scholarly journals Early Versus Delayed Microdiscectomy for Chronic Sciatica Lasting 4–12 Months Secondary to Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial

2021 ◽  
pp. 219256822110540
Author(s):  
Christopher S. Bailey ◽  
Andrew Glennie ◽  
Parham Rasoulinejad ◽  
Andrew Kanawati ◽  
David Taylor ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Early Surgery ◽  
Adverse Event Rate ◽  
Delayed Surgery ◽  
Surgery Group ◽  
Chronic Sciatica

Objectives To compare the effect of delaying surgery on clinical outcome in patients with chronic sciatica secondary to lumbar disc herniation. Methods Patients with sciatica lasting 4–12 months and lumbar disc herniation at the L4–L5 or L5–S1 level were randomized to undergo microdiscectomy (early surgery) or to receive 6 months of nonoperative treatment followed by surgery if needed (delayed surgery). Outcomes were leg pain, Oswestry Disability Index score (ODI), back pain, SF–36 physical component (PCS) and mental component (MCS) summary scores, employment, and satisfaction measured preoperatively and at 6 weeks, 3 months, 6 months, and 1 year after surgery. Results Of the 64 patients in the early surgery group, 56 underwent microdiscectomy an average of 3 ± 2 weeks after enrollment. Of the 64 patients randomized to nonoperative care, 22 patients underwent delayed surgery an average of 53 ± 24 weeks after enrollment. The early surgery group experienced less leg pain than the delayed surgery group, which was the primary outcome, at 6 months after surgery (early surgery 2.8 ± .4 vs delayed surgery 4.8 ± .7; difference, 2.0; 95% confidence interval, .5–3.5). The overall estimated mean difference between groups significantly favored early surgery for leg pain, ODI, SF36-PCS, and back pain. The adverse event rate was similar between groups. Conclusions Patients presenting with chronic sciatica treated with delayed surgery after prolonging standardized non-operative care have inferior outcomes compared to those that undergo expedited surgery.

scholarly journals Open discectomy versus microscopic discectomy for lumbar disc herniation

2020 ◽  
Author(s):  
Sherwan Hamawandi ◽  
Injam Ibrahim Sulaiman ◽  
Ameer Kadhim Al-Humairi
Keyword(s):  
Back Pain ◽  
Hospital Stay ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Postoperative Hospital Stay ◽  
Daily Activities ◽  
Leg Pain ◽  
Significant Difference ◽  
Pain Duration

Abstract Background Discectomy for symptomatic lumbar disc herniation is the most common surgical procedure in spine surgery. Lumbar discectomy can be done by traditional open method or by varieties of minimal invasive techniques mainly microscopic or endoscopic procedures. This study evaluates the effectiveness of microdiscectomy compared with open discectomy in the treatment of lumbar disc herniation as a relation to the relief of leg pain, post-operative back pain, postoperative hospital stay and returns to daily activity. Methods Sixty patients were included in this study, 30 patients underwent an open discectomy and 30 patients underwent microdiscectomy. Those patients were followed up for 12 months after surgery. Each patient was evaluated for the postoperative back pain, leg pain, duration of hospital stay postoperatively and return to sedentary daily activity. The methods used to evaluate each patient are Visual analogue scale for back pain and leg pain and Oswestry disability index. Results Results showed that there is a significant difference in the postoperative back pain, duration of postoperative hospital stay and the time of return to sedentary daily activities between open discectomy and microdiscectomy with superiority for microdiscectomy while there is no significant difference in the relieving leg pain between the open discectomy and microdiscectomy. Conclusion Microdisctomy is effective as open discectomy in the aspect of relieving the leg pain with the advantage of less postoperative back pain, less postoperative hospital stay and early return to sedentary daily activities.

Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

2021 ◽  
Author(s):  
Hai-Chao He ◽  
Xiao-qiang LV ◽  
Yong-Jin Zhang
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

scholarly journals Open Fenestration Discectomy Versus Microscopic Fenestration Discectomy for Lumbar Disc Herniation: a randomized controlled trial

2020 ◽  
Author(s):  
Sherwan Hamawandi ◽  
Injam Ibrahim Sulaiman ◽  
Ameer Kadhim Al-Humairi
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Oswestry Disability Index ◽  
Lumbar Disc ◽  
Daily Activities ◽  
Leg Pain ◽  
Group A ◽  
Group B ◽  
Type Of Surgery

Abstract Background: Fenestration 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.Methods: 60 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, 3months, 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. Results: In both groups, all patients have minimal disability by Oswestry Disability Index after surgery.There were significant differences between means of post-operative VAS for back pain between these two groups after one weeks (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).Conclusion: Use 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 registration: NCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485

scholarly journals Outcomes following discectomy for lumbar disc herniation in patients with substantial back pain

2020 ◽  
Vol 33 (5) ◽  
pp. 623-626
Author(s):  
Simon Thorbjørn Sørensen ◽  
Rachid Bech-Azeddine ◽  
Søren Fruensgaard ◽  
Mikkel Østerheden Andersen ◽  
Leah Carreon
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Patient Reported Outcomes ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Patient Reported ◽  
Vas Scores ◽  
The Mean

OBJECTIVEPatients with lumbar disc herniation (LDH) typically present with lower-extremity radiculopathy. However, there are patients who have concomitant substantial back pain (BP) and are considered candidates for fusion. The purpose of this study was to determine if patients with LDH and substantial BP improve with discectomy alone.METHODSThe DaneSpine database was used to identify 2399 patients with LDH and baseline BP visual analog scale (VAS) scores ≥ 50 who underwent a lumbar discectomy at one of 3 facilities between June 2010 and December 2017. Standard demographic and surgical variables and patient-reported outcomes, including BP and leg pain (LP) VAS scores (0–100), Oswestry Disability Index (ODI), and European Quality of Life–5 Dimensions Questionnaire (EQ-5D) at baseline and 12 months postoperatively, were collected.RESULTSA total of 1654 patients (69%) had 12-month data available, with a mean age of 48.7 years; 816 (49%) were male and the mean BMI was 27 kg/m2. At 12 months postoperatively, there were statistically significant improvements (p < 0.0001) in BP (72.6 to 36.9), LP (74.8 to 32.6), ODI (50.9 to 25.1), and EQ-5D (0.25 to 0.65) scores.CONCLUSIONSPatients with LDH and LP and concomitant substantial BP can be counseled to expect improvement in their BP 12 months after surgery after a discectomy alone, as well as improvement in their LP.

scholarly journals Use of Temporary Implantable Biomaterials to Reduce Leg Pain and Back Pain in Patients with Sciatica and Lumbar Disc Herniation

Materials ◽  
2010 ◽  
Vol 3 (5) ◽  
pp. 3331-3368 ◽  
Author(s):  
Gere S. DiZerega ◽  
Melissa M. Traylor ◽  
Lisa S. Alphonso ◽  
Samuel J. Falcone
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain

scholarly journals Spontaneous Resorption Of A Lumbar Disc Herniation In A Patient With Multiple Myeloma: A Rare Association

2020 ◽  
Author(s):  
Xingchen Yao ◽  
Yanzhe Wei ◽  
Lei Qi ◽  
Xinru Du
Keyword(s):  
Multiple Myeloma ◽  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Herniated Disc ◽  
Intervertebral Disc Herniation ◽  
Low Back

Abstract Background: The phenomenon of spontaneous resorption of a herniated disc (HD) is a common occurrence. In literature, there are many studies attempting to explain the mechanism for regression, including imaging techniques and immunohistologic analyses. Nevertheless, the exact mechanism remains uncertain. In addition, the connection between HD regression and general conditions of patients is not concerned yet. Here we report a case of spontaneous resorption of a lumbar disc herniation in a patient with multiple myeloma, which had not reported before.Case presentation: An illustrative patient, a 42-year-old Chinese man, was admitted to our hospital with a disc herniation at L5-S1, experiencing 2-months history of low back pain and 1-month left leg pain. He was treated conservatively with medication and physical therapy. Then he was symptom-free after 2 months. The low back pain of the patient recurred with the herniated lumbar disc disappearing after 2 years. The disappearance demonstrated by magnetic resonance imaging (MRI). And besides, the patient was diagnosed with multiple myeloma (MM). The emergence of MM might result in the recurred backache, and the process of HD resorption might be accelerated by the high serum Vascular endothelial growth factor (VEGF) of the MM patient.Conclusions: For patients who suffering from intervertebral disc herniation together with diseases upregulating VEGF level, such as MM, surgical treatment should be limited and the conservatively treating time can be lengthened.

scholarly journals Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

2021 ◽  
pp. 219256822097608
Author(s):  
Dinesh Kumarasamy ◽  
Shanmuganathan Rajasekaran ◽  
Sri Vijay Anand K. S ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty T ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Rating Scale ◽  
Lumbar Disc ◽  
Modic Changes ◽  
P Value ◽  
Functional Scores

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

scholarly journals Rasterstereographic Analysis of Lateral Shift in Patients with Lumbar Disc Herniation: A Case Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Britta K. Krautwurst ◽  
Jürgen R. Paletta ◽  
Sylvia Mendoza ◽  
Adrian Skwara ◽  
Melvin Mohokum
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pelvic Tilt ◽  
Lumbar Disc ◽  
Lateral Shift ◽  
Healthy Controls ◽  
Low Back

Objective. Detection of a lateral shift (LS) in patients with diagnosed disc herniation compared to healthy controls. Summary of Background Data. A specific lateral shift (LS) pattern is observed in patients with disc herniation and low back pain, as shown in earlier studies. Methods. Rasterstereography (RS) was used to investigate the LS. Thirty-nine patients with lumbar disc herniation diagnosed by radiological assessment and low back pain and/or leg pain (mean age 48.2 years, mean BMI 28.5, 28 males and 11 females) and 36 healthy controls (mean age 47.4 years, mean BMI 25.7, 25 males and 11 females) were analysed. LS, pelvic tilt, pelvic inclination, lordotic angle, and trunk torsion were assessed. Results. The patient group showed a nonsignificant increase in LS, that is, 5.6 mm compared to the healthy controls with 5.0 mm (p = 0.693). However, significant differences were found between groups regarding pelvic tilt in degrees (patients 5.9°, healthy controls 2.0°; p = 0.016), trunk torsion (patients 7.5°, controls 4.5°; p = 0.017), and lordotic angle (patients 27.5°, healthy controls 32.7°; p = 0.022). The correlation between pain intensity and the FFbH-R amounted 0.804 (p = < 0.01), and that between pain intensity and the pain disability index was 0.785 (p < 0.01). Discussion. Although some studies have illustrated LS with disc herniation and low back pain, the present findings demonstrate no significant increase in LS in the patient group compared to healthy controls. Conclusion. The patients with lumbar disc herniation did not demonstrate an increased LS compared to healthy controls. Other parameters like pelvic tilt and inclination seemed to be more suitable to identify changes in posture measured by RS in patients with low back pain or disc herniation.

scholarly journals Open discectomy vs microdiscectomy for lumbar disc herniation - a protocol for a pragmatic comparative effectiveness study

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2170 ◽  
Author(s):  
Andreas Sørlie ◽  
Sasha Gulati ◽  
Charalampis Giannadakis ◽  
Sven M. Carlsen ◽  
Øyvind Salvesen ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Relative Effectiveness ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Leg Pain ◽  
Secondary Outcome ◽  
Clinical Registry

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.

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