Lumbar discectomy for lumbar disc herniation.
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ABSTRACT:
SUBMITTER: Chen HJ
PROVIDER: S-EPMC6583408 | biostudies-literature | 2014 May
REPOSITORIES: biostudies-literature
Publications
Lumbar discectomy for lumbar disc herniation.
Chen Hua-jiang HJ Liang Lei L Wang Jian-xi JX Cao Peng P Shi Chang-gui CG Yuan Wen W
Orthopaedic surgery 20140501 2
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Project description:Study designSecondary analysis of data from a concurrent randomized trial and cohort study.ObjectiveThe aim of this study was to determine risks and predictors of recurrent pain following standard open discectomy for subacute/chronic symptomatic lumbar disc herniation (SLDH).Summary of background dataMost previous studies of recurrence after discectomy do not explicitly define pain resolution and recurrence, and do not account for variable durations of time at risk for recurrence.MethodsWe used survival analysis methods to examine predictors of leg pain recurrence. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of leg pain recurrence using Kaplan-Meier survival curves, and examined predictors of recurrence using Cox proportional hazards models. We used similar methods to examine LBP recurrence.ResultsOne- and three-year cumulative risks of leg pain recurrence were 20% and 45%, respectively. One- and three- year leg pain recurrence risks were substantially lower in participants with complete initial resolution of leg pain (17% and 41%, respectively) than in those without (27% and 54%, respectively). In multivariate analyses, complete leg pain resolution (adjusted hazard ratio [aHR] 0.69; 95% confidence interval [CI] 0.52-0.90), smoking (aHR 1.68 [95% CI 1.22-2.33]), and depression (aHR 1.74 [95% CI 1.18-2.56]) predicted leg pain recurrence. The 1- and 3-year risk of LBP recurrence was 29% and 65%, respectively. LBP recurrence risk at 3 years was substantially lower in participants with complete initial resolution of LBP than in those without, but not at 1 year.ConclusionRecurrence of leg pain and LBP is common after discectomy for SLDH. Cumulative risks of both leg pain and LBP recurrence were generally lower in participants achieving complete initial resolution of pain post-discectomy.Level of evidence2.
| S-EPMC5332353 | biostudies-literature
Project description:This study aimed to evaluate and compare the clinical effectiveness of two surgical techniques-unilateral biportal endoscopic (UBE) discectomy and percutaneous interlaminar endoscopic lumbar discectomy (IELD)-in addressing high-grade down-migrated lumbar disc herniation (HDM-LDH). A retrospective analysis was conducted on 39 patients with HDM-LDH who underwent surgical treatment between January 2020 and February 2023. This cohort included 18 patients in the UBE group and 21 patients in the IELD group. The two endoscopic techniques were compared based on operative time, intraoperative blood loss, hemoglobin decrease, C-reactive protein levels, and length of hospital stay. Efficacy was evaluated using the visual analog scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. The IELD group exhibited a shorter operative duration and reduced length of hospital stay, as well as diminished intraoperative blood loss compared to the UBE group (P < 0.05). No statistically significant differences were observed in the reduction of hemoglobin levels or the increase in C-reactive protein between the two groups (P > 0.05). Postoperatively, both groups experienced significant decreases in VAS scores and ODI scores relative to preoperative values. One day post-surgery, the VAS score for low back pain was higher in the UBE group than in the IELD group, with the difference being statistically significant (P < 0.05). However, no significant differences were found in the VAS scores for lower limb pain at any time point, nor in the ODI scores one day, one month, and three months post-surgery (P > 0.05). At the final follow-up, patient satisfaction rates were 94.44% in the UBE group and 95.24% in the IELD group, with no statistically significant difference (P > 0.05). One patient in the IELD group developed neurological symptoms following surgery. Both UBE and IELD demonstrate significant clinical efficacy in the treatment of HDM-LDH. The IELD technique is characterized by its minimally invasive nature, whereas UBE offers greater flexibility and a notably enhanced decompression effect. Clinicians are advised to select the appropriate technique based on individual patient conditions and specific clinical scenarios.
| S-EPMC11914065 | biostudies-literature
Project description:Background:Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods:Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results:The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (. Conclusions:PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.
| S-EPMC7072112 | biostudies-literature
Project description:BackgroundFenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.Methods60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3 months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years.ResultsIn both groups, all patients have minimal disability by Oswestry Disability Index after surgery. There were significant differences between means of post-operative Visual Analogue Scale for back pain between these two groups after 1 week (3.7 in group A versus 2.2 in group B) (t = 13.28, P = < 0.001*) and after 3 months (1.73 in group A versus 0.43 in group B) (t = 10.54, P = < 0.001*). There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group). There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P < 0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P < 0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P < 0.001).ConclusionUse of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.Trial registrationNCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485.
| S-EPMC7296743 | biostudies-literature
Project description:Symptomatic lumbar disc herniation (LDH) is widely treated using percutaneous endoscopic lumbar discectomy (PELD). In the present PELD surgery, performing decompression under endoscope still takes a long time to explore the rupture site of annulus fibrosus, resulting in prolonged operation time and over-invasion of the undegenerated annulus fibrosus. A wide range of intraoperative exploration also induces an iatrogenic injury of the normal annulus fibrosus, even aggravating intervertebral disc degeneration, which may lead to early postoperative recurrence in severe case. Hence, it is important to seek a precise decompression in PELD surgery. Under this kind of realization, more spinal surgeons possibly choose a disc staining before performing decompression. However, the classical disc staining technique still has its shortcomings. First of all, an appropriate dose of staining cannot be accurately mastered, even induces unqualified staining effect. Second, the duration of surgery and the times of fluoroscopy will be increased. Finally, what surgeons see under the endoscope is the staining result but not the staining process. Hence, this is accomplished more effectively by designing procedures that perform fully visible disc staining under spinal endoscope. There is no specific research to discuss the technique note of endoscopic staining in PELD surgery. We have come up with a new original technology of endoscopic staining with methylene blue injection in PELD for treatment of LDH.
| S-EPMC8274159 | biostudies-literature
Project description:ObjectiveThis meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation.MethodsMedline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods.ResultsOne RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, P < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, P = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, P = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, P = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, P = 0.861) between groups.ConclusionsEndoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-022-00636-1.
| S-EPMC9123128 | biostudies-literature
Project description:BackgroundLumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy) versus conservative removal of the offending disc fragment alone (sequestrectomy) provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis.MethodsA systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes.ResultsTwelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001), lower visual analogue scale (VAS) for low back pain (p<0.05), less post-operative analgesic usage (p<0.05) and better patients' satisfaction (p<0.05). Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference.ConclusionsAccording to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures.
| S-EPMC4376728 | biostudies-literature
Project description:This study compared the 1-year clinical outcomes and disc degeneration rates after transforaminal full-endoscopic lumbar discectomy (TF-FED), condoliase injection, open discectomy (OD), and microendoscopic discectomy (MED) for lumbar disc herniation (LDH). In total, 279 patients with LDH were divided into four treatment groups: TF-FED, OD, MED, and condoliase injection. Outcomes were evaluated on the basis of the complication rate, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS) scores, and the modified MacNab criteria. Surgical and hospital costs were assessed. Disc degeneration and endplate bone marrow edema were evaluated using magnetic resonance images. The mean postoperative JOABPEQ, VAS, or modified MacNab scores among the four groups had no significant differences. Additionally, the nerve injury or reoperation rate among the TF-FED, OD, and MED groups had no significant difference. However, the reoperation rate with condoliase injection was high because of residual disc herniation. Surgical and hospital costs were lower with condoliase injection and higher with OD and MED than those with TF-FED. With TF-FED and condoliase injection, the Pfirrmann grade progressed, and the disc height was significantly smaller than that with OD and MED. Endplate bone marrow edema was more common with condoliase injection and TF-FED. All groups had good outcomes. TF-FED and condoliase injection may reduce the burden of surgery because they can be performed under local anesthesia with little blood loss and low medical costs but tend to be associated with disc degeneration and endplate bone marrow edema. A randomized controlled study with a larger sample is needed.
| S-EPMC11461182 | biostudies-literature
Project description:Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI) over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more) improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3) years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P < 0.001). Post-surgical success was 76.0% (n = 117). The patients' rating on surgical success assessments by the ODI discriminated well between sub-groups of patients who differed with respect to the Finneson-Cooper score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy.
| S-EPMC4839763 | biostudies-literature
Project description:Introduction: Since the introduction of lumbar microdiscectomy in the 1970's, many studies have attempted to compare the effectiveness of this method with that of standard open discectomy with conflicting results. This observational study is designed to compare the relative effectiveness of microdiscectomy (MD) with open discectomy (OD) for treating lumbar disc herniation, -within a large cohort, recruited from daily clinical practice. Methods and analysis: This study will include patients registered in the Norwegian Registry for Spine Surgery (NORspine). This clinical registry collects prospective data, including preoperative and postoperative outcome measures as well as individual and demographic parameters. The primary outcome is change in Oswestry disability index between baseline and 12 months after surgery. Secondary outcome measures are improvement of leg pain and changes in health related quality of life measured by the Euro-Qol-5D between baseline and 12 months after surgery, complications to surgery, duration of surgical procedures and length of hospital stay.
| S-EPMC5089132 | biostudies-literature