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Shen Z, Wang W, Ni L, Zhao H, Yang L, Yang H, Zhang L. Lumbar lordosis and sacral slope do not differ in two types of postoperative lumbar disc re-herniation: a cross-sectional observational study. BMC Musculoskelet Disord 2024; 25:267. [PMID: 38582848 PMCID: PMC10998392 DOI: 10.1186/s12891-024-07376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/21/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND To identify the differences of lumbar lordosis (LL) and sacral slope (SS) angles between two types of postoperative lumbar disc re-herniation, including the recurrence of same level and adjacent segment herniation (ASH). METHODS We searched the medical records of lumbar disc herniation (LDH) patients with re-herniation with complete imaging data (n = 58) from January 1, 2013 to December 30, 2020 in our hospital. After matching for age and sex, 58 patients with LDH without re-herniation from the same period operated by the same treatment group in our hospital were served as a control group. Re-herniation patients were divided into two groups, same-level recurrent lumbar disc herniation group (rLDHG) and adjacent segment herniation group with or without recurrence (ASHG). The preoperative, postoperative and one month after operation LL and SS were measured on standing radiographs and compared with the control group by using t-test, ANOVA, and rank-sum test. Next, we calculated the odds ratios (ORs) by unconditional logistic regression, progressively adjusted for other confounding factors. RESULTS Compared with the control group, the postoperative LL and SS were significantly lower in LDH patients with re-herniation. However, there were no differences in LL and SS between ASHG and rLDHG at any stage. After progressive adjustment for confounding factors, no matter what stage is, LL and SS remained unassociated with the two types of re-herniation. CONCLUSIONS Low postoperative LL and SS angles are associated with degeneration of the remaining disc. Low LL and SS may be independent risk factors for re-herniation but cannot determine type of recurrence (same or adjacent disc level).
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Affiliation(s)
- Zhijia Shen
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Wenhao Wang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Li Ni
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Hongcheng Zhao
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Lianda Yang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Huilin Yang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
| | - Linlin Zhang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
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Kweon M, Bak KH, Yi HJ, Choi KS, Han MH, Na MK, Chun HJ. Changes in Disc Height as a Prognostic Factor in Patients Undergoing Microscopic Discectomy. J Korean Neurosurg Soc 2024; 67:209-216. [PMID: 37799026 PMCID: PMC10924907 DOI: 10.3340/jkns.2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc. METHODS This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery. RESULTS A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months. CONCLUSION In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.
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Affiliation(s)
- Myeonggeon Kweon
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Min-Kyun Na
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
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Musa G, Makirov SK, Chmutin GE, Susin SV, Kim AV, Antonov GI, Otarov O, Ndandja DT, Egor G C, Chaurasia B. Management of recurrent lumbar disc herniation: a comparative analysis of posterior lumbar interbody fusion and repeat discectomy. Ann Med Surg (Lond) 2024; 86:842-849. [PMID: 38333282 PMCID: PMC10849456 DOI: 10.1097/ms9.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background For recurrent lumbar disc herniation, many experts suggest a repeat discectomy without stabilization due to its minimal tissue manipulation, lower blood loss, shorter hospital stay, and lower cost, recent research on the role of instability in disc herniation has made fusion techniques popular among spinal surgeons. The authors compare the postoperative outcomes of posterior lumbar interbody fusion (PLIF) and repeat discectomy for same-level recurrent disc herniation. Methods The patients included had previously undergone discectomy and presented with a same-level recurrent lumbar disc herniation. The patients were placed into two groups: 1) discectomy only, 2) PLIF based on the absence or presence of segmental instability. Preoperative and postoperative Oswestry disability index scores, duration of surgery, blood loss, duration of hospitalization, and complications were analyzed. Results The repeat discectomy and fusion groups had 40 and 34 patients, respectively. The patients were followed up for 2.68 (1-4) years. There was no difference in the duration of hospitalization (3.73 vs. 3.29 days P=0.581) and operative time (101.25 vs. 108.82 mins, P=0.48). Repeat discectomy had lower intraoperative blood loss, 88.75 ml (50-150) versus 111.47 ml (30-250) in PLIF (P=0.289). PLIF had better ODI pain score 4.21 (0-10) versus 9.27 (0-20) (P-value of 0.018). Recurrence was 22.5% in repeat discectomy versus 0 in PLIF. Conclusion PLIF and repeat discectomy for recurrent lumbar disc herniation have comparable intraoperative blood loss, duration of surgery, and hospital stay. PLIF is associated with lower durotomy rates and better long-term pain control than discectomy. This is due to recurrence and progression of degenerative process in discectomy patients, which are eliminated and slowed, respectively, by PLIF.
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Affiliation(s)
- Gerald Musa
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University)
| | - Serik K. Makirov
- Department of Vertebrology, Scientific and Technical Center, Family Clinic
| | - Gennady E. Chmutin
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University)
| | - Sergey V. Susin
- Department of Vertebrology, Scientific and Technical Center, Family Clinic
| | - Alexander V. Kim
- Department of Neurosurgery, City Clinical Hospital 68 named after Demihov
| | - Gennady I. Antonov
- Department of Neurosurgery, Central Military Clinical Hospital named after A.A Vishnevsky of the Ministry of Defense of the Russian Federation
| | - Olzhas Otarov
- Department of Vertebrology, Scientific and Technical Center, Family Clinic
| | - Dimitri T.K. Ndandja
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN University)
| | - Chmutin Egor G
- Department of Neurological diseases and Neurosurgery, Peoples friendship University of Russia (RUDN University), Moscow, Russia
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj , Nepal
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Musa G, Abakirov MD, Chmutin GE, Mamyrbaev ST, Ramirez MDJE, Sichizya K, Kim AV, Antonov GI, Chmutin EG, Hovrin DV, Slabov MV, Chaurasia B. Advancing insights into recurrent lumbar disc herniation: A comparative analysis of surgical approaches and a new classification. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:66-73. [PMID: 38644909 PMCID: PMC11029108 DOI: 10.4103/jcvjs.jcvjs_177_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/21/2024] [Indexed: 04/23/2024] Open
Abstract
Background The management of recurrent lumbar disc herniation (rLDH) lacks a consensus. Consequently, the choice between repeat microdiscectomy (MD) without fusion, discectomy with fusion, or endoscopic discectomy without fusion typically hinges on the surgeon's expertise. This study conducts a comparative analysis of postoperative outcomes among these three techniques and proposes a straightforward classification system for rLDH aimed at optimizing management. Patients and Methods We examined the patients treated for rLDH at our institution. Based on the presence of facet resection, Modic-2 changes, and segmental instability, they patients were categorized into three groups: Types I, II, and III rLDH managed by repeat MD without fusion, MD with transforaminal lumbar interbody fusion (TLIF) (MD + TLIF), and transforaminal endoscopic discectomy (TFED), respectively. Results A total of 127 patients were included: 52 underwent MD + TLIF, 50 underwent MD alone, and 25 underwent TFED. Recurrence rates were 20%, 12%, and 0% for MD alone, TFED, and MD + TLIF, respectively. A facetectomy exceeding 75% correlated with an 84.6% recurrence risk, while segmental instability correlated with a 100% recurrence rate. Modic-2 changes were identified in 86.7% and 100% of patients experiencing recurrence following MD and TFED, respectively. TFED exhibited the lowest risk of durotomy (4%), the shortest operative time (70.80 ± 16.5), the least blood loss (33.60 ± 8.1), and the most favorable Visual Analog Scale score, and Oswestry Disability Index quality of life assessment at 2 years. No statistically significant differences were observed in these parameters between MD alone and MD + TLIF. Based on this analysis, a novel classification system for recurrent disc herniation was proposed. Conclusion In young patients without segmental instability, prior facetectomy, and Modic-2 changes, TFED was available should take precedence over repeat MD alone. However, for patients with segmental instability, MD + TLIF is recommended. The suggested classification system has the potential to enhance patient selection and overall outcomes.
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Affiliation(s)
- Gerald Musa
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia
| | - Medetbek Dzhumabekovich Abakirov
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia
| | - Gennady E. Chmutin
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia
| | | | - Manuel De Jesus Encarnacion Ramirez
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia
| | - Kachinga Sichizya
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Alexander V. Kim
- Department of Neurosurgery, City Clinical Hospital 68 Named After Demihov, Moscow, Russia
| | - Gennady I. Antonov
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia
| | - Egor G. Chmutin
- Department of Neurological Diseases and Neurosurgery, Peoples’ Friendship University of Russia (RUDN) Named After Patrice Lumumba, Moscow, Russia
| | - Dmitri V. Hovrin
- Department of Neurosurgery, City Clinical Hospital Named After C.C. Yudina, Moscow, Russia
| | - Mihail V. Slabov
- Department of Neurosurgery, City Clinical Hospital Named After C.C. Yudina, Moscow, Russia
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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Robinson C, Hussain N, Abd-Elsayed AA. Methods for percutaneous discectomy. DECOMPRESSIVE TECHNIQUES 2024:27-44. [DOI: 10.1016/b978-0-323-87751-0.00013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Zhu F, Chen Y, Jia D, Zhang Y, Peng Y, Ning Y, Leng X, Feng C, Zhou Y, Li C, Huang B. Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation. World Neurosurg 2023; 178:e673-e681. [PMID: 37543197 DOI: 10.1016/j.wneu.2023.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. METHODS We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. RESULTS Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. CONCLUSIONS A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu Chen
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Zhu F, Jia D, Zhang Y, Ning Y, Leng X, Feng C, Li C, Zhou Y, Huang B. Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation. Neurospine 2023; 20:637-650. [PMID: 37401083 PMCID: PMC10323347 DOI: 10.14245/ns.2346054.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy. METHODS We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH. RESULTS This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy. CONCLUSION Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
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Yang J, Liu R, Miao Y, Nian L, Meng X. Risk Factors for Recurrence After Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis. World Neurosurg 2023; 172:88-93. [PMID: 36764451 DOI: 10.1016/j.wneu.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Postoperative recurrence of percutaneous endoscopic lumbar disc increases the physical damage and financial burden on patients and negatively affects physicians' treatment decisions. We conducted this meta-analysis to explore the risk factors for postoperative recurrence of percutaneous endoscopic lumbar disc for lumbar disc herniation. METHODS We conducted article search in the PubMed, EMBASE and Cochrane Library databases. PRISMA guidelines were followed in this review. The data are statistically analyzed by the Roundup Manager (version 3.6.1). The results of the meta-analysis are presented in the form of forest-like plots. RESULTS We included 13 articles and identified 7524 cases. Patients with older age (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.18-1.40), higher body mass index (OR = 1.16, 95% CI: 1.05-1.28), smoker (OR = 1.73, 95% CI: 0.95-3.15), degenerative grades ≥3 (OR = 6.07, 95% CI: 2.81-13.11), and postoperative sagittal motion ≥10° (OR = 2.42, 95% CI: 1.63-3.58) have a higher recurrence rate. CONCLUSIONS A thorough preoperative evaluation is essential to prevent postoperative recurrence of percutaneous endoscopic lumbar discectomy. The study addresses several factors of preoperative evaluation, which is hopeful to provide a reference for neurosurgeons.
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Affiliation(s)
- Jiameng Yang
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Rui Liu
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
| | - Yu Miao
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
| | - Liwei Nian
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaotao Meng
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
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Abdallah A, Güler Abdallah B. Factors associated with the recurrence of lumbar disk herniation: non-biomechanical-radiological and intraoperative factors. Neurol Res 2023; 45:11-27. [PMID: 36047564 DOI: 10.1080/01616412.2022.2116525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Recurrent lumbar disk herniation (RLDH) is one of the most undesirable complications following lumbar discectomy (LD). This study aimed to prospectively investigate the non-biomechanical-radiological and intraoperative factors affecting the recurrence after discectomy. PATIENTS AND METHODS Data of 988 consecutive patients with Lumbar disk herniation (LDH) who underwent LD at our department for over 2 years (2014-2015) were prospectively collected. Patients who met our study criteria were included (n = 816). Patients were divided into the following groups; group 1 included patients with symptomatic RLDH within the first postoperative 2 years (PO24M), group 2 included patients with symptomatic RLDH after PO24M, and group 3 included patients without symptomatic RLDH/LDH. The preoperative non-biomechanical-radiological, surgical, and intraoperative characteristics were compared among the groups. RESULTS A total of 842 LDHs in 816 (386 men and 430 women) patients received LD. The mean age was 46.9 years. The mean follow-up period was 72.8 months. The first recurrence rates within the first PO24M and after PO24M were 7.1% and 3.2%, respectively. Disks with Modic changes type-II and contained disks without fragments were associated with the short- and long-term RLDH [(p = 0.004; HR = 0.6); (p < 0.0001; HR = 0.14)] and [(p = 0.041; HR = 0.6); (p < 0.0001; HR = 0.16)], respectively. CONCLUSIONS Several radiological, surgical, and intraoperative factors can play a critical role in RLDH; therefore, the selection criteria of patients with LDH should be carefully considered for surgical treatment to obtain acceptable outcomes. ABBREVIATIONS ANOVA: A one-way analysis of variance, CIs: 95% confidence intervals, HR: Hazard ratio, LD: Lumbar discectomy, LDH: Lumbar disc herniation, LF: ligamentum flavum, MRI: Magnetic resonance imaging, MC-I: Modic changes type I, MC-II: Modic changes type II, MC-III: Modic changes type III, n: Number, ODI: Oswestry Disability Index, OR: Odds ratio, p-value: Probability value, PO: Postoperative, Pre: Preoperative, Pts: Patients, RLDH: Recurrent lumbar disc herniation, RR: Relative/risk ratio, SPSS: Statistical package for the social science, T1WIs: T1-weighted images, T2WIs: T2-weighted images, VAS: Visual analog scale.
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Affiliation(s)
- Anas Abdallah
- Department of Neurosurgery, Istanbul Training and Research Hospital, Samatya-Istanbul, Turkey
| | - Betül Güler Abdallah
- Department of Psychiatry - AMATEM Unit, University of Health Sciences, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Bakırköy-Istanbul, Turkey
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Chen X, Lin F, Xu X, Chen C, Wang R. Development, validation, and visualization of a web-based nomogram to predict the effect of tubular microdiscectomy for lumbar disc herniation. Front Surg 2023; 10:1024302. [PMID: 37021092 PMCID: PMC10069648 DOI: 10.3389/fsurg.2023.1024302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/27/2023] [Indexed: 04/07/2023] Open
Abstract
Objective The purpose of this study was to retrospectively collect the relevant clinical data of lumbar disc herniation (LDH) patients treated with the tubular microdiscectomy (TMD) technique, and to develop and validate a prediction model for predicting the treatment improvement rate of TMD in LDH patients at 1 year after surgery. Methods Relevant clinical data of LDH patients treated with the TMD technology were retrospectively collected. The follow-up period was 1 year after surgery. A total of 43 possible predictors were included, and the treatment improvement rate of the Japanese Orthopedic Association (JOA) score of the lumbar spine at 1 year after TMD was used as an outcome measure. The least absolute shrinkage and selection operator (LASSO) method was used to screen out the most important predictors affecting the outcome indicators. In addition, logistic regression was used to construct the model, and a nomogram of the prediction model was drawn. Results A total of 273 patients with LDH were included in this study. Age, occupational factors, osteoporosis, Pfirrmann classification of intervertebral disc degeneration, and preoperative Oswestry Disability Index (ODI) were screened out from the 43 possible predictors based on LASSO regression. A total of 5 predictors were included while drawing a nomogram of the model. The area under the ROC curve (AUC) value of the model was 0.795. Conclusions In this study, we successfully developed a good clinical prediction model that can predict the effect of TMD for LDH. A web calculator was designed on the basis of the model (https://fabinlin.shinyapps.io/DynNomapp/).
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Affiliation(s)
| | | | | | | | - Rui Wang
- Correspondence: Chunmei Chen Rui Wang
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Sayin Gülensoy E, Gülensoy B. A 9-year retrospective cohort of patients with lumbar disc herniation: Comparison of patient characteristics and recurrence frequency by smoking status. Medicine (Baltimore) 2022; 101:e32462. [PMID: 36595869 PMCID: PMC9794230 DOI: 10.1097/md.0000000000032462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To evaluate the association between smoking status and patient characteristics and to identify risk factors associated with recurrence in patients who underwent surgery for lumbar disc herniation (LDH). This retrospective study was carried out at Lokman Hekim University, Ankara, Turkey between January 1, 2021 and January 1, 2022. The medical data of patients who underwent microsurgical discectomy for LDH were retrospectively recorded. Patients with any reemergence of LDH within a 6-month period after surgery were defined as having recurrent LDH. A total of 1109 patients were included in the study and mean age was 50.7 ± 14.3 years. The frequency of hernia at L2-L3 and L3-L4 levels was higher in the nonsmoker group (P < .001). The frequency of cases with Pfirrmann Grade 4 degeneration was higher in the nonsmoker group than in smokers and ex-smokers (P < .001). Protrusion-type hernias were more common in nonsmokers (P = .014), whereas paracentral hernias were more common in smokers (P < .001). The overall frequency of recurrence was 20.4%, and was higher in smokers than in non-smokers and ex-smokers (P < .001). Multivariable logistic regression revealed that current smoking (OR: 2.778, 95% CI [confidence interval]: 1.939-3.980, P < .001), presence of Pfirrmann Grade 4&5 disc degeneration (OR: 4.217, 95% CI: 2.966-5.996, P < .001), and paracentral herniation (OR: 5.040, 95% CI: 2.266-11,207, P < .001) were associated with higher risk of recurrence, whereas presence of sequestrated disc was associated with lower risk of recurrence (OR: 2.262, 95% CI:0.272-0.717, P = .001). Taken together, our data show that smoking, increased degree of degeneration and paracentral hernia increase the risk of LDH recurrence, while sequestrated disc appears to decrease risk. Taking steps to combat smoking in individuals followed for LDH may reduce the risk of recurrence in LDH patients.
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Affiliation(s)
- Esen Sayin Gülensoy
- Ufuk University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
- * Correspondence: Esen Sayin Gülensoy, Ufuk University, Faculty of Medicine, Department of Chest Diseases, Mevlana Bulvari 86/88 Balgat, Ankara 06520, Turkey (e-mail: )
| | - Bülent Gülensoy
- Lokman HekimUniversity, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey
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Canturk TC, Czikk D, Wai EK, Phan P, Stratton A, Michalowski W, Kingwell S. A scoping review of complication prediction models in spinal surgery: An analysis of model development, validation and impact. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 11:100142. [PMID: 35983028 PMCID: PMC9379667 DOI: 10.1016/j.xnsj.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/04/2022]
Abstract
Background Predictive analytics are being used increasingly in the field of spinal surgery with the development of models to predict post-surgical complications. Predictive models should be valid, generalizable, and clinically useful. The purpose of this review was to identify existing post-surgical complication prediction models for spinal surgery and to determine if these models are being adequately investigated with internal/external validation, model updating and model impact studies. Methods This was a scoping review of studies pertaining to models for the prediction of post-surgical complication after spinal surgery published over 10 years (2010-2020). Qualitative data was extracted from the studies to include study classification, adherence to Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines and risk of bias (ROB) assessment using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). Model evaluation was determined using area under the curve (AUC) when available. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used as a basis for the search methodology in four different databases. Results Thirty studies were included in the scoping review and 80% (24/30) included model development with or without internal validation. Twenty percent (6/30) were exclusively external validation studies and only one study included an impact analysis in addition to model development and internal validation. Two studies referenced the TRIPOD guidelines and there was a high ROB in 100% of the studies using the PROBAST tool. Conclusions The majority of post-surgical complication prediction models in spinal surgery have not undergone standardized model development and internal validation or adequate external validation and impact evaluation. As such there is uncertainty as to their validity, generalizability, and clinical utility. Future efforts should be made to use existing tools to ensure standardization in development and rigorous evaluation of prediction models in spinal surgery.
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Toyoda H. The Essence of Clinical Practice Guidelines for Lumbar Disc Herniation, 2021: 5. Prognosis. Spine Surg Relat Res 2022; 6:333-336. [PMID: 36051680 PMCID: PMC9381086 DOI: 10.22603/ssrr.2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University, Graduate School of Medicine
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14
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Abdallah A, Emel E, Güler Abdallah B. Factors associated with the recurrence of lumbar disk herniation: biomechanical-radiological and demographic factors. Neurol Res 2022; 44:830-846. [PMID: 35315735 DOI: 10.1080/01616412.2022.2056340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many risk factors associated with recurrent lumbar disk herniation (RLDH) following lumbar discectomy (LD) have been reported. This study aimed to elucidate the biomechanical-radiological, clinical, and demographic factors that affect symptomatic RLDH prospectively.We collected prospective data of 988 consecutive patients with LDH who underwent LD at our department from January 2014 to December 2015. Patients who met the study criteria and were followed up postoperatively for more than 5 years were included (n = 816). Patients were divided into 3 groups; group 1 included patients who experienced symptomatic RLDH within the first postoperative 24 months (PO24M), group 2 included patients with symptomatic RLDH after PO24M, and group 3 included the patients who hadn't experienced symptomatic RLDH/LDH. The preoperative biomechanical-radiological, clinical, and the patients' demographic characteristics were compared among the groups.A total of 816 patients with 842 LDH met our study criteria. The mean age at the first LD was 46.9 years. The mean follow-up period was 72.8 months. The preoperative trauma history, postoperative trauma history, and BMI > 24.5 kg/m2 were independent risk factors for RLDH. Large sROM at the L4-5 level and a higher intervertebral disk height index (IDH) were significantly higher in groups 1 and 2.Biomechanical-radiological and demographic factors can affect the incidence of symptomatic RLDH. To reduce the risk of RLDH, patients with these risk factors should receive more attention during surgical interventions. The patients should avoid gaining weight and potential traumatic accidents.
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Affiliation(s)
- Anas Abdallah
- Department of Neurosurgery, Osmaniye State Hospital, Merkez-Osmaniye, Turkey
| | - Erhan Emel
- Department of Neurosurgery, University of Health Sciences, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Bakırköy-Istanbul, Turkey
| | - Betül Güler Abdallah
- Department of Psychiatry-AMATEM Unit, University of Health Sciences, Bakırköy Research and Training Hospital for Neurology Neurosurgery, and Psychiatry, Bakırköy-Istanbul, Turkey
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Konovalov NA, Nazarenko AG, Brinyuk ES, Kaprovoy SV, Beloborodov VA, Stepanov IA. RISK FACTORS FOR RECURRENT LUMBAR DISK HERNIATION. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222104263325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
ABSTRACT Objective: to investigate the frequency of recurrent lumbar disk herniation (rLDH) and evaluated risk factors of rLDH in Russian population. Methods: this was a retrospective clinical study. From January 2015 to March 2022, 218 patients having single-level LDH at three institutes were included in this clinical study and who were then observed for a minimum of 5 years postoperatively. All the patients or relatives gave informed consent to participate in this study. The levels of disk herniation were L4-L5 in 132 cases (60.5 %), and L5-S1 in 86 cases (39.4 %). Results: The rLDH group was composed of 31 male and 12 female, whose ages ranged from 18 to 57 years (34.8±9.5 years). The non-rLDH group was composed of 97 male and 78 female, whose ages ranged from 19 to 73 years (47.5±9.8 years). According to the constructed binary logistic model, body mass index (p=0.021), current smoking (p=0.017), stage of disk degeneration (p=0.043), facet tropism (p=0.037), disk height index (p=0.018) and apparent diffusion coefficient (p=0.009) are significantly associated with incidence of rLDH. Conclusions: patients with these risk factors should be paid more attention for prevention of rLDH. Level of Evidence III; Retrospective Study.
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Li Y, Wang B, Li H, Chang X, Wu Y, Hu Z, Liu C, Gao X, Zhang Y, Liu H, Li Y, Li C. Adjuvant surgical decision-making system for lumbar intervertebral disc herniation after percutaneous endoscopic lumber discectomy: a retrospective nonlinear multiple logistic regression prediction model based on a large sample. Spine J 2021; 21:2035-2048. [PMID: 34298160 DOI: 10.1016/j.spinee.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar disc herniation (LDH) is a common condition that can affects an individual' quality of life. In patients for whom conservative treatment is ineffective after 3 months, surgical treatment, such as percutaneous endoscopic lumbar discectomy (PELD), is recommended. Because PELD is minimally invasive and produces thorough nerve root decompression, both surgeons and patients often prefer it to other techniques. PURPOSE Surgeons find it challenging to prevent postoperative recurrent LDH (rLDH) when they use PELD. We created and verified a model for evaluating patients' recurrence risk factors before surgery so that surgeons can choose other surgical techniques when necessary. STUDY DESIGN Retrospective study. PATIENT SAMPLE One thousand eight hundred seven patients who underwent PELD at our hospital between 2012 and 2015 were enrolled. OUTCOME MEASURE The main outcome measure was rLDH at any follow-up time point. METHODS Data were retrospectively analyzed for 1807 patients who underwent PELD at our hospital at some point between 2012 and 2015; all patients had been monitored for at least 5 years after surgery. They were divided into a recurrence group and a nonrecurrence group. Clinical and radiological risk factors were assessed over time to determine their correlations with recurrence and to exclude less important factors. A nonlinear multivariate logistic regression model was established to predict the recurrence rate before surgery. RESULTS A total of 1706 patients were monitored after PELD; data were missing for 101 additional patients. The total recurrence rate was 10.38%, and the most common time from surgery to recurrence was 1 year. Ten risk factors were assessed and included in the analysis. Regarding clinical risk factors, patients with hypertension (p < .001; correlation coefficient R [R] = 0.235; odds ratio [OR] = 4.749), diabetes (p < .001; R = 0.381; OR = 16.797), a history of smoking (p < .001; R = 0.347; OR = 9.012), and a history of performing intense physical labor (p < .001; R = 0.409; OR = 19.592) had a higher recurrence rate. Regarding radiological risk factors, patients with disc degeneration (Pfirrmann grade III) (p < .001; R = 0.228; OR = 4.919), Modic changes (level 2) (p < .001; R = 0.309; OR = 7.934), herniation in the form of extrusion (p < .001; R = 0.365; OR = 12.228), a higher disc height index (DHI) (p < .001; R = 0.336), and a larger segmental range of motion (p < .001; R = 0.243) had a higher recurrence rate. When the lumbar motion angle was negative (p < .001; R = 0.318; OR = 13.680), the recurrence rate was high. The overall accuracy of the final model was 97.6% (1665 of 1706). The recognition rate for non-rLDH cases was 99.0% (1514 of 1529), and the rate for rLDH cases was 85.3% (151 of 177); the AUC was 0.9315. A simple model was used. For those patients with postoperative trauma (p < .001; R = 0.382; OR = 13.680), a comparison model was established, and the corresponding recurrence rate was 23.0% ± 25.0% (0-76%). CONCLUSIONS A large cohort of patients underwent long-term monitoring, and 11 risk factors were verified for assessing each patient's risks before surgery to predict the postoperative recurrence of LDH following PELD. The risk of recurrence may be effectively reduced with the use of alternative surgical techniques in high risk cases.
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Affiliation(s)
- Yueyang Li
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Bo Wang
- School of microelectronics and communication engineering, Chongqing University, China
| | - Haiyin Li
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Xian Chang
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Yu Wu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Zhilei Hu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Chenhao Liu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Xiaoxin Gao
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Yuyao Zhang
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Huan Liu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Yongming Li
- School of microelectronics and communication engineering, Chongqing University, China.
| | - Changqing Li
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China.
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17
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Artificial intelligence predicts disk re-herniation following lumbar microdiscectomy: development of the "RAD" risk profile. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2167-2175. [PMID: 34100112 DOI: 10.1007/s00586-021-06866-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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18
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Mallow GM, Siyaji ZK, Galbusera F, Espinoza-Orías AA, Giers M, Lundberg H, Ames C, Karppinen J, Louie PK, Phillips FM, Pourzal R, Schwab J, Sciubba DM, Wang JC, Wilke HJ, Williams FMK, Mohiuddin SA, Makhni MC, Shepard NA, An HS, Samartzis D. Intelligence-Based Spine Care Model: A New Era of Research and Clinical Decision-Making. Global Spine J 2021; 11:135-145. [PMID: 33251858 PMCID: PMC7882816 DOI: 10.1177/2192568220973984] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- G. Michael Mallow
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Zakariah K. Siyaji
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | | | - Alejandro A. Espinoza-Orías
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Morgan Giers
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, OR, USA
| | - Hannah Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, CA, USA
| | - Jaro Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Frank M. Phillips
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Schwab
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Daniel M. Sciubba
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Frances M. K. Williams
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, United Kingdom
| | | | - Melvin C. Makhni
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Nicholas A. Shepard
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Howard S. An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
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Abdul Jalil MF, Dower A, Tawfik S, Brooks M, Davies MA, Ghahreman A. MRI predictors of revision surgery after primary lumbar discectomy. J Clin Neurosci 2020; 81:442-446. [PMID: 33222960 DOI: 10.1016/j.jocn.2020.09.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/10/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
The prognostic significance of preoperative MRI findings in patients undergoing discectomy is incompletely understood. Identifying the radiological predictors of revision surgery on pre-operative MRI can guide management decisions and potentially prevent multiple surgeries. We included 181 patients who underwent primary lumbar discectomy between 2010 and 2014. All patients were contacted via a short telephone interview to determine if they had revision surgery within 5 years of their index surgery. Preoperative MRI of the lumbosacral spine was evaluated for various radiological factors including type of disc herniation, anatomical location of herniation, direction of herniation, degree of disc degeneration, end plate changes and presence of listhesis. Other potential confounders including age, gender, smoking status and index level of surgery were also recorded. Multivariate model of all radiological predictors and confounders were developed and a step-wise approach was used to remove insignificant variables in order to develop final significant multivariate model. P value of <0.05 was considered statistically significant. Patients with retrolisthesis were found to be 2.7 times more likely than the patients without listhesis to require revision surgery (p = 0.019). Patients with foraminal disc herniation were 3.45 times more likely than the patients with paramedian disc herniation to require revision surgery (p = 0.026). Other MRI predictors failed to achieve statistical significance. Based on the data presented patients with retrolisthesis and/or foraminal disc herniation should be counselled on the relatively higher risk of revision surgery when proceeding with discectomy, or alternative options should be considered.
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Affiliation(s)
| | - Ashraf Dower
- Department of Neurosurgery, St. George Hospital, Kogarah, New South Wales, Australia; Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia
| | - Samuel Tawfik
- Department of Neurosurgery, St. George Hospital, Kogarah, New South Wales, Australia
| | - Michael Brooks
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Andrew Davies
- Department of Neurosurgery, St. George Hospital, Kogarah, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ali Ghahreman
- Department of Neurosurgery, St. George Hospital, Kogarah, New South Wales, Australia
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Dietz N, Sharma M, Alhourani A, Ugiliweneza B, Wang D, Drazin D, Boakye M. Evaluation of Predictive Models for Complications following Spinal Surgery. J Neurol Surg A Cent Eur Neurosurg 2020; 81:535-545. [PMID: 32797468 DOI: 10.1055/s-0040-1709709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Complications rates vary across spinal surgery procedures and are difficult to predict due to heterogeneity in patient characteristics, surgical methods, and hospital volume. Incorporation of predictive models for complications may guide surgeon decision making and improve outcomes. METHODS We evaluate current independently validated predictive models for complications in spinal surgery with respect to study design and model generation, accuracy, reliability, and utility. We conducted our search using Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and the Participants, Intervention, Comparison, Outcomes, Study Design model through the PubMed and Ovid Medline databases. RESULTS A total of 18 articles met inclusion criteria including 30 validated predictive models of complications after adult spinal surgery. National registry databases were used in 12 studies. Validation cohorts were used in seven studies for verification; three studies used other methods including random sample bootstrapping techniques or cross-validation. Reported area under the curve (AUC) values ranged from 0.37 to 1.0. Studies described treatment for deformity, degenerative conditions, inclusive spinal surgery (neoplasm, trauma, infection, deformity, degenerative), and miscellaneous (disk herniation, spinal epidural abscess). The most commonly cited risk factors for complications included in predictive models included age, body mass index, diabetes, sex, and smoking. Those models in the deformity subset that included radiographic and anatomical grading features reported higher AUC values than those that included patient demographics or medical comorbidities alone. CONCLUSIONS We identified a cohort of 30 validated predictive models of complications following spinal surgery for degenerative conditions, deformity, infection, and trauma. Accurate evidence-based predictive models may enhance shared decision making, improve rehabilitation, reduce adverse events, and inform best practices.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Ahmad Alhourani
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Beatrice Ugiliweneza
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, United States
| | - Max Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, United States
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21
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Krutko AV, Sanginov AJ, Baykov ES. Predictors of Treatment Success Following Limited Discectomy With Annular Closure for Lumbar Disc Herniation. Int J Spine Surg 2020; 14:38-45. [PMID: 32128301 DOI: 10.14444/7005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Previous studies have demonstrated bone-anchored annular closure to significantly reduce reherniation and reoperation rates after lumbar discectomy in patients with large annular defects. It is important to identify the prognostic factors that may be associated with successful treatment. This study aimed to identify predictors of treatment success in patients with lumbar disc herniation treated with limited microdiscectomy supplemented by a bone-anchored annular closure device (ACD). Methods This study was a retrospective analysis of 133 consecutive patients with lumbar disc herniation treated with the ACD. Treatment success was defined as ≥24% improvement in visual analog scale (VAS) for back pain, ≥39% improvement in VAS leg pain, and ≥33% in the Oswestry Disability Index (ODI), with the raw ODI score ≤48. Success was calculated at 3, 6, and 12 months after surgery. Potentially predictive outcomes included patient characteristics, operative data, and imaging outcomes, such as disc, facet, and end plate morphology. Logistic regression was used to determine the significant predictive factors for treatment success. Results After 3, 6, and 12 months, 97 of 131 (74%), 104 of 129 (81%), and 112 of 126 (89%) patients, respectively, achieved the success criteria. At 3 months follow-up, a higher proportion of younger (17-40 years) versus older (41-65 years) patients met the success criteria (P = .025). On the basis of logistic regression, the following factors were significantly associated with treatment success at 1 or more of the follow-up time points: sex (male), lower body mass index, higher baseline pain and ODI scores, lower grade preoperative disc degeneration, and the absence of a postoperative complication. The rates of index-level recurrent herniation and reoperation were 1.5% and 3.0%, respectively. Conclusions This real-world evidence supports a promising benefit-risk profile for augmenting limited microdiscectomy with a bone-anchored ACD and provides some insights into the patient populations that may have a greater chance of realizing significant improvements in pain and function. Level of Evidence 2 (Cohort study).
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Affiliation(s)
- Aleksandr V Krutko
- Research Institute of Traumatology and Orthopaedics (NRITO) n.a.Ya.L.Tsivyan, Novosibirsk, Russia
| | - Abdugafur J Sanginov
- Research Institute of Traumatology and Orthopaedics (NRITO) n.a.Ya.L.Tsivyan, Novosibirsk, Russia
| | - Evgenii S Baykov
- Research Institute of Traumatology and Orthopaedics (NRITO) n.a.Ya.L.Tsivyan, Novosibirsk, Russia
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22
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Hareni N, Strömqvist F, Strömqvist B, Rosengren BE, Karlsson MK. Predictors of satisfaction after lumbar disc herniation surgery in elderly. BMC Musculoskelet Disord 2019; 20:594. [PMID: 31818279 PMCID: PMC6902341 DOI: 10.1186/s12891-019-2975-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to evaluate satisfaction and factors associated with satisfaction in elderly undergoing lumbar disc herniation surgery. Methods In the national Swedish register for spinal surgery (SweSpine) we identified 2095 patients aged > 65 years (WHO definition of elderly) whom during 2000–2016 had undergone LDH surgery and had pre- and one-year postoperative data (age, gender, preoperative duration and degree of back- and leg pain, quality of life (SF-36) and one-year satisfaction (dissatisfied, uncertain, satisfied). We utilized a logistic regression model to examine preoperative factors that were independently associated with low and high satisfaction and after LDH surgery. Results One year after surgery, 71% of the patients were satisfied, 18% uncertain and 11% dissatisfied. Patients who were satisfied were in comparison to others, younger, had shorter preoperative duration of leg pain, higher SF-36 mental component summary and more leg than back pain (all p < 0.01). Patients who were dissatisfied were compared to others older, had longer preoperative duration of leg pain and lower SF-36 scores (all p < 0.01). 81% of patients with leg pain up to 3 months were satisfied in comparison with 57% of patients with leg pain > 2 years (p < 0.001). Conclusion Only one out of ten elderly, is dissatisfied with the outcome of LDH surgery. Age, preoperative duration of leg pain, preoperative SF 36 score, and for satisfaction also dominance of back over leg pain, are in elderly factors associated to good and poor subjective outcome after LDH surgery.
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Affiliation(s)
- Niyaz Hareni
- Departments of Orthopaedics, Varberg Hospital, Träslövsvägen 68, 432 37, Varberg, Sweden. .,Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Fredrik Strömqvist
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn Strömqvist
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Giers MB, Bardonova L, Eyster K, Byvaltsev V, Preul MC. APOPTOSIS, NUTRITION, AND METABOLISM OF TRANSPLANTED INTERVERTEBRAL DISC CELLS. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181704191006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: Apoptosis is a contributing factor to degenerating intervertebral disc (IVD). Disc regeneration has been attempted by transplanting cells into the disc, with some gains in disc height achieved in animal models. Here, we study whether the apoptotic microenvironment affects the transplanted disc cells. Methods: Human annulus fibrosus (AF) and nucleus pulposus (NP) cells were grown in media then starved for 5 days in vitro by not changing the media. Three aspects of apoptotic cell influence on the transplanted cells were tested in a total of 32 samples: 1) the effect of apoptotic cytokines in the media, 2) reduced glucose in the media, and 3) apoptotic cell bodies in the flask. The Trypan Blue, AlamarBlue®, and 1,9-Dimethyl-Methylene Blue assays for sulfated glycosaminoglycan (sGAG) content were performed (n=4). Results: There were significant decreases in cell viability between the control, 25% conditioned media (CM) and starved control group. There were no significant differences in cell number, metabolic activity or sGAG production in cells grown in different conditioned media compared to cells grown in complete media. The cells of the control decreased in viability and number over the 5 days without feeding, then improved dramatically when feeding was resumed. Flasks that received transplanted cells in addition to renewed feeding did not recover as much as the cells in the re-fed group. Conclusions: Cytokines from starved cells negatively impact on the viability of healthy cells. Starving cells that receive new sources of nutrition have even higher viability than transplanted cells. This indicates that altering and improving the nutrient supply problem in the IVD could be a valuable option. Level of Evidence III; Case control studyg.
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Affiliation(s)
- Morgan B. Giers
- St. Joseph's Hospital and Medical Center, USA; Arizona State University, USA
| | - Liudmila Bardonova
- St. Joseph's Hospital and Medical Center, USA; Irkutsk Scientific Center of Surgery and Traumatology, Russia; Irkutsk State Medical University, Russia
| | | | - Vadim Byvaltsev
- Irkutsk Scientific Center of Surgery and Traumatology, Russia; Irkutsk State Medical University, Russia
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Sanginov AJ, Krutko AV, Baykov ES, Lutsik AA. OUTCOMES OF SURGICAL TREATMENT OF LUMBAR DISK HERNIATION USING AN ANNULAR CLOSURE DEVICE. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: The aim of the study was to investigate the clinical and radiological results of using the annular closure device in patients with lumbar disc herniation (LDH). Methods: The study involved 120 patients with LDH operated on by limited discectomy and annular closure using the Barricaid device. A literature review was conducted to evaluate the effectiveness of the annuloplasty. Results: All patients showed postoperative regression of the radicular pain syndrome and were mobilized on the day of surgery. The correlation between the removed nucleus pulposus and changes in DHI was studied by linear regression. The results revealed that disc height loss is directly correlated with the volume of removed nucleus pulposus (p <0.05). Modic changes were present in 22 (22%) patients. Endplate changes (resorption and erosion) were present in 25 patients (20.7%). We found that these changes in MR and CT images have no effect on the clinical presentation of the disease. No intraoperative complications, such as severe hemorrhage requiring blood transfusion, or injury to the dura mater or nerve roots, were observed in our case series. Postoperative complications occurred in 3 (2.5%) patients. The reoperation rate was 4.2%. Conclusions: The use of the Barricaid annular closure device in 120 patients with lumbar disc herniation and high risk of recurrent herniation showed good clinical and radiographic outcomes. The reoperation rate in our study was 2.5%; disc reherniation at the operated level was observed in 1.7% of patients. This is a good outcome compared to the data reported for patients having a high risk of disc reherniation. Level of Evidence IV; Case series.
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Byvaltsev VA, Kalinin AA, Pestryakov YY, Rabinovith SS, Aliyev MA, Shvetsova SV. ANALYSIS OF POSTOPERATIVE OUTCOMES OF DEGENERATIVE DISEASES OF THE LUMBOSACRAL JUNCTION. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: The article presents an analysis of the clinical efficacy and causes of unsatisfactory outcomes of surgical treatment in patients with degenerative diseases of the lumbosacral junction of the spine. Methods: Patients were allocated to one of three groups, depending on the method of surgical intervention on the lumbosacral junction: 1) (n=352) - operated by the method of microsurgical discectomy; 2) (n=83) - operated with the use of artificial IVD prostheses; 3) (n = 183) - operated with the use of interbody fusion and posterior rigid stabilization. To investigate the causes of unsatisfactory outcomes, a correlation analysis was conducted of long-term clinical outcomes with preoperative instrumental parameters in the operated segment, surgical tactics used, and the development of complications. Results: It is determined that long-term “good” clinical outcomes are associated with individual preoperative parameters of the lumbosacral junction of the spine - linear displacement, sagittal angulation, height of the interbody space, degree of IVD degeneration by ADC. Conclusion: In degenerative diseases of the lumbosacral junction of the spine, the detailed analysis of long-term clinical outcomes enable the identification of the causes that affect the development of unsatisfactory outcomes, which are individual morphostructural changes in the lower lumbar segment: the amplitude of the segmental angle, the angle of the lumbar lordosis, the degree of linear displacement of the vertebrae, the height of the interbody space, and ADC. Complex clinical and instrumental analysis enabled us to determine possible surgical tactics. Level of Evidence II; Prognostic Studies— Investigating the Effect of a Patient Characteristic on the Disease Outcome.
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Affiliation(s)
- Vadim Anatol'evich Byvaltsev
- Irkutsk State Medical University, Russia; Railway Clinical Hospital, Russia; Irkutsk Research Center Surgery and Traumatology, Russia; Irkutsk state medical academy of postgraduate education, Russia
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Krutko AV, Sanginov AJ, Peleganchuk AV, Alshevskaya AA, Moskalev AV, Byvaltsev VA. SURGICAL TREATMENT OF LUMBAR DISC HERNIATION IN PREGNANT WOMEN: REPORT OF TWO CASES AND A SYSTEMATIC REVIEW. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181703193835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
ABSTRACT Objective: To review the surgical treatment of lumbar disc herniation in pregnancy. Methods: We systematically reviewed cases of surgical treatment of pregnant patients with lumbar IVD herniations in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We searched on electronic databases, including PubMed, Scopus, and Google Scholar, to find relevant articles by keywords. Results: A literature review of 42 cases is presented. Conclusions: The authors’ own data and the literature data demonstrate that decompression surgery in pregnancy is effective and safe for both mother and fetus; however, radical surgery (fusion) can lead to very adverse sequelae for the fetus. Level of Evidence III; Systematic reviewb of Level III studies.
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Cheng CY, Cheng YC, Wang TC, Yang WH. Fusion Techniques Are Related to a Lower Risk of Reoperation in Lumbar Disc Herniation: A 5-Year Observation Study of a Nationwide Cohort in Taiwan. World Neurosurg 2018; 117:e660-e668. [PMID: 29945009 DOI: 10.1016/j.wneu.2018.06.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Lumbar disc herniation (LDH) is a common spinal problem, with reoperation rates of 6%-24%. Although different surgical techniques are used for treatment, there is still debate regarding whether fusion techniques can reduce the reoperation rate in patients with LDH. METHODS This retrospective study used a 5-year nationwide database to analyze reoperation rates in Taiwan. Patient age groups (≥20 and <90 years) treated by index surgery and reoperation for LDH were identified. Four surgical procedures were included in the analysis: discectomy (DC), anterior lumbar fusion with DC (FA + DC), posterior lumbar fusion (FP), and posterior lumbar fusion with DC (FP + DC). RESULTS There were 1743 index surgeries between 2008 and 2012, with 184 (10.56%) reoperations. Index surgery DC had the highest reoperation rate (n = 121, 20%). The reoperation risk was significantly lower for patients undergoing fusion procedures (FA + DC vs. DC [hazard ratio (HR), 0.24; 95% confidence interval (CI), 0.12-0.47; P < 0.01], FP versus DC [HR, 0.17; 95% C, 0.09-0.33; P <0.01], FP + DC versus DC [HR, 0.31; 95% CI, 0.22-0.44; P < 0.01]). Fusion procedures had significantly higher treatment costs compared with DC (FA + DC vs. FP vs. FP + DC vs. DC: 5851.74 ± 4808.94 vs. 5116.88 ± 3428.97 vs. 4782.16 ± 2902.19 vs. 3846.79 ± 3584.45 U.S. dollars/patient, respectively; P < 0.0001). CONCLUSIONS Among surgical procedures for LDH, fusion techniques are related to lower reoperation rates compared with discectomy, but at the expense of higher medical costs.
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Affiliation(s)
- Chun-Yu Cheng
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Ya-Chung Cheng
- Department of Internal medicine, College of Medicine, Nation Taiwan University, Taiwan
| | - Ting-Chung Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hsun Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Martens F, Vajkoczy P, Jadik S, Hegewald A, Stieber J, Hes R. Patients at the Highest Risk for Reherniation Following Lumbar Discectomy in a Multicenter Randomized Controlled Trial. JB JS Open Access 2018; 3:e0037. [PMID: 30280130 PMCID: PMC6145569 DOI: 10.2106/jbjs.oa.17.00037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The purposes of the present study were to (1) confirm the risk of recurrent lumbar disc herniation in patients with a large anular defect who had undergone limited discectomy and (2) assess potential risk factors within this population. Methods The patient population was extracted from the control cohort of a prospective, randomized, multicenter controlled trial investigating the efficacy of an anular closure device following standard limited discectomy. All control patients underwent limited discectomy for the treatment of a single-level symptomatic posterior or posterolateral lumbar disc herniation. Only patients presenting with a large anular defect (6 to 10 mm wide by 4 to 6 mm long) were included in the study (n = 278). Baseline demographic, clinical, and surgical characteristics were recorded. Follow-up evaluations were performed at 6 weeks and at 3, 6, 12, and 24 months. Imaging modalities included magnetic resonance imaging, low-dose computed tomography, and radiographs. Symptomatic recurrent lumbar disc herniation was defined as any symptomatic postoperative herniation on either side of the index level. A multivariate logistic regression analysis of demographic and surgical variables associated with the incidence of recurrent lumbar disc herniation was performed. Results The mean anular defect area (and standard deviation) was 39.3 ± 9.1 mm2, and the mean excised nuclear tissue volume was 1.3 ± 0.8 mL. At 2 years, the incidence of symptomatic recurrent lumbar disc herniation was 25.3% (64 of 253), with the herniation occurring at a mean of 264 days after the index procedure. Of the 64 patients with recurrent lumbar disc herniation, 36 underwent a subsequent surgical procedure. Logistic regression analysis identified an increased risk for recurrent lumbar disc herniation in females (odds ratio, 2.2) and in patients with greater anular defect widths (odds ratio, 1.3). Furthermore, multivariate logistic regression analyses revealed a significant interaction between age and sex (p = 0.005). Conclusions The outcomes of the present study provide the most substantial evidence to date in confirming previous reports of a high risk of reherniation among patients with large anular defects. Among those with large anular defects (width, ≥6 mm), females ≤50 years of age had the highest risk (up to ∼10 times higher) of recurrent lumbar disc herniation. It is recommended that an anular repair or closure should be performed after limited discectomies in patients with large anular defects. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | | | - Aldemar Hegewald
- Department of Neurosurgery, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Jonathan Stieber
- Department of Orthopedic Surgery, NYU Orthopedic Hospital, New York, NY
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Palea O, Granville M, Jacobson RE. Selection of Tubular and Endoscopic Transforaminal Disc Procedures Based on Disc Size, Location, and Characteristics. Cureus 2018; 10:e2091. [PMID: 29564196 PMCID: PMC5860903 DOI: 10.7759/cureus.2091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The clinical effectiveness of percutaneous and transforaminal endoscopic discectomy procedures has been evaluated by the system used or compared to open laminectomy or micro-discectomy but are not evaluated based on the location and characteristics of the abnormal disc. This review proposes that outcomes are primarily related to disc size, biomechanics, location, and associated segmental fibrotic and bone changes as well as the surgeon's skill in using various systems rather than the specific system used. In these cases, the surgeon needs to decide if the goal of the procedure is simply internal decompression of an abnormal but contained herniated disc or release of the entrapped nerve root by a large contained disc, extruded and migrated disc fragment, or coexistent foraminal stenosis. Percutaneous and tubular transforaminal procedures are quite different, technically ranging from simple discectomy aspirating probes to larger endoscopic systems, providing the capability to remove large extruded free disc fragments, with or without foraminotomy. Recently, the ability to perform interbody fusion has been added to the range of procedures able to be performed endoscopically. At the same time, biologic solutions to disc degeneration are rapidly evolving and may have a place in combination with these procedures. This article reviews the interrelationship between clinical signs and symptoms, radiologic findings, and the biochemistry and biomechanics of the affected disc segment. Understanding the role played by all these factors enables the surgeon to evaluate both the disc and surrounding bone structures pre-operatively to determine if the clinical signs and symptoms are related to enlargement and displacement of a contained disc or compression or impingement of the nerve root. Based on this, the surgeon can choose different surgical systems, allowing simple decompression of a contained disc, possibly adding biologics, with a 'small' system, while a large herniated disc, or extruded fragment, causing root impingement, would require a ‘larger’ system that provides direct endoscopic visualization within the epidural space, foraminal decompression with drills, and direct surgical manipulation and freeing of the nerve root. By choosing the surgical system based on characteristics such as disc size, location, and associated inflammatory and fibrotic changes, the effectiveness of minimally invasive procedures will be more consistent and improve as the surgeon's diagnostic and operative skills improve.
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Affiliation(s)
- Ovidiu Palea
- Anesthesiology and Pain Management, Provita Hospital
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Abstract
PURPOSE OF REVIEW Substantial advancements have been made in the cause, diagnosis, imaging, and treatment options available for patients with lumbar disc herniation (LDH). We examined the current evidence and highlight the concepts on the frontline of discovery in LDH. RECENT FINDINGS There are a myriad of novel etiologies of LDH detailed in recent literature including inflammatory factors and infectious microbes. In the clinical setting, recent data focuses on improvements in computer tomography as a diagnostic tool and non-traditional injection options including tumor necrosis alpha inhibitors and platelet-rich plasma. Operative treatment outcomes have focused on minimally invasive endoscopic approaches and demonstrated robust 5-year post-operative outcomes. Advances in the molecular etiology of LDH will continue to drive novel treatment options. The role of endoscopic treatment for LDH will continue to evolve. Further research into10-year outcomes will be necessary as this surgical approach continues to gain widespread popularity.
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Affiliation(s)
- Raj M Amin
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
- Johns Hopkins Orthopaedic and Spine Surgery, 601 N. Caroline Street #5241, Baltimore, MD, 21287, USA.
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Byvaltsev VA, Kalinin AA, Stepanov IA, Pestryakov YY, Shepelev VV. RESULTS OF TOTAL LUMBAR INTERVERTEBRAL DISK REPLACEMENT WITH M6-L: A MULTICENTER STUDY. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171604182049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: In this paper we report the clinical and radiological results of lumbar intervertebral disk (IVD) replacement with M6-L for the treatment of patients with IVD degeneration. Methods: One hundred and fifty-six patients with IVD degeneration were operated with the one level implantation of an M6-L prosthesis at three neurosurgical departments, in Irkutsk, Krasnoyarsk and Vladivostok. We assessed pain intensity (VAS), the Oswestry disability index (ODI) and outcomes by the Macnab scale up to 36 months after surgery. Instrumental data were used to assess range of motion in the operated segment and heterotopic ossification by the McAfee-Suchomel classification. Results: The average VAS before surgery was 6.9 ± 1.6 cm. After surgery, this value reduced significantly, to an average of 1.3 ± 1.2 cm (p<0.001). The average ODI before surgery was 40.2 ± 6.9%, and after IVD arthroplasty, this indictor improved to 12.3 ± 6.1% (p <0.001). Range of motion in the operated segment at baseline averaged 36.8 ± 2.6o, and within 36 months after the operation, this had increased to 41.2 ± 2.9o. During the entire follow-up period, signs of severe (13.4%, n = 21) or moderate (10.2%, n = 16) heterotopic ossification were observed. Conclusions: The use of M6-L prosthesis can significantly reduce the level of pain, improve quality of life and maintain the physiological range of motion in the operated spinal segment in patients with degenerative lesions IVD at a low level of adverse outcomes. [249 Words].
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Reitman CA. CORR Insights ®: What is the Rate of Revision Discectomies After Primary Discectomy on a National Scale? Clin Orthop Relat Res 2017; 475:2763-2764. [PMID: 28884269 PMCID: PMC5638761 DOI: 10.1007/s11999-017-5492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Charles A. Reitman
- Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas, 708 CSB, Charleston, SC 29425 USA
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