scholarly journals Surgical Outcomes for Upper Lumbar Disc Herniation: Decompression Alone versus Fusion Surgery

2019 ◽  
Vol 8 (9) ◽  
pp. 1435 ◽  
Author(s):  
Tung-Yi Lin ◽  
Ying-Chih Wang ◽  
Chia-Wei Chang ◽  
Chak-Bor Wong ◽  
You-Hung Cheng ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Lumbar Disc ◽  
Demographic Data ◽  
Fusion Surgery ◽  
Surgical Interventions ◽  
Spinal Fusion Surgery ◽  
Oswestry Disability Index Score ◽  
Functional Scores ◽  
Lower Lumbar ◽  
Upper Lumbar Disc Herniation

Upper lumbar herniated intervertebral disc (HIVD), defined as L1-2 and L2-3 levels, presents with a lower incidence and more unfavorable surgical outcomes than lower lumbar levels. There are very few reports onthe appropriate surgical interventions for treating upper lumbar HIVD. This study aimed to evaluate the surgical outcome of decompression alone, when compared with spinal fusion surgery. A retrospective study involving a total of 7592 patients who underwent surgery due to HIVD in our institution was conducted. A total of 49 patients were included in this study: 33 patients who underwent decompression-only surgery and 16 patients who underwent fusion surgery. Demographic data, perioperative information, and functional outcomes were recorded. The visual analog scale (VAS) scores showed improvement in both groups postoperatively. The three-month postoperative Oswestry Disability Index score was significantly better in the fusion group. Additionally, 10 patients (76.9%) in the decompression group and 5 patients (83.3%) in the fusion group reported improvement in preoperative motor weakness. The final “satisfactory” rate was 66.7% in the decompression group and 93.8% in the fusion group (p = 0.034). The overall surgical outcomes of patients with upper lumbar HIVD were satisfactory in this study without any major complications. More reliable satisfactory rates and better functional scores at the three-month postoperative follow-up were reported in the fusion group.

scholarly journals Surgical outcomes of decompression alone versus transpedicular screw fixation for upper lumbar disc herniation

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Ahmed Y. Soliman ◽  
Amr Abu Elfadle
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Outcomes ◽  
Screw Fixation ◽  
Lumbar Disc ◽  
Transpedicular Screw ◽  
Group 2 ◽  
Upper Lumbar Disc Herniation ◽  
Transpedicular Screw Fixation ◽  
Group 1

Abstract Background Surgical outcomes of upper lumbar disc herniations (ULDHs) including T12-L1, L1-L2, and L2-L3 levels are characteristically less favorable and more unpredictable. Objectives This study was conducted to compare the surgical outcomes of decompression alone versus decompression combined with transpedicular screw fixation in treating upper lumbar disc herniation. Methods This retrospective cohort study was carried out at Neurosurgery Departments, Tanta University. The study included 46 patients with a symptomatic high lumbar herniated disc at T12-L1, L1-L2, and L2-L3 levels. The enrolled patients were divided into two groups depending on whether they were operated on via decompression and partial medial facetectomy (group 1, 22 patients) or via the previous maneuver plus transpedicular screw fixation (group 2, 24 patients). All patients were medically evaluated immediately after the operation; then, they were followed up at the 3rd and the 6th months following surgery. Patients’ outcomes were assessed by visual analogue score (VAS) and Oswestry Disability Index (ODI) scores. Results Median VAS scores in each group revealed significant reduction immediately following surgery and at each of 7 days, 3 months, and 6 months in comparison with the preoperative VAS score (p<0.001). Furthermore, each group showed significant stepwise reduction in the median ODI score at the 3rd and the 6th months postoperative compared to the preoperative ODI score (group 1 = 68.0, 19.0, 15.0; p< 0.001 and group 2 = 66.5, 20.0, 15.0; p< 0.001), with no significant differences between both groups (p> 0.05). Conclusions Both standalone decompression and decompression combined with transpedicular screw fixation revealed comparable favorable outcomes in patients with ULDH.

scholarly journals Compared to Conventional Dressing Techniques, Tranexamic Acid Injection Provide Better Surgical Outcomes in Spinal Fusion Surgery

2018 ◽  
Vol 11 (4) ◽  
pp. 2215-2220
Author(s):  
Ahmad Fauzi ◽  
Adam Moelyono ◽  
S. Dohar Tobing
Keyword(s):  
Tranexamic Acid ◽  
Spinal Fusion ◽  
Surgical Outcomes ◽  
Acid Group ◽  
Adhesive Tape ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Acid Injection ◽  
Group 2 ◽  
Sterile Gauze

The use of mechanical and chemical hemostatic control techniques in spinal fusion surgery is common in Indonesia. However, there has been no study comparing the two in a single clinical trials. This study aims to find out which best of tranexamic acid injection, a bulky compression dressing and a standard dressing in providing surgical outcomes in spinal fusion surgery. Thirty patients were grouped into three, 10 patients each. To Group 1, tranexamic acid at a dose of 500 mg/ml was administered pre operation and 2 hours later. For Group 2, a bulky compression dressing was performed by covering the surgical wounds with a low-adherent dressing, overlaid with four layers of sterile gauze and then sealed with a conformable adhesive retention tape. Standard dressing was applied to the patients of Group-3 using the same type of bandage and adhesive tape given to the Group-2, but only overlaid with two layers of sterile gauze. There is no statistical difference among trials groups for preoperative (P > 0.220) and postoperative (P > 0.380) hemoglobin levels and the level of perioperative blood loss (P > 0.110). With respect to number of transfusion required, the tranexamic acid group was significantly lower compared to the standard dressing group (P = 0.018). No abnormality of wound seen in all three trials groups and only 2 patients of bulky compression dressing group reported experience of headache. In conclusion, tranexamic acid is better to promote hemostasis compared to conventional dressing techniques.

scholarly journals Is Microendoscopic Discectomy Effective for Patients With Concomitant Lumbar Disc Herniation and Spondylolysis?

2019 ◽  
Vol 10 (6) ◽  
pp. 700-705 ◽  
Author(s):  
Yasushi Oshima ◽  
Hirohiko Inanami ◽  
Hiroki Iwai ◽  
Hisashi Koga ◽  
Yuichi Takano ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Outcomes ◽  
Retrospective Cohort ◽  
Lumbar Disc ◽  
Fusion Surgery ◽  
Additional Surgery ◽  
Microendoscopic Discectomy ◽  
The Mean

Study Design: A retrospective cohort study. Objective: Although it is controversial whether to choose only discectomy or fusion surgery in patients with disc herniation and spondylolysis, we expected that aggravation of the spondylolysis may be prevented if posterior supporting muscles can be well-preserved without extensive exploration. The purpose of this study was to investigate the influence of L5 spondylolysis on surgical outcomes following microendoscopic discectomy (MED) in patients with concomitant lumbar disc herniation and spondylolysis. Methods: We reviewed 811 patients who underwent MED for L4/5 or L5/S1 disc herniation. Patients with spondylolisthesis were excluded. We compared surgical outcomes of patients with and without L5 spondylolysis, whose age, sex, and surgical level were matched. Results: A total of 655 patients (80.7%) with complete data were considered eligible for the study. MED was performed at L4/5 and L5/S1 in 338 and 317 patients, respectively. A total of 20 patients (3.1%) had concomitant L5 spondylolysis and disc herniation at L4/5 (9 patients) or L5S1 (11 patients). As we compared each outcome of the 20 patients having L5 spondylolysis with 40 matched patients without L5 spondylosis, there were no significant differences in preoperative or postoperative outcomes between the 2 groups, and no patient with spondylolysis had undergone additional surgery during the mean follow-up period of 24 months. Conclusions: MED demonstrated good surgical results regardless of the presence or absence of spondylolysis. In patients with sciatica with concomitant disc herniation and spondylolysis, but without spondylolisthesis, fusion surgery may not be always necessary.

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 Is there a correlation between upper lumbar disc herniation and multifidus muscle degeneration? A retrospective study of MRI morphology

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chong Liu ◽  
Jiang Xue ◽  
Jingjing Liu ◽  
Gang Ma ◽  
Abu Moro ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Lumbar Disc ◽  
Fatty Infiltration ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Muscle Degeneration ◽  
Multifidus Muscle ◽  
Cross Sectional ◽  
Upper Lumbar Disc Herniation ◽  
Muscle Cross Sectional Area

Abstract Background The purpose of the study is to investigate the correlation between upper lumbar disc herniation (ULDH) and multifidus muscle degeneration via the comparison of width, the cross-sectional area and degree of fatty infiltration of the lumbar multifidus muscle. Methods Using the axial T2-weighted images of magnetic resonance imaging as an assessment tool, we retrospectively investigated 132 patients with ULDH and 132 healthy individuals. The total muscle cross-sectional area (TMCSA) and the pure muscle cross-sectional area (PMCSA) of the multifidus muscle at the L1/2, L2/3, and L3/4 intervertebral disc levels were measured respectively, and in the meantime, the average multifidus muscle width (AMMW) and degree of fatty infiltration of bilateral multifidus muscle were evaluated. The resulting data were analyzed to determine the presence/absence of statistical significance between the study and control groups. Multivariate logistical regression analyses were used to evaluate the correlation between ULDH and multifidus degeneration. Results The results of the analysis of the two groups showed that there were statistically significant differences (p < 0.05) between TMCSA, PMCSA, AMMW and degree of fatty infiltration. The multivariate logistic regression analysis indicated that the TMCSA, PMCSA, AMMW and the degree of fatty infiltration of multifidus muscle were correlated with ULDH, and the differences were statistically significant (P < 0.05). Conclusions A correlation could exist between multifidus muscles degeneration and ULDH, that may be a process of mutual influence and interaction. Lumbar muscle strengthening training could prevent and improve muscle atrophy and degeneration.

Fatal pulmonary fat embolism after posterior spinal fusion surgery

2006 ◽  
Vol 11 (2) ◽  
pp. 217-220 ◽  
Author(s):  
Yoshimasa Takahashi ◽  
Ken’ichiro Narusawa ◽  
Kenji Shimizu ◽  
Masakazu Takata ◽  
Toshitaka Nakamura
Keyword(s):  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Fat Embolism ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pulmonary Fat Embolism

OBESITY AND SELF-REPORTED OUTCOME AFTER MINIMALLY INVASIVE LUMBAR SPINAL FUSION SURGERY

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 956-960 ◽  
Author(s):  
David S. Rosen ◽  
Sherise D. Ferguson ◽  
Alfred T. Ogden ◽  
Dezheng Huo ◽  
Richard G. Fessler
Keyword(s):  
Minimally Invasive ◽  
Linear Models ◽  
Short Form ◽  
Length Of Hospital Stay ◽  
Fusion Surgery ◽  
Body Habitus ◽  
Short Form 36 ◽  
Spinal Fusion Surgery ◽  
The Mean ◽  
Lumbar Spinal

Abstract OBJECTIVE Many patients undergoing lumbar spine fusion are overweight or obese. The relationship between body habitus and outcome after lumbar spine fusion surgery is not well defined. METHODS We analyzed a prospectively maintained database of self-reported pain and quality of life measures, including Visual Analog Scale pain score, Short Form 36, and Oswestry Disability Index. We selected patients undergoing minimally invasive transforaminal lumbar interbody fusion between September 2002 and June 2006 at a single institution. We used linear regression models and mixed-effects linear models to examine the relationships between body habitus and self-reported outcomes. RESULTS The analysis identified 110 patients meeting the study criteria, with a median follow-up period of 14.8 months. The mean age was 56 years, mean height was 169 cm, and mean weight was 82.2 kg. The mean body mass index (BMI) was 28.7 kg/m2; 31% of patients were overweight (BMI, 25–29.9), and 32% of patients were obese (BMI, &gt;30). Linear regression analysis did not identify a correlation between weight or BMI and pre- and postsurgery changes in any of the outcome measures. The significant findings observed in the mixed-effects linear models were that the changing patterns of Short Form 36 Body Pain subscale and Short Form 36 Vitality subscale varied significantly by category of BMI (P = 0.01 and P = 0.002, respectively), but not significantly if continuous BMI was used (P = 0.53 and P = 0.46, respectively). BMI correlated marginally with estimated blood loss (P = 0.08), but not operative time, length of hospital stay, or complications. CONCLUSION Among this cohort of minimally invasive lumbar fusion patients, body habitus measured by BMI, weight, or height did not have a significant relationship with most self-reported outcome measures, operative time, length of hospital stay, or complications. Obesity should not be considered a contraindication to minimally invasive lumbar spinal fusion surgery.

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