disc degeneration and herniation.Overview of LiteratureLSTV is the most common congenital anomaly of the lumbosacral spine. The prevalence has been debated to vary between 7% and 30%, and its relationship to back pain, disc degeneration and herniation has also not been established.MethodsThe study involved examining the radiological images of 3 groups of patients. Group A consisted of kidney urinary bladder (KUB) X-rays of patients attending urology outpatient clinic. Group B consisted of X-rays with or without magnetic resonance images (MRIs) of patients at-tending a spine outpatient clinic, and group C consisted of X-rays and MRI of patients who had undergone surgery for lumbar disc herniation. One thousand patients meeting the inclusion criteria were selected to be in each group. LSTV was classified by Castellvi's classification and disc degeneration was assessed by Pfirrmann's grading on MRI scans.ResultsThe prevalence of LSTV among urology outpatients, spine outpatients and discectomy patients was 8.1%, 14%, and 16.9% respectively. LSTV patients showed a higher Pfirrmann's grade of degeneration of the last mobile disc. Results were found to be significant statistically.ConclusionsThe prevalence of LSTV in spinal outpatients and discectomy patients was significantly higher as compared to those attending the urology outpatient clinic. There was a definite causal relationship between the transitional vertebra and the degeneration of the disc immediately cephalad to it.

Remote cerebellar hemorrhage as an early and potentially lethal complication of a discal lumbar herniation surgery

Remote cerebellar hemorrhage (RCH) is an infrequent but serious complication after lumbar herniation surgery. Little is known about this complication but excessive cerebrospinal fluid (CSF) leakage is thought to be a leading cause of RCH. We describe the case of a patient suffering from a life-threatening RCH, which occurred a few hours after lumbar disc herniation surgery.

Local irrigation of the surgical field with antibiotics in the end of procedure reduces the infection rate in herniated lumbar disc surgery.

Introduction:Reported rate of infections after lumbar discectomy is 1%–15 %. This complication may result in disability or even the death.AimThe aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed.Patients and methods:In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatient’s clinic along postoperative course of three months.Results:A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 20–65 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus.Conclusion:Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only.

Early Outcome of Sciatica after Redo Surgeries for Recurrent Lumbar Disc Herniation

Background Data: Result of redo discectomies varies widely in the literature. This may be due to variability in inclusion criteria and associated pathologies which may alter results. We tried to evaluate the early outcome of recurrent sciatica after redo discectomies in highly selected cases and risk factors for poor outcome. Purpose: to assess the rate of success of redo lumbar discectomy in patients with recurrent sciatica. Study Design: A retrospective clinical case studyPatients and Methods: A retrospective study including 30 cases with recurrent sciatica caused by true recurrent disc herniation over a period of 8 years. Clinical and radiological data were analyzed for proper selection and to exclude cases with associated pathologies. A Visual Analogue Scale was used to score pain severity before and after surgeries. Complications following redo surgeries were classified as minor and major. The outcome depended on pain relief and complications. Probable risk factors were recorded to detect those that might have contributed for unsatisfactoryresults. Results: Outcome was satisfactory in 20 cases, accepted in 6 cases and unsatisfactory in 4 cases. The overall improvement in sciatic pain after redo surgeries was comparable with that following primary surgery. We found diabetes the major risk factor for unsatisfactory results. Conclusion: Redo discectomy for recurrent sciatica proved to be of value and high rate of success when attempted in well-selected cases. (2014ESJ065)

The relationship between morphology of lumbar disc herniation and MRI changes in adjacent vertebral bodies.

Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE) and T2 MRI (long TR/TE). The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients' age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes) demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%). However, patients with protruded discs showed less changes (30.9%). It showed that the difference was statistically significant (P<0.05). Extruded discs are associated with increased signal in T1-weighted MRI (short TR/TE) in the upper adjacent vertebrae. Signal changes in T2-weighted MRI (long TR/TE) in upper adjacent vertebrae are significantly more common in extruded discs, in comparison with protruded discs.

Spinal textiloma (gossypiboma): a report of three cases misdiagnosed as tumour.

Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. Retrospective study. This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes.

Microdiscectomy for recurrent L5–S1 disc herniation

Recurrent lumbar disc herniation (RLDH) is a complication in the surgery for lumbar disc herniation (LDH). In different cohorts, a range between 0.5 [3] and 25 % [5] of patients primarily operated for LDH suffered from RLDH (symptomatic or asymptomatic). Many of them needed repeat surgery. Risk factors for RLDH seem to include obesity, smoking and persistence of weight lifting after first surgery [2, 4–6]. Male patients who undergo surgery when still young carry a higher risk of recurrence [3]. Surgical management and decisions are variable, and they depend on many aspects: patient age, level of discopathy, foraminal stenosis and segmental instability. There is good common agreement about the indication of selective excision of the prolapsed disc in cases of first recurrence of disc herniation, unless instability or significant chronic low back pain emerging from the affected disc is present [1, 5, 7]. In the remaining cases, dynamic stabilization or, more commonly, spinal fusion is frequently indicated [7].