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Pontén S, Lagerbäck T, Blomé S, Jensen K, Skorpil M, Gerdhem P. Lumbar degeneration and quality of life in patients with lumbar disc herniation: a case-control long-term follow-up study. Acta Orthop 2024; 95:92-98. [PMID: 38305634 PMCID: PMC10836153 DOI: 10.2340/17453674.2024.39944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND AND PURPOSE Adults treated surgically for lumbar disc herniation in adolescence have a higher degree of lumbar disc degeneration than controls. We aimed to establish whether the degree of lumbar degeneration differs at diagnosis or at follow-up between surgically and non-surgically treated individuals. METHODS We identified individuals with a lumbar disc herniation in adolescence diagnosed with magnetic resonance imaging (MRI) and contacted them for follow-up MRI. Lumbar degeneration was assessed according to Pfirrmann, Modic, and total end plate score (TEP score). Patient-reported outcome measures at follow-up comprised the Oswestry Disability Index (ODI), EQ-5D-3-level version, 36-Item Short Form Health Survey (SF-36), and Visual Analogue Scale (VAS) for back and leg pain. Fisher's exact test, Mann-Whitney U tests, Wilcoxon tests, and logistic regression were used for statistical analysis. RESULTS MRIs were available at diagnosis and after a mean of 11.9 years in 17 surgically treated individuals and 14 non-surgically treated individuals. Lumbar degeneration was similar at diagnosis (P = 0.2) and at follow-up, with the exception of higher TEP scores in surgically treated individuals at levels L4-L5 and L5-S1 at follow-up (P ≤ 0.03), but this difference did not remain after adjustment for age and sex (P ≥ 0.8). There were no significant differences in patient-reported outcome measures between the groups at follow-up (all P ≥ 0.2). CONCLUSION Adolescents with a lumbar disc herniation have, irrespective of treatment, a similar degree of lumbar degeneration at the time of diagnosis, and similar lumbar degeneration and patient-reported outcomes at long-term follow-up.
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Affiliation(s)
- Sebastian Pontén
- Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
| | - Tobias Lagerbäck
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm
| | - Sebastian Blomé
- Department of Clinical Neuroscience, Division of Neuro, Karolinska Institutet, Stockholm
| | - Karin Jensen
- Department of Clinical Neuroscience, Division of Neuro, Karolinska Institutet, Stockholm
| | - Mikael Skorpil
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm; Department of Neuroradiology, Karolinska University Hospital, Stockholm
| | - Paul Gerdhem
- Department of Orthopaedics and Hand Surgery, Uppsala University Hospital, Uppsala; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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2
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Bajaj A, Telfeian AE. Pediatric applications of endoscopic spine surgery. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Balafif F, Faris M, Subagio EA, Bajamal AH, Kusumadewi A. Lumbar disc herniation in a 15-year-old girl: A case report. Int J Surg Case Rep 2022; 98:107560. [PMID: 36057249 PMCID: PMC9482986 DOI: 10.1016/j.ijscr.2022.107560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fachriy Balafif
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia; Department of Neurosurgery, Adi Husada Undaan Hospital, Surabaya, East Java, Indonesia.
| | - Eko Agus Subagio
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Annie Kusumadewi
- Department of Pediatrics, Adi Husada Undaan Hospital, Surabaya, East Java, Indonesia
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Cordover JB, Fleisig GS, Raszewski JA, Dumont AS, Cordover AM. Return to sport after lumbar microdiscectomy in high school and college age athletes. World Neurosurg 2022; 163:e516-e521. [PMID: 35421588 DOI: 10.1016/j.wneu.2022.04.025] [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: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have reported return to play (RTP) rates for athletes after lumbar discectomy, but not specifically younger athletes. The purpose of this study was to evaluate RTP rate of young athletes after lumbar microdiscectomy. METHODS Medical records for a single spine surgeon were reviewed to identify lumbar microdiscectomy patients. Patients were included if they were 21 years old or younger at the time of surgery and were athletes. 38 patients (25 male, 13 female) were identified, with mean age at surgery of 19 years. Level of herniated nucleus pulposus, variant anatomy, degenerative change, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. Patients were contacted to determine when and if they RTP. RESULTS Most patients had degenerative changes at the time of surgery, with a mean Pfirrmann score of 2.2. The average time from onset of symptoms until surgery was 11 months. All patients were reached for follow-up at an average 51 months post-op. 71% returned to play at an average of 4.5 months. There were no statistical differences in Pfirrmann Grade and RTP rates between high school and collegiate athletes, between males and females, nor between patients with two-level and one-level discectomies. Pfirrmann Grade was not significantly different between patients who RTP and those who did not RTP. CONCLUSIONS The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. RTP rate and Pfirrmann Grade were not related to gender, sport level, or discectomy level.
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Affiliation(s)
| | - Glenn S Fleisig
- American Sports Medicine Institute, Birmingham, Alabama, USA.
| | | | - Aaron S Dumont
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Cordover
- Andrews Sports Medicine & Orthopaedic Center, Birmingham, Alabama, USA
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Shimony N, Louie C, Barrow D, Osburn B, Noureldine MHA, Tuite GF, Carey CM, Jallo GI, Rodriguez L. Adolescent Disc Disease: Risk Factors and Treatment Success-Related Factors. World Neurosurg 2021; 148:e314-e320. [PMID: 33412329 DOI: 10.1016/j.wneu.2020.12.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/25/2020] [Accepted: 12/26/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A paucity of literature is available discussing the associated risk factors, treatment options (including the use of minimally invasive surgery), and outcomes related to lumbar disc herniation (LDH) in children. We have discussed the risk factors for disc disease among pediatric patients and evaluated the efficacy of the minimally invasive approach. METHODS A retrospective review of pediatric patients with lumbar disc disease who had undergone microdiscectomy at our institution from 2005 to 2016 was conducted. The preoperative presentation, hospital course, postoperative course, and follow-up data (≥3 years) were reviewed. We evaluated the risk factors for LDH and the surgical outcomes for both groups. RESULTS A total of 52 pediatric patients had undergone 61 lumbar disc surgeries for LDH in our department from 2005 to 2016. Their average age at surgery was 16.65 years. Of the 61 procedures, 48 (78.7%) had been performed via the minimally invasive spine microdiscectomy approach and 13 (21.3%) via the open microdiscectomy approach. The average body mass index for all cases was 29.3 kg/m2. The average interval to diagnosis was 7.9 months. Of the 61 cases, 21 (34.4%) had been required for patients who were competitive athletes. In addition, 15 had been for LDH related to trauma (24.6%). In 46 of the 61 cases, complete resolution of the symptoms had occurred at the 1-year follow-up visit (79.2% of minimally invasive spine microdiscectomy vs 61.5% of open microdiscectomy). CONCLUSION Risk factors similar to those for adult LDH, such as an elevated body mass index, can be seen in the pediatric population. However, some unique risk factors such as post-traumatic LDH were found in the pediatric age group. Minimally invasive techniques are demonstrably safe and useful in this patient population.
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Affiliation(s)
- Nir Shimony
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Division of Pediatric Neurosurgery, Institute of Neuroscience, Geisinger Medical Center, Danville, Pennsylvania, USA; Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
| | - Christopher Louie
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - David Barrow
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Brooks Osburn
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Mohammad Hassan A Noureldine
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA
| | - Gerald F Tuite
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Carolyn M Carey
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - George I Jallo
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Luis Rodriguez
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
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Shah K, Bharuka A, Gadiya A, Nene A. Assessment of Outcomes of Spine Surgery in Indian Athletes Involved in High-End Contact Sports. Asian Spine J 2020; 15:192-199. [PMID: 32521952 PMCID: PMC8055450 DOI: 10.31616/asj.2019.0376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/25/2020] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This study was a retrospective analysis. PURPOSE This study aimed to analyze the functional outcome following spinal surgery in elite athletes using return-to-play criteria. OVERVIEW OF LITERATURE Spinal ailments are relatively common in athletes and are bound to increase due to the ever-growing popularity of contact sports. An elite athlete is highly motivated to make a rapid recovery and return to full participation in sports. Although the criteria for diagnosis and surgical treatment of various spinal disorders in athletes have been well defined in the literature, there is no clear definition about the factors determining the return to play in athletes. METHODS This study was a retrospective analysis of the data of 10 elite athletes who underwent spinal surgery for symptomatic degenerative disorder of the spine. Eight patients underwent lumbar spine surgery (two patients of microdiscectomy and six patients of fusion), and the remaining two patients underwent cervical spine surgery (one each anterior cervical discectomy and fusion and anterior cervical disc replacement). Outcome measures were investigated using return-to-training and return-to-sports criteria, as indicated by the length of time between surgery and return to competitive sports as parameters. RESULTS Of the 10 patients, eight were males and two were females. The average age of the patients at the time of surgery was 32.4 years (range, 25-41 years). All patients returned to active participation of their sports. The average time for return to training was 7.3 weeks (range, 3-12 weeks). The average time for return to sports was 45.6 weeks (range, 36-72 weeks), and the average follow-up period was 59 months (range, 27-120 months). CONCLUSIONS Spine surgery in an elite athlete involved in contact sports is safe and effective. Currently, there is a lack of standardized guidelines for return to sports after spine injuries. An athlete needs to be symptom-free, with full range of motion and full strength before returning to sports.
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Affiliation(s)
- Kunal Shah
- Department of Spine Surgery, Pain and Spine Clinic, Mumbai, India
| | - Anuj Bharuka
- Department of Spine Surgery, Lilavati Hospital and Research Center, Mumbai, India
| | - Akshay Gadiya
- Department of Spine Surgery, Lilavati Hospital and Research Center, Mumbai, India
| | - Abhay Nene
- Department of Spine Surgery, Lilavati Hospital and Research Center, Mumbai, India
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Size Matters: Which Adolescent Patients Are Most Likely to Require Surgical Decompression for Lumbar Disk Herniations? J Pediatr Orthop 2020; 39:e791-e795. [PMID: 30925581 DOI: 10.1097/bpo.0000000000001371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar herniated nucleus pulposis (HNP) occurs infrequently in the pediatric/adolescent population. A minority of patients with radicular symptoms fail to improve with conservative management and require discectomy. The authors hypothesize that children who ultimately require surgical intervention have an underlying lumbar stenosis predisposing them to continued symptoms. METHODS Pediatric patients with a lumbar HNP on advanced imaging were retrospectively identified at a tertiary pediatric orthopaedic institution. Patients with spondylolisthesis, fractures, previous spine surgery, or structural thoracolumbar scoliosis were excluded. On sagittal magnetic resonance imagings, measurements were taken of the L4 and L5 vertebral body diameters (VBD) and canal diameters (CD) by 2 independent reviewers. Statistical analysis was performed using 2 sample T tests followed by logistic regression analysis. This was utilized to identify significant associations between CD and need for surgical decompression. RESULTS A total of 76 patients (37 males/39 females) were identified with a lumbar HNP from 2001 to 2016. Eleven patients underwent discectomy. Sixty-five patients were managed conservatively. Age at magnetic resonance imaging was not different between groups (15.1±1.7 vs. 14.9±2.2 y, P=0.82). VBD at L4 and L5 were not different between groups (P=0.2 and 0.36, respectively). The reviewers had fair to good (0.584-0.854) interrater reliability correlation coefficients. CD was decreased in the surgically treated cohort at L4 (11.6±1.6 vs. 14.2±2.1 mm, P=0.0002) and at L5 (10.1±1.3 vs. 14.2±2.2 mm, P<0.00001). The ratio of CD:VBD was lower in the surgically treated group at L4 (0.36±0.06 vs. 0.46±0.08, P=0.0002) and L5 (0.31±0.68 vs. 0.45±0.08, P<0.00001). Patients with a L4 CD<12.6 mm were 18.8× more likely to require surgical decompression. 100% of patients with a L5 CD<12.36 mm ultimately underwent surgical decompression. CONCLUSIONS Adolescent patients with congenital lumbar stenosis that develop a lumbar HNP are significantly more likely to require surgical decompression to relieve persistent radicular symptoms. A L4 CD<12.6 mm and a L5 CD<12.36 mm were highly correlated with the need for decompression. LEVEL OF EVIDENCE Level III-prognostic study.
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Lepard JR, Zimmerman KD, Arynchyna AA, Gutman JA, Salehani AA, Rocque BG, Rozzelle CJ. Pediatric herniated lumbar disc: a population-based risk factor analysis. J Neurosurg Pediatr 2019; 25:311-318. [PMID: 31783360 DOI: 10.3171/2019.9.peds19167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of herniated lumbar disc (HLD) remains rare in children. The purpose of this study was to evaluate for potential disease risk factors leading to surgery based on a large single-center experience. METHODS Data for all patients who had undergone surgical treatment for HLD between December 2008 and December 2016 at a single pediatric tertiary care referral center were collected and compared to data for a healthy control population obtained through a Youth Risk Behavior Surveillance System (YRBSS) survey in order to determine relevant disease risk factors. Univariate and multivariate logistic regression were used to determine the effect of potential risk factors. RESULTS Twenty-seven patients in the disease cohort and 5212 healthy controls from the general population were included in the risk factor analysis. The mean body mass index was significantly higher in the disease population (30.2 vs 24.0 kg/m2, p < 0.0001). Children who had undergone microdiscectomy were more likely to be obese (OR 7.4, 95% CI 3.46-15.8, p < 0.001). No association was found between lumbar microdiscectomy and sports participation (OR 1.0, 95% CI -0.002 to 0.005, p = 0.37). CONCLUSIONS Microdiscectomy remains a viable and safe option in the setting of failed conservative management for pediatric HLD. Childhood obesity is a risk factor for HLD and many other diseases, which increases its importance as a public health priority.
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9
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Raghu ALB, Wiggins A, Kandasamy J. Surgical management of lumbar disc herniation in children and adolescents. Clin Neurol Neurosurg 2019; 185:105486. [DOI: 10.1016/j.clineuro.2019.105486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
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Sellyn GE, Hale AT, Tang AR, Waters A, Shannon CN, Bonfield CM. Pediatric thoracolumbar spine surgery and return to athletics: a systematic review. J Neurosurg Pediatr 2019; 24:702-712. [PMID: 31561230 DOI: 10.3171/2019.7.peds19290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal conditions and injuries in the pediatric population can necessitate surgical treatment. For many pediatric patients, a return to athletic activity after spinal surgery is a significant postoperative focus. However, there is a lack of standardized guidelines to determine criteria for safe return to play (RTP). To understand clinical criteria for patients to safely RTP, the authors conducted a systematic review of outcomes and the period of time before physicians recommend an RTP for pediatric patients undergoing spinal surgery. METHODS English-language publications were searched systematically in the PubMed electronic database, and a review was conducted in accordance with the PRISMA guidelines. Additional relevant studies found via a supplementary literature search were also included. Studies assessing return to athletic activity in a pediatric population after spinal surgery were included. Studies without an RTP, postsurgical activity outcomes, or surgical intervention were excluded. RESULTS A PubMed search identified 295 articles, with 29 included for the systematic review. In addition, 4 studies were included from a supplementary literature search. The majority of these studies were retrospective case series and cohort studies, and the remaining studies included questionnaire-based studies, prospective cohorts, and case-control studies. The most common spinal conditions or injuries included spondylolysis, and this was followed by adolescent idiopathic scoliosis. Overall, the most frequent recommendation for RTP for noncontact and contact sports was 6 months after surgery (range 1-12 months), and for collision sports it was 12 months after surgery. However, some physicians recommended never returning to collision sports after spinal intervention. CONCLUSIONS Most pediatric patients are able to return to some level of sports after spinal surgery. However, no standardized criteria have been proposed, and RTP recommendations vary according to the treating surgeon. In addition, limited data are published on the variation in timelines for RTP with regard to classifications of sports (noncontact, contact, and collision). Further analysis of specific spinal conditions and injuries with postoperative athletic recovery is needed.
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Affiliation(s)
- Georgina E Sellyn
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Andrew T Hale
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 2Vanderbilt University School of Medicine; and
| | - Alan R Tang
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 2Vanderbilt University School of Medicine; and
| | - Alaina Waters
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
| | - Chevis N Shannon
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 1Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital of Vanderbilt University
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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McAvoy M, McCrea HJ, Chavakula V, Choi H, Bi WL, Mekary RA, Stone S, Proctor MR. Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series. J Neurosurg Pediatr 2019; 24:549-557. [PMID: 31470400 DOI: 10.3171/2019.6.peds18716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period. METHODS A retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes. RESULTS Over the 19-year study period, 199 patients underwent LMD at the authors' institution. The mean age at presentation was 16.0 years (range 12-18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion). CONCLUSIONS Microdiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.
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Affiliation(s)
- Malia McAvoy
- 1Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts
- 6Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School; and
| | - Heather J McCrea
- 2Department of Neurosurgery, Holtz Children's Hospital, Nicklaus Children's Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Vamsidhar Chavakula
- 3Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hoon Choi
- 4Department of Neurosurgery, The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wenya Linda Bi
- 3Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rania A Mekary
- 5School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences
- 6Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School; and
| | - Scellig Stone
- 7Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark R Proctor
- 6Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School; and
- 7Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Gadia A, Shah K, Nene A. Outcomes of Various Treatment Modalities for Lumbar Spinal Ailments in Elite Athletes: A Literature Review. Asian Spine J 2018; 12:754-764. [PMID: 30060387 PMCID: PMC6068423 DOI: 10.31616/asj.2018.12.4.754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/17/2017] [Indexed: 01/11/2023] Open
Abstract
Lumbar spinal injuries are common in elite athletes, who can present with a spectrum of ailments ranging from lumbar strain to prolapsed intervertebral discs. Sequelae can include neurological impairment and lumbar instability among other possible outcomes. This group of patients is unique in terms of their clinicoradiological presentation and treatment modalities. The primary goals of treatment are a rapid return to play and prevention of recurrence, thus prolonging the athlete’s professional career. Treatment modalities can range from activity restriction to nerve root blocks and surgery. A successful treatment outcome is based on timely diagnosis, treatment suiting the demands of the particular sport, and early rehabilitation. A multidisciplinary team approach involving the coach, rehabilitation specialist, pain management specialist, and spine surgeon helps in planning appropriate treatment. In this article, we review special considerations in the elite athletic population with lumbar spinal ailments as well as the outcomes of various treatment modalities.
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Affiliation(s)
- Akshay Gadia
- Department of Spine, Wockhardt Hospital, Mumbai, India
| | | | - Abhay Nene
- Department of Spine, Wockhardt Hospital, Mumbai, India
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Montejo JD, Camara-Quintana JQ, Duran D, Rockefeller JM, Conine SB, Blaise AM, Kahle KT, DiLuna ML. Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation. J Neurosurg Pediatr 2018; 21:449-455. [PMID: 29473813 DOI: 10.3171/2017.11.peds17293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated. METHODS Twelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors' institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements. RESULTS The mean age at surgery was 17 ± 1.6 years (range 13-19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1-36 months). The LDH level was L5-S1 in 75% of patients and L4-5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0-3 days). The median follow-up duration was 2.2 years (range 0-5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%). CONCLUSIONS To the authors' knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.
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Pediatric spondylolysis/spinal stenosis and disc herniation: national trends in decompression and discectomy surgery evaluated through the Kids' Inpatient Database. Childs Nerv Syst 2017. [PMID: 28643037 DOI: 10.1007/s00381-017-3471-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to describe national trends in spinal decompression without fusion and discectomy procedures in the US pediatric inpatient population. METHODS The Kids' Inpatient Database (KID) was queried for pediatric patients with primary diagnoses of spinal spondylolysis/stenosis or disc herniation and having undergone spinal decompression without fusion or discectomy over more than a decade (2000 to 2012). The primary (indirect) outcomes of interest were in-hospital complication rates, length of stay (LOS), total costs, and discharge dispositions. RESULTS A total of 7315 patients, comprised of pediatric spinal spondylolysis/stenosis (n = 287, 3.92%) and pediatric disc herniation (n = 7028, 96.1%) patients, were included in the study. During the years 2000 to 2012, diagnoses of pediatric spondylolysis/spinal stenosis increased from 61 to 90 diagnoses per 3-year period, while diagnoses of pediatric disc herniation decreased from 2133 to 1335 diagnoses per 3-year period. Spinal decompression was associated with higher in-hospital complication rates (18.1 vs 5.3%, p < 0.0001), longer hospital stays (5 vs 1.69 days, p < 0.0001), higher mean total charges ($49,186 vs $19,057, p < 0.0001), and higher non-routine discharge rates (12.3 vs 2.5%, p < 0.0001) versus discectomy. CONCLUSIONS Spinal decompression is associated with longer hospital stays, more complications, higher costs, and more non-routine discharges when compared to discectomy. The data supports the disparate nature of these disease processes and elucidates basic clinical trends in uncommon spinal disorders affecting children.
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Gulati S, Madsbu MA, Solberg TK, Sørlie A, Giannadakis C, Skram MK, Nygaard ØP, Jakola AS. Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study. Acta Neurochir (Wien) 2017; 159:509-516. [PMID: 28091818 PMCID: PMC5306165 DOI: 10.1007/s00701-017-3077-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022]
Abstract
Background Lumbar disc herniation (LDH) is rare in the adolescent population. Factors predisposing to LDH in adolescents differ from adults with more cases being related to trauma or structural malformations. Further, there are limited data on patient-reported outcomes after lumbar microdiscectomy in adolescents. Our aim was to compare clinical outcomes at 1 year following single-level lumbar microdiscectomy in adolescents (13–19 years old) compared to younger adults (20–50 years old) with LDH. Methods Data were collected through the Norwegian Registry for Spine Surgery. Patients were eligible if they had radiculopathy due to LDH, underwent single-level lumbar microdiscectomy between January 2007 and May 2014, and were between 13 and 50 years old at time of surgery. The primary endpoint was change in Oswestry Disability Index (ODI) 1 year after surgery. Secondary endpoints were generic quality of life (EuroQol five dimensions [EQ-5D]), back pain numerical rating scale (NRS), leg pain NRS and complications. Results A total of 3,245 patients were included (97 patients 13–19 years old and 3,148 patients 20–50 years old). A significant improvement in ODI was observed for the whole population, but there was no difference between groups (0.6; 95% CI, −4.5 to 5.8; p = 0.811). There were no differences between groups concerning EQ-5D (−0.04; 95% CI, −0.15 to 0.07; p = 0.442), back pain NRS (−0.4; 95% CI, −1.2 to 0.4; p = 0.279), leg pain NRS (−0.4; 95% CI, −1.2 to 0.5; p = 0.374) or perioperative complications (1.0% for adolescents, 5.1% for adults, p = 0.072). Conclusions The effectiveness and safety of single-level microdiscectomy are similar in adolescents and the adult population at 1-year follow-up.
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Epidural Steroid Injections for Radiculopathy and/or Back Pain in Children and Adolescents: A Retrospective Cohort Study With a Prospective Follow-Up. Reg Anesth Pain Med 2016; 41:86-92. [PMID: 26655219 DOI: 10.1097/aap.0000000000000338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Epidural steroid injections (ESIs) are commonly performed for adults with spinal pain and/or radiculopathy. Previous pediatric ESI case series were not identified by literature review. The primary aim of this study was to examine the safety and provisional outcomes of pediatric ESIs. METHODS With institutional review board approval, medical records were reviewed for patients aged 9 to 20 years receiving a first ESI at Boston Children's Hospital from 2003 through 2013. A subset of patients completed a Web-based follow-up questionnaire. Descriptive statistics included frequencies, medians, interquartile ranges, and Kaplan-Meier methods. Statistical comparisons were made using Wilcoxon rank sum, χ2, Fisher exact, and Cox proportional hazards regression analyses. RESULTS A total of 224 patients aged 9 to 20 years underwent 428 ESIs. One hundred seventy-four (76.0%) patients had a lumbar disc herniation with radiculopathy; the others had a spectrum of other spinal disorders. There were no serious adverse events, hospitalizations, dural punctures, or nerve injuries. During follow-up, 69 (41.6%) of 166 previously nonoperated lumbar disc plus radiculopathy patients underwent discectomy at a median time of 128 days (interquartile range, 76-235 days) after first injection. Degrees of straight-leg raising at presentation was significantly associated with subsequent discectomy. On follow-up, patients who did and did not undergo discectomy had low pain scores and high function scores. CONCLUSIONS Children and adolescents can receive ESIs under conscious sedation with good safety. Further prospective studies may better define the role for these injections in the comprehensive management of pediatric spinal pain disorders.
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Shriver MF, Xie JJ, Tye EY, Rosenbaum BP, Kshettry VR, Benzel EC, Mroz TE. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus 2016; 39:E6. [PMID: 26424346 DOI: 10.3171/2015.7.focus15281] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.
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Affiliation(s)
| | - Jack J Xie
- Department of Physiology and Biophysics, Case Western Reserve University
| | | | | | | | | | - Thomas E Mroz
- Center for Spine Health, and.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Abstract
CONTEXT Pediatric patients who undergo spinal surgery are frequently involved in sporting activities. Return to play is often an important postoperative concern for the patient and family. EVIDENCE ACQUISITION A PubMed search was conducted for articles in the English language on return to play after treatment of pediatric acute disc herniation, degenerative disc disease, spondylolysis, spondylolisthesis, and scoliosis from 1980 to 2015. Reference lists were reviewed for additional pertinent articles. We included articles that focused on return to sports after surgical treatment of these conditions in this review. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS There are no published guidelines, and most of the literature in this area has focused on return to play after spinal injury rather than after spinal surgery. Most children and adolescents have excellent outcomes with minimal pain at 1 year after lumbar discectomy. The majority of surgeons allow return to full activity once pain-free range of motion and strength are regained, typically at 8 to 12 weeks postoperatively. Pediatric patients with spondylolysis have good outcomes after direct pars repair. Satisfactory outcomes have been demonstrated after fusion for low- and high-grade spondylolisthesis. Most surgeons allow return to noncontact sports by 6 months after surgical treatment of spondylolysis and spondylolisthesis. Return to contact and collision sports is controversial. After posterior spinal fusion for scoliosis, most surgeons allow return to noncontact sports by 3 months and return to contact sports between 6 months and 1 year. Return to collision sports is controversial. CONCLUSION There is little evidence to guide practitioners on return to sports after pediatric spinal surgery. Ultimately, the decision to allow any young athlete to resume sports participation after spinal injury or surgery must be individualized.
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Affiliation(s)
- Tyler Christman
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Ying Li
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Lagerbäck T, Elkan P, Möller H, Grauers A, Diarbakerli E, Gerdhem P. An observational study on the outcome after surgery for lumbar disc herniation in adolescents compared with adults based on the Swedish Spine Register. Spine J 2015; 15:1241-7. [PMID: 25701544 DOI: 10.1016/j.spinee.2015.02.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/07/2015] [Accepted: 02/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Disc-related sciatica has a prevalence of about 2% in adults, but is rare in adolescents. If conservative treatment is unsuccessful, surgery is an option. PURPOSE The aim of this study was to compare the outcomes of surgery for lumbar disc herniation in adolescents with adults in the Swedish Spine Register. STUDY DESIGN/SETTING This is a prospective observational study: National Quality Register. PATIENT SAMPLE This study included 151 patients, 18 years or younger, 4,386 patients, 19-39 years, and 6,078 patients, 40 years or older, followed for 1-2 years after surgery. OUTCOME MEASURES The primary outcomes were patient satisfaction and global assessment of leg and back pain. Secondary outcomes were Visual Analog Scale (VAS) leg pain, VAS back pain, Oswestry disability index (ODI), and EuroQol-5 dimensions (EQ-5D). METHODS Statistical analyses were performed with the Welch F test, the chi-square test, and the Wilcoxon signed-rank test. RESULTS At follow-up, 86% of the adolescents were satisfied compared with 78% in the younger adults and 76% in the older adults group (p<.001). According to the global assessment, significantly decreased leg pain was experienced by 87% of the adolescents, 78% of the younger adults, and 71% of the older adults (p<.001). Corresponding figures for back pain were 88%, 73%, and 70%, respectively (p<.001). All groups experienced significant postoperative improvement of VAS leg pain, VAS back pain, ODI, and EQ-5D (all p<.001). CONCLUSIONS The adolescent age group was more satisfied with the treatment than the adult groups. There was a significant improvement in all age groups after surgery.
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Affiliation(s)
- Tobias Lagerbäck
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Elkan
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Södersjukhuset, Karolinska Institutet, SE 118 83 Stockholm, Sweden; Department of Orthopaedics, Södersjukhuset, SE 118 83 Stockholm, Sweden
| | - Hans Möller
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Grauers
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden; Department of Orthopaedics, Sundsvall and Härnösand County Hospital, SE 851 86 Sundsvall, Sweden
| | - Elias Diarbakerli
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
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Adolescent lumbar disc herniation: Experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. Clin Neurol Neurosurg 2013; 115:1415-9. [DOI: 10.1016/j.clineuro.2013.01.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 12/24/2012] [Accepted: 01/20/2013] [Indexed: 11/20/2022]
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Kasliwal MK, Deutsch H. Lumbar disc replacement in adolescents: An initial experience in two cases. J Pediatr Neurosci 2012; 7:129-32. [PMID: 23248694 PMCID: PMC3519072 DOI: 10.4103/1817-1745.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Management of painful lumbar disc degeneration is one of the most common conditions treated by spine surgeons. Several recent prospective multicenter trials have demonstrated the effectiveness of artificial lumbar disc replacement in treating discogenic lower back pain. Though data on the safety and effectiveness has gradually been accumulated in adults, there is a lack of published data on the effectiveness and feasibility of lumbar artificial disc replacement in adolescents. The authors share their initial clinical experience with lumbar disc replacement in a couple of adolescents.
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Affiliation(s)
- Manish K Kasliwal
- Department of Neurosurgery, RUSH University Medical Center, Chicago, IL, USA
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Wang B, Lü G, Liu W, Cheng I, Patel AA. Full-endoscopic interlaminar approach for the surgical treatment of lumbar disc herniation: the causes and prophylaxis of conversion to open. Arch Orthop Trauma Surg 2012; 132:1531-8. [PMID: 22763864 DOI: 10.1007/s00402-012-1581-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To analyze the causes of conversion to open for the surgical treatment of lumbar disc herniation with use of full endoscopic (FE) technique, and prophylaxis of conversion to open also proposed. METHOD 50 patients with lumbar disc herniation underwent discectomy using unilateral portal FE interlaminar approach collected from August 2008 to August 2010. All FE operations were performed under general anesthesia and endotracheal intubation. According to the level incision of the ligament flavum, the starting point of nerve root at the dura under endoscopic view was classified as: Type I (starting point of the nerve root was higher than the incision) and Type II (the starting point of nerve root was lower than the incision). The causes and effective prophylactic measurements for cases of conversion to open were analyzed. RESULTS There were 47 cases classified as Type I for a rate of 94 %, and Type II in 3 cases for a rate of 6 %. Five cases were converted to open surgery, and the conversion rate was 10 %. There were three males and two females with a mean age of 36.2 (29-44) years, the average duration of symptoms was 58.4 (35-105) days. The level was L5-S1 in four cases and L4-5 in one, lateral extrusion in three cases, paracentral extrusion in one, and sequestration in one. Leg pain resolved in three cases and improved in two after open surgery. Of five cases of conversion to open, misplacement of the working portal occurred in one case (Type I). Difficult dissection of nerve root and hemostasis resulting in open conversion occurred in one case (Type II); this patient sustained a dural injury. The nerve root could not be exposed in three cases (Type II), the FE changed to open finally. During the open procedure with Type II, we found that the location of origin of the nerve root was caudal to the inferior laminar edge. Therefore, partial removal of bony structures along lateral recess was necessary in order to visualize the nerve root. CONCLUSION Misplacement of working portal during the exposure of the ligament flavum and difficulty in indentifying anatomy are potential causes for conversion to open in the initial adoption of FE technique. However, uncommon conditions such as variation of the nerve root origin can also result in conversion to open in experienced hands. Endoscopic experience, proper patient selection and specific radiographic examination are needed to obtain optimal outcomes using a full endoscopic technique for microdiscectomies.
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Affiliation(s)
- Bing Wang
- Department of Spine Surgery, Second Xiangya Hospital of Central South University, 139 Renmin Rd, Changsha, 410011, Hunan, China.
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Abstract
Back pain in the young athlete is a common complaint and often perceived as a challenging problem. A well-directed approach will usually provide the practitioner with a higher comfort zone. The etiology of back pain in the pediatric and adolescent population is different from that of the adult population due to the presence of open physes and increased linear growth velocity. In addition, the frequency and intensity of sports participation in children continues to increase, leading to more overuse injuries. This review article will discuss the anatomy and physiology of the spine and pelvis, as well as focus on the chronic and overuse causes of back pain in the young athlete.
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Affiliation(s)
- Warren K Young
- Department of Orthopaedic Surgery, New York University Hospital for Joint Disease, New York, NY, USA.
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Abstract
Pediatric disk herniation is a rare condition that should be considered in the differential diagnosis of the child with back pain or radiating leg pain. Because pediatric disk herniation is relatively uncommon, there is typically a delay in diagnosis compared with time to diagnosis of adult disk herniation. Pediatric disk herniations are often recalcitrant to nonsurgical care, but such measures should be attempted in patients who present with isolated pain symptoms and have a normal neurologic examination. Twenty-eight percent of adolescent disk herniations involve apophyseal fractures; this presentation has a higher rate of surgical intervention than do herniations without fracture. Surgical management of pediatric disk herniation involves laminotomy and fragment excision. Short-term data demonstrate excellent pain relief, with 1% of children requiring repeat surgery for lumbar disk pathology in the first year. Long-term data suggest that 20% to 30% of patients will require additional surgery later in life.
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Thomas JG, Hwang SW, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Minimally invasive lumbar microdiscectomy in pediatric patients: a series of 6 patients. J Neurosurg Pediatr 2011; 7:616-9. [PMID: 21631198 DOI: 10.3171/2011.3.peds10570] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Lumbar disc herniation is rare in the pediatric age group, but may still cause a significant amount of pain and disability. Whereas minimally invasive surgery (MIS) for lumbar disc herniation is routinely performed in adults, it has not yet been described in the pediatric population. The purpose of this study was to describe the surgical results of pediatric MIS-treated lumbar disc disease. METHODS The authors retrospectively reviewed a series of 6 consecutive cases of lumbar microdiscectomy performed using MIS techniques between April 2008 and July 2010. Presenting symptoms, physical examination findings, and preoperative MR imaging results were obtained from medical records. Perioperative results, including blood loss, length of hospital stay, and complications were assessed. Findings at latest follow-up evaluation were also recorded. RESULTS This report represents the first surgical series regarding pediatric lumbar microdiscectomies performed using MIS. The mean patient age was 16 years (range 14-17 years); there were 4 girls and 2 boys. Preoperative signs and symptoms of radiculopathic pain were notable in 100% of patients, and myotomal weakness was noted in 33% of patients. The first line of treatment in all patients was a period of conservative management lasting an average of 11.5 months (range 6-12 months). The mean intraoperative blood loss was 10.8 ml, and the mean postoperative length of stay was 1.3 days. There were no complications in this small series. CONCLUSIONS The treatment of pediatric lumbar disc herniation by using MIS techniques can be safe and efficacious. However, further study with a larger number of patients and longer follow-up is needed to compare outcomes between MIS and open microdiscectomies.
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Affiliation(s)
- Jonathan G Thomas
- Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA
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Wang B, Lü G, Patel AA, Ren P, Cheng I. An evaluation of the learning curve for a complex surgical technique: the full endoscopic interlaminar approach for lumbar disc herniations. Spine J 2011; 11:122-30. [PMID: 21296295 DOI: 10.1016/j.spinee.2010.12.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/28/2010] [Accepted: 12/08/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Compared with conventional microsurgical technique, the full endoscopic (FE) interlaminar approach is a more minimally invasive technique for the surgical treatment of lumbar disc herniations. Its efficacy and safety have been confirmed by numerous studies. However, a steep learning curve with the use of such a complex technique is a major concern for the initial adoption of this technique. PURPOSE To evaluate the learning curve of using an FE interlaminar technique for the surgical treatment of lumbar disc herniation. STUDY DESIGN A prospective study of patients with lumbar disc herniation who underwent discectomy via interlaminar approach assisted by FE instruments. PATIENT SAMPLE Thirty patients with lumbar disc herniation underwent discectomy using an interlaminar endoscopic-only approach between 2008 and 2009. METHODS The patients were divided into three groups of 10 sequential cases each. Group A consisted of the first 10 cases, Group B the subsequent 10 cases, and Group C the last 10 cases. The clinical evaluation data included operative time, length of hospital stay, visual analog scale (VAS) leg and back pain scores, complications, and rate of conversion to an open. RESULTS All patients were observed prospectively for 1.61 ± 0.22 years (range, 1.2-2.0 years). There was no measurable intraoperative bleeding and postoperative infections in the three groups. Compared with Group A, the operative time in Group B was significantly decreased (p < .001). The patients in Group C had much less operative time than in Group B (p = .002). There was no significant difference with length of hospital stay in the three groups (p = .897). The improvement of VAS leg and back pain scores in each group was similar: there was a significant improvement (p < .01) at 3 months after surgery when compared with preoperative scores, but there was no statistical difference (p > .05) in the VAS leg and back pain scores between 3 months after surgery and final follow-up. The complication rate was 12.5% for Group A, 10% for Group B, and 0% for Group C. The need for conversion to an open procedure for Group A was 20% compared with zero cases in both Groups B and C. There were no symptomatic recurrences in our study. CONCLUSIONS Excellent clinical and minimally invasive outcomes can be obtained in the surgical treatment of lumbar disc herniation via the interlaminar approach assisted by FE technique. However, attention must be paid to the steep learning curve by using this complex technique. Imprecise anatomic orientation and manipulation inside the spinal canal are key factors in the steep learning curve. Obtaining microsurgical experience, attending workshops, and suitable patient selection can help shorten the learning curve and decrease the complications.
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Affiliation(s)
- Bing Wang
- Department of Spine Surgery, Second Xiangya Hospital of Central South University, 139 Renmin Rd, Changsha, Hunan Province 410011, China.
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Çelik S, Göksu K, Çelik SE, Emir CB. Benign neurological recovery with low recurrence and low peridural fibrosis rate in pediatric disc herniations after lumbar microdiscectomy. Pediatr Neurosurg 2011; 47:417-22. [PMID: 22776976 DOI: 10.1159/000338982] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/17/2012] [Indexed: 11/19/2022]
Abstract
Lumbar disc herniation (LDH) is a very rare clinical entity in the pediatric age group, therefore only a few clinical studies have until now investigated the clinical behavior of pediatric LDH. The natural clinical history, postoperative neurological recovery with radiological follow-up and quality of life related to the disorder continue to be unknown. We prospectively planned and designed two groups of LDH patients scheduled for surgery in this study. The operations were performed by the same surgeon in a randomized fashion. The first group consisted of pediatric patients and the second group of adult patients. Both groups contained 32 cases. Postoperative neurological recovery was assessed using the visual analog scale and Aberdeen Low Back Pain Scale. Postoperative peridural fibrosis was also evaluated in postcontrast magnetic resonance sections. After 3 years of follow-up, all parameters were significantly better in the pediatric LDH group with no recurrence of the disease. The pediatric LDH group was postoperatively better than the adult group both clinically and radiologically. Although LDH seems a catastrophic disease in the pediatric age group, the clinical picture and neurological recovery have a significantly more benign course than in adult patients even in operated cases.
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Affiliation(s)
- Sevinç Çelik
- Department of Neurology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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