Surgery For Lumbar Disc Herniation Research Articles

腰部脊柱管狭窄を合併した腰椎椎間板ヘルニア症例に対する全脊椎内視鏡治療．後方除圧併用でのヘルニア摘出術（FEL）と前方除圧術（FELD TF）の比較

腰部脊柱管狭窄を合併した腰椎椎間板ヘルニア症例に対する全脊椎内視鏡治療．後方除圧併用でのヘルニア摘出術（FEL）と前方除圧術（FELD TF）の比較

It is evident when to make a surgery for lumbar disc herniation?

It is evident when to make a surgery for lumbar disc herniation?

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Adjacent segment disease following anterior cervical fusion and the presence of surgery for lumbar disc herniation and surgery at the musculoskeletal joints: are they related?

A potential correlation between surgery for symptomatic adjacent segment degeneration (sASD) and the development of degenerative disease of the lumbar spine or osteoarthritis of the musculoskeletal joints remains to be determined. To assess the rate of sASD following anterior cervical discectomy and fusion (ACDF), the rate of lumbar discectomy (LD), and rate of surgery performed for osteoarthritis at the joints of the musculoskeletal in a long term follow-up. Cohort study OUTCOME MEASURES: Repeat procedure for sASD, microsurgical LD (MSD), and/or the musculoskeletal joints (shoulder, knee, hip). Retrospectively, a total of 833 consecutive patients who underwent ACDF for degenerative disorders ≥20 years ago were identified. Charts were reviewed for preoperative neurological status, smoking status, physical labor, and repeat procedures. Missing data lead to exclusion from follow-up assessment. At final follow-up the need for pain medication, Neck disability index (NDI), and Odoms criteria were evaluated. An MRI was performed to assess the grade of degeneration of the cervical spine via the segmental degeneration index (SDI). Patients without (group 1) and with (group 2) repeat procedure for sASD were compared. Collectively, 313 patients met inclusion criteria and 136 patients were evaluated. The mean follow-up was 26 years. Clinical success rate according to Odoms was 85.3%, mean NDI was 14.4%, the rate of regular intake of pain medication was 14.7%, the rate of repeated procedure for sASD was 10.3%. MSD was performed in 23.5%, surgery for osteoarthritis of the shoulder, the hip, and the knee were performed in 11.8%, 6.9%, and 27.7%, respectively. The rate of MSD (p=.018) was significantly higher in group 2 compared to group 1. Gender, smoking status, surgery of the musculoskeletal joints, and the grade of degeneration of the cranial and caudal adjacent segments were similar between group 1 and group 2. The overall clinical success following ACDF was 85.3%. The rate of repeat procedure for sASD was 10.3% within 26 years. Patients with sASD had a significantly higher rate of MSD and poorer clinical outcome compared to patients without sASD.

Clinical outcomes of spinal endoscopic surgery for tiny lumbar disc herniation with severe radiating pain of lower limb

To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD). From January 2014 to February 2019, 34 patients with tLDHSS were reviewed retrospectively, including 20 males and 14 females, aged from 31 to 73 (48.8±10.1) years, with a follow up duration ranged from 8 to 48 (21.8±10.3) months. The clinical manifestations, imaging and surgical data were analyzed. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were analyzed before operation, 1 month after operation and at the latest follow-up. The preoperative and postoperativescores were compared. At the latest follow up, the Macnab system was used to evaluate the effects of the operation. The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L4, 5 and 27 cases of L5S1. According to the MSU division of lumbar disc herniation, 31 cases were located in area B. In all cases, it was confirmed that the protruding nucleus compressed the nerve root, and in 26 cases, the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min, with a mean time of (43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1± 0.3, 0.7±0.4 on the first month after operation and the latest follow up, respectively. The ODI score was 5.3±2.1 and 0 to 10 (with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores.At the latest follow up, 28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period, only one patient had recurrent disc herniation. The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients, thin layer CT scan has an important diagnostic value. In the treatment of this kind of patients, the symptoms are relieved rapidly, the curative effect is definite and the recurrence rate is low.

Assessment and Post-Intervention Recovery After Surgery for Lumbar Disk Herniation Based on Objective Gait Metrics from Wearable Devices Using the Gait Posture Index

Surgery for lumbar disk herniation (LDH) presents an option for patients when conservative measures fail. The objective of this clinical study is to investigate a novel, objective outcome measure in patients undergoing lumbar microdiscectomy. Twenty-four patients were evaluated pre- and postoperatively using the Oswestry Disability Index (ODI), and a novel objective scoring tool, the Gait Posture index (GPi). The score is calculated from 4 key physical health metrics: daily step count, walking speed, step length, and walking posture. The GPi ranges from 0 (nonambulant) to 100 (excellent walking performance). Wearable accelerometers and observational recordings were used to evaluate the components of the GPi. The GPi was calculated and compared with the ODI, pre- and postintervention. The study was designed as a proof of concept and confirmation of validity for use of the GPi in LDH. At follow-up (average 66 ± 36 days), 23 of 24 patients had an improvement in their GPi after surgery. The average GPi of the cohort improved from 59.33 ± 16.06 to 85.75± 9.22 with P < 0.001, with significant changes in all 4 components. The average preoperative ODI was 54.54 ± 20.70, improving to 16.33 ± 14.095 with P < 0.001. The Pearson correlation coefficient was r= 0.56, indicating a correlation between change in ODI and change in GPi. The GPi score is a new, objective descriptor of mobility in spinal surgery which can be used to augment traditional subjective outcome scoring surveys such as the ODI. Significant changes are seen in the GPi and its constituent metrics in patients undergoing surgery for LDH.

Percutaneous Endoscopic Lumbar Discectomy (PELD) via a Transforaminal and Interlaminar Combined Approach for Very Highly Migrated Lumbar Disc Herniation (LDH) Between L4/5 and L5/S1 Level.

BackgroundPercutaneous endoscopic lumbar discectomy (PELD) has become one of the most popular minimally invasive surgeries for lumbar disc herniation (LDH), however, very highly migrated LDH is still a tricky issue for PELD. This study reported a new endoscopic discectomy strategy for the treatment of very highly migrated LDH between the L4/5 and L5/S1 level.Material/MethodsThe current study retrospectively analyzed 12 patients who accepted PELD for very highly migrated LDH between the L4/5 and L5/S1 level. Under local anesthesia, the transforaminal approach was chosen for the L4/5 level and the interlaminar approach was chosen for the L5/S1 level. The 10-point visual analogue scale (VAS) was used to assess back pain (VAS-Back) and leg pain (VAS-Leg). Oswestry disability index (ODI) and Modified Mac Nab Criteria were adopted as the functional evaluation methods. All patients were followed in the outpatient department for at least 12 months after their operation.ResultsOur study showed that very highly migrated disc between L4/5 and L5/S1 level could be removed completely by this strategy. Except for 1 case of postoperative dysesthesia and 1 case of dural tear, no severe complication occurred. At the last follow-up, the average VAS-Back score of the study patients was reduced from 5.17±2.12 to 2.08±1.08 (P<0.05) and the average VAS-Leg score was reduced from 7.25±1.48 to 1.33±0.89 (P<0.05). The average ODI scores improved from 48.50±10.59 to 13.00±2.76 (P<0.05). According to the Modified Mac Nab Criteria, 83.33% of patients (10 out of 12 patients) received an excellent or good recovery and no poor result was reported. No recurrence was observed during follow up.ConclusionsPELD via a transforaminal and interlaminar combined approach provides an alternative option for select patients with very highly migrated LDH between the L4/5 and L5/S1 level.

Leisure Time Physical Activities and the Results of Surgery of Lumbar Disc Herniation

The aim of this study was to elucidate the consequences of leisure time physical activities on the one-year results of surgery of lumbar intervertebral disc herniation. Pre- and postoperative leisure time physical activities and severity of occupation handicap were analyzed from 212 patients. Only to a certain degree the findings support the claim that a high preoperative level of physical activities during leisure time is linked with good postoperative results.

Sequence variation at 8q24.21 and risk of back pain

Back pain (BP) is a common condition of major social importance and poorly understood pathogenesis. Intervertebral lumbar disc degeneration in all its guises is one of the major biological risk factors for BP. Previously, we identified the locus at 8q24.21 associated with chronic BP, which has been found elsewhere associated with sciatica after surgery for lumbar disc herniation. In the current study we used co-localisation methods to identify the gene most likely to harbor the causal variant. We show that the same functional variant at the 8q24.21 locus is responsible for both lumbar disc degeneration and BP, and we also studied the effects of this locus on related phenotypes. Our results link the locus to intervertebral disc and bone mineral density, but not to anthropometric measurements, thus corroborating the epidemiological evidence. Moreover, the same functional variant at the locus is more likely to affect the expression of the nearby FAM49B gene, rather than the GSDMC gene, which was previously proposed as a causative one for BP.

Intervertebral disc herniation effects on multifidus muscle composition and resident stem cell populations.

AbsractBackgroundParaspinal muscles are crucial for vertebral stabilization and movement. These muscles are prone to develop fatty infiltration (FI), fibrosis, and atrophy in many spine conditions. Fibro‐adipogenic progenitors (FAPs), a resident muscle stem cell population, are the main contributors of muscle fibrosis and FI. FAPs are involved in a complex interplay with satellite cells (SCs), the primary myogenic progenitor cells within muscle. Little is known about the stem cell composition of the multifidus. The aim of this study is to examine FAPs and SCs in the multifidus in disc herniation patients. Multifidus muscle samples were collected from 10 patients undergoing decompressive spine surgery for lumbar disc herniation. Hamstring muscle was collected from four patients undergoing hamstring autograft ACL reconstruction as an appendicular control. Multifidus tissue was analyzed for FI and fibrosis using Oil‐Red‐O and Masson's trichrome staining. FAPs and SCs were visualized using immunostaining and quantified with fluorescence‐activated cell sorting (FACS) sorting. Gene expression of these cells from the multifidus were analyzed with reverse transcription‐polymerase chain reaction and compared to those from hamstring muscle. FI and fibrosis accounted for 14.2%± 7.4% and 14.8%±4.2% of multifidus muscle, respectively. The multifidus contained more FAPs (11.7%±1.9% vs 1.4%±0.2%; P<.001) and more SCs (3.4%±1.6% vs 0.08%±0.02%; P=.002) than the hamstring. FAPs had greater α Smooth Muscle Actin (αSMA) and adipogenic gene expression than FAPs from the hamstring. SCs from the multifidus displayed upregulated expression of stem, proliferation, and differentiation genes.ConclusionThe multifidus in patients with disc herniation contains large percentages of FAPs and SCs with different gene expression profiles compared to those in the hamstring. These results may help explain the tendency for the multifidus to atrophy and form FI and fibrosis as well as elucidate potential approaches for mitigating these degenerative changes by leveraging these muscle stem cell populations.

Simulated Health Education Measures after Lumbar Disk Herniation Surgery: A Quasi-Experimental Study in Taiwan

BackgroundSevere lumbar disc herniation is the main cause of sciatica and lower back pain. After surgery, various factors may impede a patient's self-care ability, recovery status, and lower the quality of life (QOL). Providing appropriate health education to patients is of paramount importance. To accomplish this, we developed a set of innovative measures using virtual reality (VR) for postoperative patients and measured their effectiveness. MethodA convenience sampling method was used for a total of 50 patients from a teaching hospital in northern Taiwan, making up the experimental (VR/simulation health education measures) and control groups (routine care). Data were collected using structured questionnaires. ResultsInnovative integration of VR and simulation used in health management education has significant effects on the physical component score of QOL (p = .002) one month after surgery. Patients receiving such education expressed feeling reassured and more confident to perform daily tasks. ConclusionsHealth education simulation techniques using VR can improve QOL after lumbar disc herniation surgery.

30-Day Recurrence, Readmission Rate, and Clinical Outcome After Emergency Lumbar Discectomy.

A retrospective cohort study. To investigate the 30-day recurrence rate after emergency lumbar discectomy. Secondary aims were to investigate the factors affecting the 30-day recurrence and readmission rates and clinical outcome. Excluding cauda equine syndrome (CES) due to massive intervertebral disc herniation, emergency surgery for lumbar disc herniation (LDH) is rarely required. The operation may, however, be performed for other reasons such as persistent or progressive motor paresis associated with radiculopathy or uncontrolled pain. Literature on these topics is scarce. All patients admitted for inpatient care after a visit to the emergency department (ED) due to acute low back pain and who had subsequently undergone an emergency lumbar discectomy during the 4-year study period were included in the study. Patients attending the ED who subsequently had a delayed discectomy formed the control group. Recurrence and readmission rates were analyzed and clinical outcome at 30 days post-surgery was assessed with the Oswestry Disability Index (ODI) and the visual analog pain scale (VAS). One hundred thirty patients were admitted to the hospital after visiting the ED and underwent an emergency discectomy after a median of 1.0 days from admittance. Six patients in the study group [4.6% (95% CI: 2.1-9.7)] had recurrent LDH and nine patients in total [6.9% (95% CI: 3.9-12.6)] were readmitted within 30 days. None of the baseline variables clearly predicted recurrence. Mean ODI difference between the study group and controls was 8.1 (95% CI: -6.7-23.2). BMI and surgery by a non-spine surgeon were associated with higher ODI values. An emergency discectomy is associated with a higher rate than expected of both recurrent LDHs and 30-day readmissions. Surgeon experience and patient-related factors had minor effects on the 30-day clinical outcome. 4.

Surgery for extraforaminal lumbar disc herniation: a single center comparative observational study

BackgroundSurgery on extraforaminal lumbar disc herniation (ELDH) is a commonly performed procedure. Operating on this type of herniation is known to come with more difficulties than on the frequently seen paramedian lumbar disc herniation (PLDH). However, no comparative data are available on the effectiveness and safety of this operation. We sought out to compare clinical outcomes at 1 year following surgery for ELDH and PLDH.MethodsData were collected through the Norwegian Registry for Spine Surgery (NORspine). The primary outcome measure was change at 1 year in the Oswestry Disability Index (ODI). Secondary outcome measures were quality of life measured with EuroQol 5 dimensions (EQ-5D); and numeric rating scales (NRSs).ResultsData of a total of 1750 patients were evaluated in this study, including 72 ELDH patients (4.1%). One year after surgery, there were no differences in any of the patient reported outcome measurements (PROMs) between the two groups. PLDH and ELDH patients experienced similar changes in ODI (− 30.92 vs. − 34.00, P = 0.325); EQ-5D (0.50 vs. 0.51, P = 0.859); NRS back (− 3.69 vs. − 3.83, P = 0.745); and NRS leg (− 4.69 vs. − 4.46, P = 0.607) after 1 year. The proportion of patients achieving a clinical success (defined as an ODI score of less than 20 points) at 1 year was similar in both groups (61.5% vs. 52.7%, P = 0.204).ConclusionsPatients operated for ELDH reported similar improvement after 1 year compared with patients operated for PLDH.

Feasibility of diffusion tensor imaging quantitative analysis in evaluation of nerve repair after minimally invasive surgery for lumbar disc herniation

前瞻性纳入2017年12月至2018年9月河北医科大学第三医院经临床及MRI确诊，并接受经皮椎间孔镜下髓核摘除术（PTED）治疗的19例腰椎间盘单侧侧后方突出患者，于术前1 d，术后3、30、90 d行腰5(L5）、骶1(S1）神经根扩散张量成像（DTI）。由2名放射科医师于L5、S1患侧神经近、中、远节段及同节段健侧相应部位以播点法勾画感兴趣区（ROI ），测量DTI参数各向异性分数（FA）和表观扩散系数（ADC）值，计算每侧神经3个ROI的平均值。采用配对t检验比较患侧与健侧神经DTI参数的差异，手术前后DTI参数的比较采用单因素方差分析或Kruskal-Wallis H检验。结果显示：（1）术前1 d L5神经患侧和健侧FA值分别为0.35±0.03、0.45±0.01, S1患侧和健侧分别为0.36±0.02、0.46±0.02，L5、S1患侧神经根FA值低于健侧（t=-10.188、-37.683，P均 0.05）。表明DTI可用于定量评估腰骶神经PTED术后修复状况。

Timing of Surgery in Tubular Microdiscectomy for Lumbar Disc Herniation and Its Effect on Functional Impairment Outcomes

ObjectiveWhile it has been established that surgery for lumbar disc herniation, excluding emergent indications, should only be performed after weeks of conservative treatment, it has also been established that late surgery is associated with poorer outscomes in terms of leg pain. However, nothing is known concerning the timinig and functional outcome. We quantify the association of time to surgery (TTS) with functional impairment outcome and identify a maximum TTS cutoff. MethodsA consecutive series of patients who underwent tubular microdiscectomy for lumbar disc herniation was included. A reduction of ≥ 30% in the Oswestry Disability Index from baseline to 12 months was defined as the minimum clinically important difference (MCID). TTS was defined as time of symptom onset to surgery in weeks. The maximum TTS cutoffs were derived both quantitatively by an area under the curve (AUC) analysis, as well as qualitatively based on cutoff-specific MCID rates. ResultsInclusion was met by 372 patients, among which 327 (87.9%) achieved MCID. MCID achievement was associated with lower TTS (hazard ratio, 0.725; 95% confidence interval, 0.557–0.944; p = 0.014). The optimum maximum TTS based on AUC was 21.5 weeks. The qualitative analysis showed a continuous drop of MCID rates with increasing TTS, with values > 80% until week 14. ConclusionOur findings suggest that longer TTS is associated with a poorer patient-reported outcome in terms of functional impairment, and that—depending on the calculation method and according to the literature—a maximum TTS of between 14 to 22 weeks should likely be aimed for.

The probability of iatrogenic major vascular injury in lumbar discectomy

Purpose: To estimate the frequency of iatrogenic injury of major vascular structures during lumbar discectomy.Materials and methods: The medical records of patients who underwent surgery for lumbar disc herniation at our neurosurgical clinic between April 2000 and April 2016 were retrospectively reviewed. Patients with intraoperative iatrogenic vascular injury were identified by reading the surgical notes and the post-operative progress records of patients who had undergone lumbar discectomy. The standard calculation of the incidence of iatrogenic major vascular injury in lumbar discectomy was used to analyse the data. The formula for estimating the standard probability by calculating the incidence rate is: =n/N, where is the estimated probability, n is the number of events and N is the total number of cases. The standard error of this estimate is SE=Results: During the study period, 2498 patients underwent lumbar discectomy at one or more levels of the lumbar spine. The operations were performed by more than 40 different neurosurgeons or surgical residents. More than 95% of the operations were done under a surgical microscope. Two cases were found to have iatrogenic major vascular injuries. The standard frequentist estimate of the probability, (risk-per-case), of iatrogenic major vascular injuries in lumbar discectomy was: =2/2498 = 0.0008 (0.08%). The standard error of this estimate was: ==0.000566 = 10−4 (5.66) (95% confidence interval for true p = 10−4 (801)±(1.96)×10−3 (566)).Conclusions: In this study, the incidence of iatrogenic major vascular injuries in lumbar discectomy was 1 in 1249 operations (0.08%). If utmost care is taken, at least some of these iatrogenic intraoperative vascular complications can be avoided or more rapidly treated, and the lives of such patients can be saved.

Development and temporal validation of a prognostic model for 1-year clinical outcome after decompression surgery for lumbar disc herniation.

Surgeons need tools to provide individualised estimates of surgical outcomes and the uncertainty surrounding these, to convey realistic expectations to the patient. This study developed and validated prognostic models for patients undergoing surgical treatment of lumbar disc herniation, to predict outcomes 1year after surgery, and implemented these models in an online prediction tool. Using the data of 1244 patients from a large spine unit, LASSO and linear regression models were fitted with 90% upper prediction limits, to predict scores on the Core Outcome Measures Index, and back and leg pain. Candidate predictors included sociodemographic factors, baseline symptoms, medical history, and surgeon characteristics. Temporal validation was conducted on 364more recent patients at the same unit, by examining the proportion of observed outcomes exceeding the threshold of the 90% upper prediction limit (UPL), and by calculating mean bias and other calibration measures. Poorer outcome was predicted by obesity, previous spine surgery, and having basic obligatory (rather than private) insurance. In the validation data, fewer than 12% of outcomes were above the 90% UPL. Calibration plots for the model validation showed values for mean bias < 0.5 score points and regression slopes close to 1. While the model accuracy was good overall, the prediction intervals indicated considerable predictive uncertainty on the individual level. Implementation studies will assess the clinical usefulness of the online tool. Updating the models with additional predictors may improve the accuracy and precision of outcome predictions. These slides can be retrieved under Electronic Supplementary Material.

Interchangeability of the EQ-5D and the SF-6D, and comparison of their psychometric properties in a spinal postoperative Spanish population.

EuroQol-5D (EQ-5D) and Short-Form Six-Dimensions (SF-6D) are widely used to calculate quality-adjusted life-years in cost-utility analysis. The choice of the instrument could influence the results of cost-utility analysis. Our objective was to compare the psychometric properties of the EQ-5D and SF-6D in a postoperative Spanish population, as well as assess their interchangeability in a cost-utility analysis. Ambispective study. Tertiary public hospital. 275 Spanish patients who had undergone surgery for lumbar disc herniation. Patients completed EQ-5D-3L and Short-Form 36 (SF-36v2) questionnaires. Internal consistency, floor and ceiling effects, agreement, and construct validity (convergent validity, including dimension-to-dimension correlations, and "known groups" validity) were assessed. The Spanish tariffs were applied. Cronbach's α coefficient, Spearman's rank correlation coefficient, Lin's concordance correlation coefficient, intraclass correlation coefficient and Bland-Altman plot. Main findings were: (a) lack of agreement between EQ-5D and SF-6D utilities (Lin's concordance correlation coefficient: 0.664 [95% CI: 0.600-0.720]; the Bland-Altman plot showed a mean difference of 0.0835 and wide limits of agreement [- 0.2602-0.4272]). (b) Lack of correlation between domains that theoretically measure similar aspects of quality of life, with the exception of "pain" domain. The preference-based EQ-5D and SF-6D instruments showed valid psychometric properties to assess generic outcome in a Spanish population who had undergone surgery for lumbar disc herniation; however, utility scores derived from the measures were different. Thus, these two instruments cannot be used interchangeably to perform a cost-utility analysis, and they should both be included in sensitivity analyses.

Prevalence of Spondyloarthritis Among Patients Who Underwent Lumbar Disc Herniation Surgery.

This study aims to estimate the prevalence of spondyloarthritis (SpA) among patients who had been surgically treated for lumbar disc herniation (LDH), according to the modified New York (mNY) criteria for the diagnosis of ankylosing spondylitis and Amor, the European Spondyloarthropathy Study Group (ESSG), the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for SpA. The study included 321 patients (142 males, 179 females; mean age 49±10.8 years; range, 18 to 79 years) who underwent LDH surgery between April 2008 and May 2012 in the neurosurgery clinic of our hospital. Patients were contacted by phone on at least two attempts. Totally, 123 patients accepted to come to the outpatient clinic, while the remaining 198 agreed to be interviewed on the phone. Patients who agreed to come to the outpatient rheumatology clinic underwent clinical examination, and pelvic X-ray and magnetic resonance imaging (MRI) scan of the sacroiliac joints when indicated. Inflammatory back pain was diagnosed in 108 patients (34%) and 40 patients (13%) according to Calin criteria and the ASAS criteria, respectively. Prevalence of SpA among all patients was estimated as 17.7% according to the ESSG criteria, and 8.7% according to Amor criteria. Five of the 308 pelvic radiographs had definite radiographic sacroiliitis as required by the mNY criteria. Four patients had a characteristic pattern of bone marrow edema on MRI examination in accordance with the ASAS definitions. The overall prevalence of sacroiliitis (MRI sacroiliitis+X-ray sacroiliitis) among the patients who came to the clinic was 7.3% ([4+5]/123). The relatively increased prevalence of SpA among patients who underwent LDH surgery indicates the necessity of increasing awareness on the new concept of axial SpA for specialists treating patients with low back pain.

Cost-effectiveness of postoperative rehabilitation after surgery for lumbar disc herniation: an analysis based on a randomized controlled trial.

The aim of this study was to examine whether routine referral to municipal postoperative rehabilitation is cost-effective in comparison to no referral after surgery for lumbar disc herniation (LDH). One hundred forty-six patients scheduled for primary discectomy due to LDH were included. This secondary analysis, based on data from a previous randomized controlled trial, compared costs and quality-adjusted life years (QALYs) between two groups of patients recovering from LDH surgery: one group of patients received a referral for municipal physical rehabilitation (REHAB) and the other group was sent home without a referral to any postoperative rehabilitation (HOME). Primary outcomes were QALYs calculated from the EQ-5D utility score, societal costs, and incremental cost-effectiveness ratios (ICERs). The main cost-effectiveness analysis used intention-to-treat data, whereas sensitivity analyses included as-treated data. Questionnaires were collected after 1, 3, 6, 12, and 24 months postoperatively. The main cost-effectiveness analysis showed a small, insignificant incremental QALY of 0.021 and an incremental cost of €211.8 for the REHAB group compared to the HOME group, resulting in an ICER of €10,085. In the as-treated sensitivity analysis, the REHAB group had poorer outcomes and higher costs compared to the HOME group. Routine referral to municipal physical rehabilitation in patients recovering from LDH surgery was not cost-effective compared to no referral.Clinical trial registration no.: NCT03505918 (clinicaltrials.gov).