Undergoing Lumbar Microdiscectomy Research Articles

Discrepancy between global- and disease-specific outcome measures following lumbar spine surgery.

The aim of this study was to assess the correlation between patient-perceived changes in health and commonly utilized patient-reported outcome measures (PROMs) in lumbar spine surgery. This was a retrospective review of prospectively collected data on consecutive patients who underwent lumbar microdiscectomy, lumbar decompression, or lumbar fusion at a single academic institution from 2017 to 2023. Correlation between the global rating of change (GRC) questionnaire, a 5-item Likert scale (much better, slightly better, about the same, slightly worse, and much worse), and PROMs (Oswestry Disability Index, visual analog scale for back and leg pain, 12-Item Short Form Health Survey Physical Component Summary and Mental Component Summary, and PROMIS physical function) was assessed using Spearman's rank correlation coefficients. A total of 1871 patients (397 microdiscectomies, 965 decompressions, and 509 fusions) were included. A majority of patients in each group rated their lumbar condition as much better at each postoperative time point compared with preoperatively and reported improved health status at each postoperative time point compared with the previous follow-up visit. Statistically significant but weak to moderate correlations were found between GRC and change in PROM scores from the preoperative time point. Correlation between GRC and change in PROM scores from the prior visit showed some statistically significant correlations, but the strengths ranged from very weak to weak. A majority of patients undergoing lumbar microdiscectomy, decompression, or fusion endorsed notable improvements in health status in the early postoperative period and continued to improve at late follow-up. However, commonly used PROMs demonstrated very weak to moderate correlations with patient-perceived changes in overall lumbar spine-related health status as determined by GRC. Therefore, currently used PROMs may not be as sensitive at detecting these changes or may not be adequately reflecting changes in health conditions that are meaningful to patients undergoing lumbar spine surgery.

The Effect of Muscle Quality on Outcomes after Microdiscectomy

ObjectivesTo investigate the relationship between muscle quality and (1) patient-reported outcomes and (2) surgical outcomes after lumbar microdiscectomy surgery. MethodsAdult patients (>18 years) who underwent lumbar microdiscectomy from 2014-2021 at a single academic institution were identified. Outcomes were collected during the preoperative, three-month, six-month, and one-year postoperative periods. Those included were the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS-Back and VAS-Leg, respectively), and the mental and physical component of the short-form 12 survey (MCS and PCS). Muscle quality was determined by two systems: the normalized total psoas area (NTPA) and a paralumbar-based grading system. Surgical outcomes including 90-day surgical readmissions and 1-year reoperations were also collected. ResultsOf the 218 patients identified, 150 had good paralumbar muscle quality and 165 had good psoas muscle quality. Bivariant analysis demonstrated no difference between groups regarding surgical outcomes (p>0.05). Multivariable analysis demonstrated that better paralumbar muscle quality was not associated with any consistent changes in patient reported outcomes. Higher NTPA was associated with improved PCS at six months (est. = 6.703, [95% CI: 0.759 – 12.646], p=0.030) and twelve months (est. = 6.625, [95% CI: 0.845 – 12.405], p=0.027). There was no association between muscle quality and surgical readmissions or reoperations. ConclusionsOur analysis demonstrated that higher psoas muscle quality was associated with greater physical improvement postoperatively. Muscle quality did not affect surgical readmissions or reoperations. Additional studies are needed for further assessment of the implications of muscle quality on postoperative outcomes.

The impact of being overweight or obese on 12 month clinical recovery in patients following lumbar microdiscectomy for radiculopathy

BACKGROUND CONTEXTThe proportion of patients who undergo lumbar microdiscectomy due to lumbar radiculopathy who are also overweight or obese is high. However, whether high body mass index (BMI) affects clinical outcomes is not well-studied. PURPOSETo investigate the difference in the clinical course between normal weight, overweight, and obese patients with radiculopathy who underwent lumbar microdiscectomy followed by physical therapy and to evaluate whether high BMI is associated with poor recovery. STUDY DESIGN/SETTINGA prospective cohort study with a 12-month follow-up was conducted in a multidisciplinary clinic. PATIENT SAMPLEWe included 583 patients (median [IQR] age: 45 [35–52] years; 41% female) with clinical signs and symptoms of lumbar radiculopathy, consistent with magnetic resonance imaging findings, who underwent microdiscectomy followed by postoperative physical therapy. OUTCOME MEASURESOutcomes were leg pain and back pain intensity measured with a visual analogue scale, disability measured with the Roland Morris Disability Questionnaire at 3 and 12-month follow-ups, and complications. METHODSPatients were classified as being normal weight (46.9%), overweight (38.4%), or obese (14.7%). A linear mixed-effects model was used to assess the difference in the clinical course of pain and disability between the three BMI categories. The association between BMI and outcomes was evaluated using univariable and multivariable logistic regression analyses. RESULTSAll three patient groups experienced a significant improvement in leg pain, back pain, and disability over 3 and 12-month follow-up. Patients who were overweight, obese, or normal weight experienced comparable leg pain (p=.14) and disability (p=.06) over the clinical course (p=.14); however, obese patients experienced higher back pain (MD=−6.81 [95%CI: −13.50 to −0.14]; p=.03). The difference in back pain scores was not clinically relevant. CONCLUSIONSIn the first year following lumbar microdiscectomy, patients demonstrated clinical improvements and complications that were unrelated to their preoperative BMI.

LOMBER MİKRODİSKEKTOMİ AMELİYATINDA AMELİYAT SONRASI HIZLANDIRILMIŞ İYİLEŞME (ERAS) PROTOKOLLERİNİN ETKİNLİĞİ

Aim: This study aimed to asses the efficacy of enhanced recovery after surgery (ERAS) protocols in the lumbar discectomy surgeries. Methods: Data obtained from 92 patients who underwent lumbar microdiscectomy surgery at a single institution between January 2021 and January 2023. Then, the patients were divided into two groups: ERAS protocol group (n=60), and conventional surgery group (n=32). Results: The mean age of the patients was 49.4±14 years. Among these, 31 were females, and 61 were males. The demographic, surgical and outcome parameters of two groups were compared. There were statistically significant decreases in length of stay and spondylodiscitis rates in the ERAS protocol group. Length of stay was found 25.52±12.53 hours in ERAS group, and 34±20.06 hours in conventional surgery group (p=0.002). Spondylodiscitis rates were 3.3% and 15.6% in the ERAS and conventional surgery groups, respectively (p=0.034). Conclusions: This study revealed that ERAS protocol reduces length of stay in hospital, and spondylodiscitis rates in lumbar microdiscectomy surgery. We conclude that ERAS protocols should be encouraged and applied more widely in spine surgeries.

Minimally Invasive Transforaminal Interbody Fusion Versus Microdiscectomy Without Fusion for Recurrent Lumbar Disk Herniation: A Prospective Comparative Study.

The objective of this study was to compare the clinical outcome of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) versus standard revision diskectomy for recurrent lumbar disk herniation (RLDH). RLDH is the most common cause of redo surgery after a microdiscectomy. Commonly, in patients without evidence of spinal instability, many surgeons would simply redo microdiscectomy, while others proceed to a redo microdiscectomy with arthrodesis. According to the literature, there is no evidence of what the best management of an RLDH would be. This study involved 90 patients who underwent lumbar microdiscectomy in the past and were now experiencing a new lumbar disk herniation for the first time. The patients were divided into two groups, each with 45 patients: group A received standard revision microdiscectomy, whereas group B received revision microdiscectomy with MIS TLIF.The Japanese Orthopaedic Association score, operating time, blood loss, duration of hospital stay, costs, and complications were all prospectively recorded in a database and examined. Back and leg discomfort were measured using the visual analog scale. The mean total postoperative Japanese Orthopaedic Association score across the groups exhibited no statistically significant difference, nor did the preoperative clinical and epidemiological data. Although postoperative leg pain was comparable in both groups, postoperative lower back pain in group A was much worse than that in group B. Additional revision surgery was necessary for six individuals in group A. Group A had higher rates of dural rupture and postoperative neurological impairment. Group A experienced much less intraoperative blood loss, longer operation times, and postoperative hospital stays. In patients with RLDH, revision microdiscectomy is effective. In comparison with conventional microdiscectomy, MIS TLIF reduces intraoperative risk of dural rupture or neural injury, postoperative incidence of mechanical instability or recurrence, and postoperative lower back pain. Prospective, randomized, multicenter, comparative study.

Differences in evaluation and management coding of outpatient clinic visits for patients undergoing elective spine surgery with use of a standardized template.

In a large teaching institution with providers of various levels of training and backgrounds, and a coding department responsible for all evaluation and management (E&M) billing, variations in documentation can hinder accurate medical management and compensation. The purpose of this study is to assess differences in re-imbursement between templated and non-templated outpatient documentation for patients who eventually underwent single level lumbar microdiscectomy and anterior cervical discectomy and fusion (ACDF) both before and after the E&M billing changes were implemented in 2021. Data was collected from three spine surgeons on 41 patients who underwent a single level lumbar microdiscectomy at a tertiary care center from July 2018 to June 2019 and 35 patients seen by four spine surgeons from January through December of 2021 given the new E&M billing changes. ACDF data was collected for 52 patients between 2018 and 2019 for three spine surgeons and 30 patients from January through December of 2021 from four spine surgeons. Billing level was decided by independent coders for preoperative visits. During the study period from 2018-2019 for lumbar microdiscectomy, each surgeon averaged about 14 patients. Results showed variability of billing level between the three spine surgeons (surgeon 1, 3.2±0.4; surgeon 2, 3.5±0.6; and surgeon 3, 2.9±0.8). Interestingly, even after the implementation of the 2021 E&M billing changes, there was a statistically significant increased level of billing for templated notes for lumbar microdiscectomy (P=0.013). However, this did not translate to the clinic visits for patients who underwent ACDF in 2021. When data was aggregated for all the patients from 2021 who either underwent lumbar microdiscectomy or ACDF, using a template still resulted in a statistically significant higher level of billing (P<0.05). Utilization of templates for clinical documentation reduces variability in billing codes. This impacts subsequent reimbursements and potentially prevents significant financial losses at large tertiary care facilities.

497 Does Physical Activity Improve Patient Outcomes Following Lumbar Microdiscectomy?

INTRODUCTION: Lumbar microdiscectomy is widely performed for disc herniation, however outcomes may be unsatisfactory in 10-40% patients and up to 12.5% require re-operation. Evidence regarding the effect of physical activity on post-operative outcomes is scant. The majority of existing studies rely on biased activity self-reporting or short-term monitoring. Duration of physical activity presents a tangible goal for patient counselling, can be measured using wearable technology, and can be targeted to improve outcomes. METHODS: 53 patients underwent lumbar microdiscectomy and wore an accelerometer for 30 days post-operatively, which measured activity duration (lying, sitting, standing, walking, cycling) and intensity. Patient-reported outcome scores (VASB, VASL, ODI, EQ-5D, SF-12) at 1, 3, 6, and 12 months, and activity data were analysed. The primary outcome (treatment success) was a predetermined reduction in VASB, VASL, and ODI. The relationship between treatment success and activity was assessed using the Mann-Whitney U test. Associations between outcomes and activity were investigated using MANOVA and Pearson Correlations. RESULTS: Longer standing time was associated with worse ODI scores at 6 months (p = .034). There was no other statistically significant association between treatment success and activity duration or intensity. MANOVA demonstrated that shorter sitting time was associated with less back pain at 3 (p = .01) and 12 months (p = .011). Univariate analysis revealed that longer walking time was associated with improved EQ-5D scores at 3 (p = .001) and 12 months (p = .034), and improved SF-12 physical scores at 3 months (p = .026). CONCLUSIONS: Shorter standing time was associated with less disability, shorter sitting time with less back pain, and longer walking time with improved physical wellbeing after lumbar microdiscectomy. Higher-powered studies are needed to further explore the relationship between physical activity and outcomes.

Would Cutibacterium acnes Be the Villain for the Chronicity of Low Back Pain in Degenerative Disc Disease? Preliminary Results of an Analytical Cohort.

In the last decade, several studies have demonstrated Cutibacterium acnes colonization in intervertebral discs (IVDs) in patients with lumbar disc degeneration (LDD) and low back pain (LBP), but the meaning of these findings remains unclear. Being aware of this knowledge gap, we are currently conducting a prospective analytical cohort study with LBP and LDD patients undergoing lumbar microdiscectomy and posterior fusion. The IVDs samples collected during the surgeries are subjected to a stringent analytical protocol using microbiological, phenotypic, genotypic, and multiomic techniques. Additionally, pain-related scores and quality-of-life indexes are monitored during patient follow-up. Our preliminary results for 265 samples (53 discs from 23 patients) revealed a C. acnes prevalence of 34.8%, among which the phylotypes IB and II were the most commonly isolated. The incidence of neuropathic pain was significantly higher in the colonized patients, especially between the third and sixth postoperative months, which strongly suggests that the pathogen plays an important role in the chronicity of LBP. The future results of our protocol will help us to understand how C. acnes contributes to transforming inflammatory/nociceptive pain into neuropathic pain and, hopefully, will help us to find a biomarker capable of predicting the risk of chronic LBP in this scenario.

P129. Impact of muscle health on patient reported outcomes after lumbar microdiscectomy

<h3>BACKGROUND CONTEXT</h3> Poor muscle health has been implicated as a source of back pain among patients with lumbar spine pathology. However, the impact of muscle health on postoperative outcomes following spine surgery remains to be investigated. <h3>PURPOSE</h3> To determine whether muscle health measured by preoperative psoas and paralumbar muscle cross-sectional areas impact achievement of MCID for PROMs following lumbar microdiscectomy. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Consecutive patients who underwent 1-level lumbar microdiscectomy in a single institution between 2017-2021. <h3>OUTCOME MEASURES</h3> Rate of MCID achievement, time to MCID achievement, PROMs including Oswestry Disability Index (ODI), visual analog scale for back pain (VAS back), VAS leg, Short Form 12 Physical Component Summary (SF-12 PCS), SF-12 Mental Component Summary (SF-12 MCS) and Patient Reported Outcomes Measurement Information System Physical Function (PROMIS PF). <h3>METHODS</h3> Two previously validated methods for muscle health grading were applied. Axial T2 MRI were analyzed for muscle measurements. The psoas-based method utilized the normalized total psoas area (NTPA), which is the psoas cross-sectional area divided by the square of patient height (mm2/m2). Patients were divided into low and high NTPA groups based on sex-specific lowest quartile NTPA thresholds. The paralumbar-based method incorporated the paralumbar cross-sectional area normalized by body mass index (PL-CSA/BMI) and Goutallier classification. Score of 1 was added for either PL-CSA/BMI >130 or Goutallier class of 2. "Good" muscle health was defined as score of 2, and "poor" muscle health was defined as score of 0-1. Prospectively collected PROMs were analyzed at 2-week, 6-week, 3-month, 6-month, 1-year and 2-year postoperative timepoints. The rate of and time to MCID achievement were compared among the cohorts. Bivariate analyses were performed to assess for correlations between psoas/paralumbar cross-sectional areas and change in PROM scores from baseline. <h3>RESULTS</h3> The total cohort included 163 patients with minimum followup of 6 months and mean followup of 16.5 months. Forty patients (24.5%) were categorized into the low NTPA group, and 55 patients (33.7%) were categorized into the poor paralumbar muscle group. Low NTPA was associated with older age, lower BMI and greater frequencies of Charlson Comorbidity Index (CCI) 1. Poor paralumbar muscle health was associated with older age, female sex, higher BMI and CCI 1. There were no differences in rates of MCID achievement for any PROMs between low vs high NTPA groups or between poor vs good paralumbar groups. Low NTPA was associated with longer time to MCID achievement for ODI, VAS back, VAS leg and SF-12 MCS. Poor paralumbar muscle health was associated with longer time to MCID achievement for VAS back, and SF-12 PCS. NTPA negatively correlated with change in VAS back (6-week, 12-week) and VAS leg (6-month). <h3>CONCLUSIONS</h3> Among patients undergoing lumbar microdiscectomy, patients with worse muscle health grades achieved MCID at similar rates but required longer time to achieve MCID. Lower NTPA was weakly correlated with larger improvements in pain scores. Our findings suggest that with regards to functional outcomes, patients with worse muscle health may take longer to recuperate postoperatively compared to those with better muscle health. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A Simple New Cost-Effective Retractor System for Exposure in Lumbar Microdiscectomy: 1-Year Outcome Analysis

To introduce a new technique for retraction in lumbar microdiscectomy, the rubber band technique (RT), and compare 1-year clinical outcomes of the technique with standard microdiscectomy (SM). In this retrospective analysis, 81 consecutive patients with single-level lumbar disc herniation underwent lumbar microdiscectomy by either RT or SM. The primary outcome was Oswestry Disability Index score 1 year after surgery. Secondary outcomes included Short-Form Health Survey (SF-36) physical functioning subscale score, SF-36 bodily pain subscale score, and visual analog scale back pain and leg pain scores. Other parameters were operative time, hospital stay, skin incision, complications, and redo surgery. Of 81 patients, 93% (76 patients) had complete data up to 1-year follow up. The RT group comprised 39 patients (20 males, 19 females), and the SM group comprised 37 patients (19 males 18 females). Primary and secondary outcomes Oswestry Disability Index score, SF-36 physical functioning score, SF-36 bodily pain score, VAS back and leg pain scores, complications, and redo surgery did not differ significantly between the treatment groups at follow-up points (P > 0.05). Skin incision was smaller in the RT group compared with the SM group (P= 0.0001). Over the 1-year follow-up period, clinical outcomes of patients treated with RT were comparable to patients treated with SM. RT appears to be an alternative safe, effective, and economical approach for lumbar microdiscectomy.

Association between muscle health and patient-reported outcomes after lumbar microdiscectomy: early results

BACKGROUND CONTEXTPoor muscle health has been implicated as a source of back pain among patients with lumbar spine pathology. Recently, a novel magnetic resonance imaging (MRI)-based lumbar muscle health grade was shown to correlate with health-related quality of life scores. However, the impact of muscle health on postoperative functional outcomes following spine surgery remains to be investigated. PURPOSETo determine whether muscle health grade measured by preoperative psoas and paralumbar muscle cross-sectional areas impact the achievement of minimal clinically important difference (MCID) following lumbar microdiscectomy. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLEConsecutive patients who underwent 1-level lumbar microdiscectomy in a single institution between 2017 and 2021. OUTCOME MEASURESRate of MCID achievement, time to MCID achievement, PROMs including Oswestry Disability Index (ODI), visual analog scale for back pain (VAS back), VAS leg, Short Form 12 Physical Component Summary (SF-12 PCS), SF-12 Mental Component Summary (SF-12 MCS), and Patient Reported Outcomes Measurement Information System Physical Function (PROMIS PF). METHODSTwo previously validated methods for muscle health grading were applied. Axial T2 MRI were analyzed for muscle measurements. The psoas-based method utilized the normalized total psoas area (NTPA), which is the psoas cross-sectional area divided by the square of patient height (mm2/m2). Patients were divided into low and high NTPA groups based on sex-specific lowest quartile NTPA thresholds. The paralumbar-based method incorporated the paralumbar cross-sectional area normalized by body mass index (PL-CSA/BMI) and Goutallier classification. Score of 1 was added for either PL-CSA/BMI >130 or Goutallier class of ≤2. “Good” muscle health was defined as score of 2, and “poor” muscle health was defined as score of 0 to 1. Prospectively collected PROMs were analyzed at 2-week, 6-week, 3-month, 6-month, 1-year, and 2-year postoperative timepoints. The rate of and time to MCID achievement were compared among the cohorts. Bivariate analyses were performed to assess for correlations between psoas/paralumbar cross-sectional areas and change in PROM scores from baseline. RESULTSThe total cohort included 163 patients with minimum follow-up of 6 months and mean follow-up of 16.5 months. 40 patients (24.5%) were categorized into the low NTPA group, and 55 patients (33.7%) were categorized into the poor paralumbar muscle group. Low NTPA was associated with older age, lower BMI, and greater frequencies of Charlson Comorbidity Index (CCI) ≥1. Poor paralumbar muscle health was associated with older age, female sex, higher BMI, and CCI ≥1. There were no differences in rates of MCID achievement for any PROMs between low versus high NTPA groups or between poor versus good paralumbar groups. Low NTPA was associated with longer time to MCID achievement for ODI, VAS back, VAS leg, and SF-12 MCS. Poor paralumbar muscle health was associated with longer time to MCID achievement for VAS back, VAS leg, and SF-12 PCS. NTPA negatively correlated with change in VAS back (6-week, 12-week) and VAS leg (6-month). PL-CSA/BMI positively correlated with change in PROMIS-PF at 3 months follow-up. CONCLUSIONSAmong patients undergoing lumbar microdiscectomy, patients with worse muscle health grades achieved MCID at similar rates but required longer time to achieve MCID. Lower NTPA was weakly correlated with larger improvements in pain scores. PL-CSA/BMI positively correlated with change in PROMIS-PF. Our findings suggest that with regards to functional outcomes, patients with worse muscle health may take longer to recuperate postoperatively compared to those with better muscle health.

Return to Sport After Lumbar Microdiscectomy in High School and College-Age Athletes

Previous studies have reported the return to play (RTP) rates for athletes after lumbar discectomy but not specifically for younger athletes. The purpose of the present study was to evaluate the RTP rate for young athletes after lumbar microdiscectomy. The medical records from a single spine surgeon were reviewed to identify patients who had undergone lumbar microdiscectomy. The patients were included if they were aged ≤21 years at surgery and were athletes. A total of 38 patients (25 males and 13 females) were identified, with a mean age at surgery of 19 years. The level of the herniated nucleus pulposus, variant anatomy, degenerative changes, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. The patients were interviewed to determine when and if they had returned to play. Most patients had had degenerative changes at surgery, with a mean Pfirrmann score of 2.2. The average time from symptom onset to surgery was 11 months. All patients were reached for follow-up at an average of 51 months postoperatively. Of the 38 patients, 71% had returned to play at an average of 4.5 months postoperatively. No statistically significant differences were found in the Pfirrmann grade and RTP rates between the high school and collegiate athletes, between the genders, nor between patients with 2-level and 1-level discectomy. The Pfirrmann grade was not significantly different between the patients who had and had not returned to play. The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. The RTP rate and Pfirrmann grade were not related to gender, sport level, or discectomy level.

EXPERIENCIA EN MICRODISECTOMÍA LUMBAR EN EL HOSPITAL GUILLERMO ALMENARA IRIGOYEN 2018 - 2021

Objective: Herniation of the nucleus pulposus (HNP) is the leading cause of sciatica. The standard diagnostic test is magnetic resonance imaging, and treatment can be conservative or surgical. The most common surgical technique is lumbar microdiscectomy. The objective of the study was to know the epidemiological and clinical profile, as well as the surgical results of patients undergoing lumbar microdiscectomy at the Almenara Hospital from January 2018 to August 2021. Methods: Descriptive, retrospective, and cross-sectional epidemiological study. We found 82 patients who underwent lumbar microdiscectomy with complete data in the clinical history. The data was collected from the clinical history of hospitalization and outpatient consultation. Proportions were applied for qualitative variables and mean with confidence interval in quantitative variables. Results: Of the total number of patients, 69.51% were male, the most frequent age group was 31-50 years, and most came from Lima. The most frequently operated anatomical levels were L4 and L5. Regarding the clinic, 95.12% presented positive Lasegue. The mean preoperative VAS decreased from 7.83 to 2.00. Recurrence was 4.88%, and the most frequent complication was inadvertent durotomy. Conclusions: HNP is the most common cause of sciatica. The most frequent surgical management is lumbar microdiscectomy, which has good clinical results as well as a low rate of complications and recurrence. Keywords: Spine, Sciatica, Nucleus Pulposus, Diskectomy, Neurosurgical Procedures. (Source: MeSH NLM)

Comparative evaluation of relationship between Body Mass Index and outcome after lumbar microdiscectomy

: The incidence of obesity has risen steadily to epidemic proportions in many regions of the world. Surgeons often encounter problems in surgeries on the obese patients. In this study, we evaluated the effect of Body Mass Index (BMI) on outcome of patients undergoing lumbar microdiscectomy. : This was primarily a case series retrospective study of patients who underwent single level lumbar microdiscectomy at our institution between January 2014 and April 2018. BMI was used to categorize our patients. Outcome measures were Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS). The Patients were also analyzed according to the operative time, average blood loss during surgery, hematoma formation, wound infection, CSF leak, deep vein thrombosis, length of stay after surgery, recurrent disk herniation and neurologic deficit. ANOVA and regression analysis were used to assess differences between variables. : Five_ hundred Patients (225 male and 275 female) with a mean age of 40± 5.2 years old (ranged 19_70) who underwent single-level lumbar microdiscectomy were enrolled for the study. All patients were followed up for 24 months after surgery. The VAS and ODI were significantly improved in all patients. There was no significant difference between groups with respect to the operative time, average blood loss during surgery, hematoma formation, wound infection, CSF leak, deep vein thrombosis, length of stay after surgery, recurrent disk herniation and neurologic deficit. : The findings from this study showed that BMI does not have negative impact on outcome of patients undergoing lumbar microdiscectomy.

Is surgery for recurrent lumbar disc herniation worthwhile or futile? A single center observational study with patient reported outcomes

ObjectiveTo examine outcomes and complications following microdiscectomy for recurrent lumbar disc herniation. MethodsProspectively collected data for patients operated at the Department of Neurosurgery, St. Olavs University Hospital, Norway, were obtained from the Norwegian Registry for Spine Surgery from May 2007 through July 2016. All patients underwent lumbar microdiscectomy. The primary outcome was change in the Oswestry Disability Index (ODI) at one year. Secondary endpoints were change in quality of life measured with EuroQol 5 Dimensions (EQ-5D), back and leg pain measured with numerical rating scales (NRS), complications, and duration of surgery and hospital stays. Results276 patients were enrolled in the study. A total of 161 patients (58.3%) completed one-year follow-up. The mean improvement in ODI at one year was 27.1 points (95% CI 23.1 to 31.0, P <0.001). The mean improvement in EQ-5D at one year of 0.47 points (95% CI 0.40–0.54, P <0.001), representing a large effect size (Cohens D ​= ​1.3). The mean improvement in back pain and leg pain NRS were 4.3 points (95% CI 2.2–3.2, P <0.001) and 3.8 points (95% CI 2.8–3.9, P <0.001), respectively. Nine patients (3.3%) experienced intraoperative complications, and 15 (5.5%) out of 160 patients reported complications within three months following hospital discharge. ConclusionsThis study shows that patients operated for recurrent lumbar disc herniation in general report significant clinical improvement.

The Effects of Body Mass Index on Lumbar Microdiscectomy Outcomes

Background and Aim: The incidence of obesity has steadily risen to epidemic proportions in numerous world regions. Surgeons often encounter problems in surgeries on obese patients. This study evaluated the effects of Body Mass Index (BMI) on the outcome of patients undergoing lumbar microdiscectomy. Methods and Materials/Patients: This was primarily a case-series retrospective study of patients who underwent single-level lumbar microdiscectomy at our institution between January 2014 and April 2018. BMI was used to categorize our patients. Outcome measures were Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). The Patients were also analyzed according to the operative time, average blood loss during surgery, hematoma formation, wound infection, Cerebrospinal Fluid (CSF) leak, deep vein thrombosis, length of stay after surgery, recurrent disc herniation, and neurologic deficit. Analysis of Variance (ANOVA) and regression analysis methods was used to assess differences between the study variables. Results: Five hundred patients (225 male &amp; 275 female) with a Mean±SD age of 40.3±5.2 years (range: 19-70 y) who underwent single-level lumbar microdiscectomy were enrolled for the study. All patients were followed up for 24 months after surgery. The VAS and ODI were significantly improved in all patients. There was no significant difference between groups concerning the operative time, average blood loss during surgery, hematoma formation, wound infection, CSF leak, deep vein thrombosis, length of stay after surgery, recurrent disc herniation, and neurologic deficit. Conclusion: The obtained findings indicated that BMI did not negatively impact the outcome of patients undergoing lumbar microdiscectomy.

120. Revision discectomy: analysis of 1-year incidence and risk factors

<h3>BACKGROUND CONTEXT</h3> Prior reports have noted rates of recurrent disc herniation following discectomy to be as high as 25%. As such, the primary cause of surgical failure and indication for revision following lumbar discectomy is recurrent disc herniation. However, information varies regarding the rate of incidence and timing of disc herniations following discectomies. <h3>PURPOSE</h3> The primary aim of this study was to determine the rate of revision discectomy following single-level lumbar discectomy at various postoperative time points. A secondary aim was to identify risk factors for revision discectomy. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> Patients from the Mariner Claims Database who underwent lumbar microdiscectomy between 2010 and 2018 with 1-year follow-up. <h3>OUTCOME MEASURES</h3> Rates of revision discectomy for reherniation at various postoperative intervals for up to a year following index surgery were calculated. <h3>METHODS</h3> The group was then followed up to one year after the initial indexed lumbar discectomy for revision according to the CPT codes (63030, 63047, 63042). The second part of the study assessed the independent effects of age, gender, and body mass index (BMI kg/m²) on rates of revision. Groups were separated by risk factors of interest and propensity score matched with respect to age, smoking, obesity, morbid obesity, Charlson Comorbidity Index (CCI). Risk factors for revision discectomy were determined using bivariate analyses following by multivariable logistic regression. Log rank test was used to construct Kaplan Meier survival curves. Significance was set at p<0.05. <h3>Results</h3> Of 29,688 patients included in the analysis, 1.1% (N =325) underwent revision surgery for reherniation within seven days of index discectomy, and 18.5% (N=5,476) underwent revision surgery within a year of index discectomy. Compared to men, women had greater odds of revision (OR1.1, 95% CI 1.03-1.16, p<0.01). Compared to patients aged >40, those aged <40 had greater odds of revision (OR 1.29, 95% CI 1.19-1.39, p<0.01). Compared to nonobese patients, both obese (OR 3.60, 95% CI 3.47-3.88, p<0.01) and morbidly obese (OR 3.30, 95% CI 3.07-3.55, p<0.001) patients had significantly greater odds of revision. <h3>Conclusions</h3> The overall rate of 1-year revision surgery for reherniation following lumbar discectomy is 18.5%, and the rate of revision surgery for reherniation within a week of index discectomy is low. These findings can assist surgeons in risk-stratifying patients based on the expected timing of postoperative reherniation in high-risk patients undergoing lumbar discectomy. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the "RAD" risk profile.

Surgical treatment of herniated lumbar intervertebral disks is a common procedure worldwide. However, recurrent herniated nucleus pulposus (re-HNP) may develop, complicating outcomes and patient management. The purpose of this study was to utilize machine-learning (ML) analytics to predict lumbar re-HNP, whereby a personalized risk prediction can be developed as a clinical tool. A retrospective, single center study was conducted of 2630 consecutive patients that underwent lumbar microdiscectomy (mean follow-up: 22-months). Various preoperative patient pain/disability/functional profiles, imaging parameters, and anthropomorphic/demographic metrics were noted. An Extreme Gradient Boost (XGBoost) classifier was implemented to develop a predictive model identifying patients at risk for re-HNP. The model was exported to a web application software for clinical utility. There were 1608 males and 1022 females, 114 of whom experienced re-HNP. Primary herniations were central (65.8%), paracentral (17.6%), and far lateral (17.1%). The XGBoost algorithm identified multiple re-HNP predictors and was incorporated into an open-access web application software, identifying patients at low or high risk for re-HNP. Preoperative VAS leg, disability, alignment parameters, elevated body mass index, symptom duration, and age were the strongest predictors. Our predictive modeling via an ML approach of our large-scale cohort is the first study, to our knowledge, that has identified significant risk factors for the development of re-HNP after initial lumbar decompression. We developed the re-herniation after decompression (RAD) profile index that has been translated into an online screening tool to identify low-high risk patients for re-HNP. Additional validation is needed for potential global implementation.

The effect of pedometer‐supported walking and telemonitoring after disc hernia surgery on pain and disability levels and quality of life

The aim of this study was to determine the effect of pedometer-supported walking and telemonitoring after lumbar disc hernia surgery on pain and disability levels and quality of life. This was a randomized controlled trial with two randomly selected groups conducted between March 2018 and January 2019. Sixty-seven participants (33 in the intervention group and 34 in the control group) who had undergone lumbar microdiscectomy were allocated to receive and not to receive walking exercise. Pain and disability levels and quality of life of groups were tested with the McGill Pain Questionnaire, the Oswestry Disability Index and the 36-Item Short Form Survey. Measurements were taken 3 weeks after surgery and following completion of the first, second and third months. Compared with the control group, pain level at the first and second months and disability level at the second and third months in the intervention group were significantly lower (p < 0.05), and in the third month, subdimension scores of quality of life (the physical role difficulty, energy and vitality, mental health, social functionality and pain) were higher (p < 0.05). Walking after herniated disc surgery decreased pain and disability levels and increased the quality of life; nurses can encourage adherence to walking as an effective intervention.

How do high preoperative pain scores impact the clinical course and outcomes for patients undergoing lumbar microdiscectomy?

Preoperative pain assessment is often used to gauge the amount of disability in patients with lumbar disc herniation. How high preoperative pain scores impact the clinical course and outcomes of patients after lumbar microdiscectomy is not always clear. Here, the authors aimed to determine whether patients reporting higher preoperative pain scores have worse outcomes after lumbar microdiscectomy than those reporting lower preoperative scores. The authors performed a retrospective review of patients with symptomatic lumbar disc herniations that had failed to improve with nonsurgical methods and who had undergone tubular lumbar microdiscectomy. Health-related quality of life (HRQOL) scores had been collected in the preoperative and postoperative period. The anatomical severity of disease was graded based on lumbar disc health (Pfirrmann classification), facet degeneration, thecal sac cross-sectional area, and disc herniation grade. Data on each patient's narcotic consumption and length of stay were collected. A Student t-test and chi-square test were used to compare patients with high preoperative pain scores (HP cohort) and those with lower preoperative scores (non-HP cohort). One hundred thirty-eight patients were included in this analysis. The 47 patients in the HP cohort had taken more preoperative opioids (12.0 ± 21.2 vs 3.6 ± 11.1 morphine equivalent doses, p = 0.01). However, there was no statistically significant difference in Pfirrmann classification (p > 0.15), facet grade (p > 0.11), thecal sac cross-sectional area (p = 0.45), or disc herniation grade (p = 0.39) between the HP and non-HP cohorts. The latter cohort had statistically significant higher preoperative PROMIS scores (36.5 ± 7.0 vs 29.9 ± 6.4, p < 0.001), SF-12 mental component summary scores (48.7 ± 11.5 vs 38.9 ± 16.1, p < 0.001), and SF-12 physical component summary scores (PCS; 32.4 ± 8.6 vs 27.5 ± 10.0, p = 0.005), but a lower Oswestry Disability Index (56.4 ± 22.1 vs 35.4 ± 15.5, p < 0.001). There were only two time points after microdiscectomy when the HP cohort had worse HRQOL scores: at the 2-week follow-up for SF-12 PCS scores (32.4 ± 8.6 vs 29.3 ± 7.1, p = 0.03) and the 12-week follow-up for PROMIS scores (45.2 ± 9.5 vs 39.5 ± 7.1, p = 0.01). All other postoperative HRQOL measurements were similar between the two cohorts (p > 0.05). A patient's perceived severity of disease often does not correlate with the actual clinical pathology on imaging. Although patients who report high pain and have a symptomatic lumbar disc herniation may describe their pain as more extreme, they should be counseled that the outcomes of microdiscectomy are positive.