Short Term Clinical Outcome of Micro Lumbar Discectomy in Tertiary Care Center

Background: Minimal invasive open lumbar microdiscectomy has been associated with good success rate and low morbidity. The present study is aimed to evaluate the clinical outcome of patients who underwent open minimal invasive open lumbar microdiscectomy for herniated intervertebral disc. Materials and Methods: This is a prospective observational hospital based study of prolapsed lumbar intervertebral disc operated in the department of neurosurgery at Nobel Medical College Teaching Hospital, Biratnagar, Nepal from January 2018 to June 2021. All patients of lumbar herniated intervertebral disc subjected for surgery were included. Recurrent prolapsed intervertebral disc, Disc surgery requiring stabilization was excluded from the study. During surgery types of prolapsed intervertebral disc, level and operative time were noted. In the post-operative period Visual Analogue Scale was used to assess the change in severity of pain. Duration of hospital stay and the complications occurred were also noted. Results: The mean age of the study population was was 41.50 (±14.56) years ranging from 20 years to 79 years. The commonest lumbar prolapsed intervertebral disc was at L4-L5 level. The mean operative time was 42 minutes excluding the time for anaesthesia preparation. There was statistically significant difference (p<0.001) in pre-operative and post-operative Visual Analogue Scale. Mean duration of hospital stay was 5.58 (1.87) days. Conclusion: A through workup and surgical planning is associated with better outcome avoiding complications in minimal invasive open micro lumbar discectomy.

Rehabilitation of patients after lumbar microdiscectomy

Objective: to investigate movement-based therapy (kinesitherapy) effectiveness in the rehabilitation of patients after lumbar microdiscectomy.Patients and methods. We enrolled 90 patients (33 men and 57 women, mean age — 59.78±12.0 years) after lumbar microdiscectomy due to the ineffectiveness of conservative management of discogenic lumbosacral radiculopathy. One-half of the participants (45 patients: 15 men and 30 women, mean age — 60.24±12.0 years) underwent kinesitherapy under the supervision of a physician; in other 45 patients (18 men and 27 women, mean age — 59.33±11.0 years), kinesitherapy was not included in the radiculopathy treatment protocol. We assessed pain intensity with visual analogue scale (VAS) and disability using the Roland-Morris scale (RMS) before surgery, ten days after the surgery, and 1, 3, and 6 months after surgery.Results and discussion. We observed a significant decrease in pain intensity - up to 4 points on the VAS, and an improvement in activities of daily living up to 10 points on the RMS 10 days after microdiscectomy. After six months, there was a decrease in pain intensity according to the VAS to 2 points in the kinesitherapy group and to 3 points in the group without kinesitherapy (p=0.088), as well as an improvement in activities of daily living according to RMS up to 5 points in the kinesitherapy group and up to 8 points in the group without kinesitherapy (p=0.003). Reoperations were required in two of 45 patients in the group without kinesitherapy (4.4%) and in one of 45 patients (2.2%) in the kinesitherapy group (p≥0.05).Conclusion. Kinesitherapy can improve functional recovery in patients after lumbar microdiscectomy.

A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery

Objective To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. Methods This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. Results The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. Conclusion We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery.

Comparison of the Outcomes of Percutaneous Endoscopic Interlaminar Lumbar Discectomy and Open Lumbar Microdiscectomy at the L5-S1 Level

BACKGROUND: Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) and open lumbar microdiscectomy (OLM) at the L5-S1 level. OBJECTIVES: We compared the clinical, surgical, and radiological outcomes of patients with disc herniation at the L5-S1 level who underwent either PEILD, or OLM, performed by a single surgeon with novice-level proficiency. STUDY DESIGN: Observational, retrospective matched cohort design. SETTING: An analysis of clinical data was performed at a single center, collected from September 2012 to August 2016. METHODS: The study enrolled 56 patients who underwent discectomy at the L5-S1 level, with a minimum one-year follow-up. Patients were allocated to 2 groups: a PEILD group (n = 27; September 2014 to August 2016), or an OLM group (n = 29; September 2012 to August 2014). Clinical, surgical, and radiological outcomes were retrospectively evaluated. RESULTS: Baseline characteristics including age, gender, past medical history, body mass index, preoperative symptom, and preoperative radiological findings did not differ significantly between the groups. Further, overall clinical outcomes including back and leg pain; surgical outcomes including blood loss, complication rate, and recurrence rate; and radiological outcomes including degree of decompression, disc height, and sagittal alignment were not different significantly between the 2 groups. However, the PEILD group showed significant advantages including lower immediate postoperative back pain (mean 1.44 [95% confidence interval (CI), 1.16-1.72] versus 2.41 [95% CI, 2.14-2.69], P < 0.001), favorable immediate postoperative Odom’s criteria (excellent 57.14% versus 24.14%, P = 0.025), shorter operation time (mean 63.89 ±17.99 minutes versus 109.66 ±31.42 minutes, P < 0.001), shorter hospital stay (3.15 [95% CI, 2.21-4.09] days versus 5.72 [95% CI, 3.29-8.16] days, P < 0.001), and rapid return to work (15.67 [95% CI, 12.64-18.69] days versus 24.31 [95% CI ,19.97-28.65] days, P = 0.001). LIMITATION: Due to its retrospective nature, it was not possible to control for all variations. Moreover, the number of patients in the final cohort was relatively small. CONCLUSIONS: Our findings indicate that the PEILD group achieved better perioperative outcomes despite no significant intergroup difference in mid-term clinical and radiological outcomes. KEY WORDS: Complication, discectomy, full endoscopic surgery, lumbar disc herniation, lumbar spine, microscopic surgery, outcome, recurrence