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Kang MS, You KH, Hwang JY, Cho TG, Yoon JH, Lee CS, Park HJ. In Vivo Comparison of Positive Microbial Culture by Wound Irrigation Methods: Biportal Endoscopic Versus Open Microscopic Transforaminal Lumbar Interbody Fusion. Spine (Phila Pa 1976) 2024; 49:941-949. [PMID: 37642480 DOI: 10.1097/brs.0000000000004812] [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: 06/25/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE This study aimed to evaluate the risk factors and prevalence of intraoperative contamination (IoC) through the microbial culture of superficial and deep samples obtained during surgery. SUMMARY OF BACKGROUND DATA Surgical site infection (SSI) in spinal surgery is a serious complication. The prevalence of IoC may differ based on surgical approach and technique, even in the setting of the same procedure. MATERIALS AND METHODS In this in vivo study, microbial cultivation was performed with superficial (ligamentum flavum, LF) and deep (nucleus pulposus, NP) surgical specimens to evaluate IoC in 132 patients undergoing single-level transforaminal lumbar interbody fusion (TLIF). Biportal endoscopic -TLIF was performed under continuous wound irrigation (group A, n=66), whereas open microscopic (OM) TLIF was performed under intermittent wound irrigation (group B, n=66). LF and NP specimens were homogenized, gram stained, and cultured in aerobic and anaerobic media for 14 days. Microbial culture results and the occurrence of SSI in the two groups were assessed. The χ 2 test and Fisher exact test were used to determine significant differences among categorical variables. Logistic regression analysis was used to assess the influence of patient characteristics on the prevalence of positive microbial cultures. RESULTS Of the 132 patients, 34 (25.8%) had positive microbial cultures, and positive culture required an incubation period of 72 hours to 2 weeks in all these patients except for three. Overall, positive culture was significantly higher in group B than in group A ( P =0.029). The subgroups of LF- and NP-positive cultures were 18.18% (n=24) and 12.88% (n=17), respectively; the SSI was 0.76% (n=1). Group A had a significantly lower subgroup of NP-positive culture than group B ( P =0.035). OM technique was an independent risk factor associated with overall positive culture ( P <0.05). The most common microorganism was Cutibacterium acnes ( C. acnes ). CONCLUSIONS Biportal endoscopic-TLIF with continuous wound irrigation showed significantly lower overall and NP-positive cultures than OM-TLIF with intermittent irrigation. The most common strain of positive culture was C. acnes . LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Min-Seok Kang
- Department of Orthopedic Surgery, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yeun Hwang
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Tack-Geun Cho
- Department of Neurosurgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Joon-Hyeok Yoon
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chong-Suh Lee
- Department of Orthopedic Surgery, Spine Center, Haeundae Bumin Hospital, Busan, Republic of Korea
| | - Hyun-Jin Park
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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La Rocca G, Galieri G, Mazzucchi E, Pignotti F, Orlando V, Pappalardo S, Olivi A, Sabatino G. The Three-Step Approach for Lumbar Disk Herniation with Anatomical Insights Tailored for the Next Generation of Young Spine Surgeons. J Clin Med 2024; 13:3571. [PMID: 38930100 PMCID: PMC11204482 DOI: 10.3390/jcm13123571] [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: 04/23/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Lumbar disc herniation, a complex challenge in spinal health, significantly impacts individuals across diverse age groups. This article delves into the intricacies of this condition, emphasising the pivotal role of anatomical considerations in its understanding and management. Additionally, lumbar discectomy might be considered an "easy" surgery; nevertheless, it carries significant risks. The aim of the study was to present a groundbreaking "three-step approach" with some anatomical insight derived from our comprehensive clinical experiences, designed to systematise the surgical approach and optimise the outcomes, especially for young spine surgeons. We highlighted the purpose of the study and introduced our research question(s) and the context surrounding them. Methods: This retrospective study involved patients treated for lumbar disc herniation at a single institution. The patient demographics, surgical details, and postoperative assessments were meticulously recorded. All surgeries were performed by a consistent surgical team. Results: A total of 847 patients of the 998 patients initially included completed the follow-up period. A three-step approach was performed for every patient. The recurrence rate was 1.89%. Furthermore, the incidence of lumbar instability and the need for reoperation were carefully examined, presenting a holistic view of the outcomes. Conclusions: The three-step approach emerged as a robust and effective strategy for addressing lumbar disc herniation. This structured approach ensures a safe and educational experience for young spinal surgeons.
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Affiliation(s)
- Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
| | - Gianluca Galieri
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
| | - Edoardo Mazzucchi
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
- Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Fabrizio Pignotti
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Vittorio Orlando
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
| | - Simona Pappalardo
- Department of Anatomical Pathology, Giovanni Paolo II Hospital, 97100 Olbia, Italy;
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
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Chang MC, Choo YJ, Denis I, Mares C, Majdalani C, Yang S. Effectiveness of intradiscal ozone injections for treating pain following herniated lumbar disc: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2024:BMR240024. [PMID: 38905033 DOI: 10.3233/bmr-240024] [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] [Indexed: 06/23/2024]
Abstract
BACKGROUND Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P< 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P< 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P< 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD =-0.05, 95% CI [-0.67, 0.57], P= 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P< 0.01). CONCLUSION Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Korea
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Korea
| | - Isabelle Denis
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christopher Mares
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Carl Majdalani
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Seoyon Yang
- Department of Rehabilitation Medicine, School of Medicine, Ewha Woman's University Seoul Hospital, Seoul, Korea
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Prasse T, Heck VJ, Leyendecker J, Hofstetter CP, Kernich N, Eysel P, Bredow J. Economic Implications of Dural Tears in Lumbar Microdiscectomies: A Retrospective, Observational Study. World Neurosurg 2024:S1878-8750(24)00615-6. [PMID: 38631663 DOI: 10.1016/j.wneu.2024.04.052] [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: 03/16/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Dural tears (DTs) are a frequent complication after lumbar spine surgery. We sought to determine the incidence of DTs and the related impact on health care expenditures after lumbar discectomies. METHODS In this retrospective cohort study, all patients with first-time single-level lumbar discectomies at our institution who underwent minimally invasive surgery from 2015 to 2019 were reviewed. Age, sex, weight, height, body mass index, costs, revenues, length of stay, American Society of Anesthesiologists score, Charlson Comorbidity Index, and operative time (OT) were assessed. Exclusion criteria were age <18 years, previous spine surgery, multiple or traumatic disc herniations, and malignant and infectious diseases. RESULTS The follow-up time was at least 12 months postoperatively. Of 358 patients identified with lumbar discectomies, 230 met the inclusion criteria. Incidence of DTs was 3.5%. Mean costs (P < 0.001), economic loss (P < 0.01), and OT (P < 0.0001) were found to be significantly higher in the DT group compared with the control group of patients without a DT. The revenues were not statistically different between the 2 groups (P > 0.05). Further analysis of the control group by profit and loss revealed significantly higher body mass index (P < 0.05), length of stay (P < 0.0001), and OT (P < 0.0001) in the loss group. CONCLUSIONS DTs represent a significant socioeconomic burden in lumbar spine surgery and cause severe secondary complications. The impact of DTs on health care expenses is primarily based on significantly higher OT and a higher mean length of stay.
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Affiliation(s)
- Tobias Prasse
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
| | - Vincent J Heck
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jannik Leyendecker
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
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Abu-Zahra MS, Mayfield CK, Thompson AA, Garcia O, Bashrum B, Hwang NM, Liu JN, Petrigliano FA, Alluri RK. Evaluation of Spin in Systematic Reviews and Meta-Analyses of Minimally Invasive Surgical Techniques and Standard Microdiscectomies for Treating Lumbar Disc Herniation. Global Spine J 2024; 14:731-739. [PMID: 37268297 PMCID: PMC10802545 DOI: 10.1177/21925682231181873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Spin in scientific literature is defined as bias that overstates efficacy and/or underestimates harms of procedures undergoing review. While lumbar microdiscectomies (MD) are considered the gold standard for treating lumbar disc herniations (LDH), outcomes of novel procedures are being weighed against open MD. This study identifies the quantity and type of spin in systematic reviews and meta-analyses of LDH interventions. METHODS A search was conducted on the PubMed, Scopus, and SPORTDiscus databases for systematic reviews and meta-analyses evaluating the outcomes of MD against other LDH interventions. Each included study's abstract was assessed for the presence of the 15 most common types of spin, with full texts reviewed during cases of disagreement or for clarification. Full texts were used in the assessment of study quality per AMSTAR 2. RESULTS All 34 included studies were observed to have at least 1 form of spin, in either the abstract or full text. The most common type of spin identified was type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies"), which was observed in ten studies (10/34, 29.4%). There was a statistically significant association between studies not registered with PROSPERO and the failure to satisfy AMSTAR type 2 (P < .0001). CONCLUSION Misleading reporting is the most common category of spin in literature related to LDH. Spin overwhelmingly tends to go in the positive direction, with results inappropriately favoring the efficacy or safety of an experimental intervention.
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Affiliation(s)
- Maya S. Abu-Zahra
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Cory K. Mayfield
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Ashley A. Thompson
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Oswaldo Garcia
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Bryan Bashrum
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - N. Mina Hwang
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Joseph N. Liu
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
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Seruya M. Differential Diagnosis of "Foot Drop": Implications for Peripheral Nerve Surgery. J Reconstr Microsurg 2024. [PMID: 38267007 DOI: 10.1055/a-2253-6360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND At least 128,000 patients in the United States each year suffer from foot drop. This is a debilitating condition, marked by the inability to dorsiflex and/or evert the affected ankle. Such patients are rendered to a lifetime of relying on an ankle-foot orthosis (AFO) for walking and nighttime to prevent an equinovarus contracture. METHODS This narrative review explores the differential diagnosis of foot drop, with a particular focus on clinical presentation and recovery, whether spontaneously or through surgery. RESULTS Contrary to popular belief, foot drop can be caused by more than just insult to the common peroneal nerve at the fibular head (fibular tunnel). It is a common endpoint for a diverse spectrum of nerve injuries, which may explain its relatively high prevalence. From proximal to distal, these conditions include lumbar spine nerve root damage, sciatic nerve palsy at the sciatic notch, and common peroneal nerve injury at the fibular head. Each nerve condition is marked by a unique clinical presentation, frequency, likelihood for spontaneous recovery, and cadre of peripheral nerve techniques. CONCLUSION The ideal surgical technique for treating foot drop, other than neurolysis for compression, remains elusive as traditional peripheral nerve procedures have been marred by a wide spectrum of functional results. Based on a careful understanding of why past techniques have achieved limited success, we can formulate a working set of principles to help guide surgical innovation moving forward, such as fascicular nerve transfer.
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Affiliation(s)
- Mitchel Seruya
- Division of Plastic and Reconstructive Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Wang Y, He X, Chen S, Weng Y, Liu Z, Pan Q, Zhang R, Li Y, Wang H, Lin S, Yu H. Annulus Fibrosus Repair for Lumbar Disc Herniation: A Meta-Analysis of Clinical Outcomes From Controlled Studies. Global Spine J 2024; 14:306-321. [PMID: 37068762 PMCID: PMC10676185 DOI: 10.1177/21925682231169963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVES This study aimed to summarize the clinical efficacy and safety of the various annular defect repair methods that have emerged in recent years. METHODS A meta-analysis of randomized and non-randomized controlled trials was conducted. Articles from PubMed, Embase, and the Cochrane Library (CENTRAL) on Lumbar disc herniation treatment with annular repair published from inception to April 2, 2022 were included. We summarized the clinical efficacy and safety of annular repair techniques based on a random-effects model meta-analysis. RESULTS 7 randomized controlled studies and 8 observational studies with a total of 2161 participants met the inclusion criteria. The pooled data analysis showed that adding the annular repair technique reduced postoperative recurrence rate, reoperation rate, and loss of intervertebral height compared with lumbar discectomy alone. Subgroup analysis based on different annular repair techniques showed that the Barricaid Annular Closure Device (ACD) was effective in preventing re-protrusion and reducing reoperation rates, while there was no significant difference between the other subgroups. The annulus fibrosus suture (AFS) did not improve the postoperative Oswestry Disability Index (ODI). No statistically significant difference was observed in the incidence of adverse events between the annular repair and control groups. CONCLUSIONS Lumbar discectomy combined with ACD can effectively reduce postoperative recurrence and reoperation rates in patients with LDH. AFS alone was less effective in reducing recurrence and reoperation rates and did not improve postoperative pain and function.
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Affiliation(s)
- Yangbin Wang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Xiaoyu He
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Shupeng Chen
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yiyong Weng
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Zhihua Liu
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Qunlong Pan
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Rongmou Zhang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Yizhong Li
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Hanshi Wang
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Royal National Orthopaedic Hospital NHS Trust, Quanzhou, Fujian, China; Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St, Sydney, Australia
| | - Haiming Yu
- Department of Orthopaedic, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China
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Hasegawa T, Akeda K, Yamada J, Kawaguchi K, Takegami N, Fujiwara T, Natsume T, Ide K, Matsuyama Y, Sudo A. Regenerative effects of platelet-rich plasma releasate injection in rabbit discs degenerated by intradiscal injection of condoliase. Arthritis Res Ther 2023; 25:216. [PMID: 37941067 PMCID: PMC10631205 DOI: 10.1186/s13075-023-03200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Intradiscal condoliase injection is an alternative therapeutic option for lumbar disc herniation (LDH). However, it is often associated with disc degeneration. Several in vivo studies have demonstrated the regenerative potential of platelet-rich plasma (PRP) in disc degeneration. Thus, we hypothesized that the intradiscal injection of PRP releasate (PRPr), a soluble releasate isolated from PRP, has the potential to regenerate degenerated intervertebral discs (IVDs) induced by condoliase. This study examined the regenerative effects of PRPr on rabbit IVDs degenerated following condoliase injection. METHODS Eleven New Zealand white rabbits were used in this study. Condoliase (12.5 mU/10 μl) was injected into two non-contiguous discs (L2-L3 and L4-L5), and L3-L4 disc was left intact as a non-injection control. Saline (20 μl) or PRPr (20 μl) was randomly injected into L2-L3 and L4-L5 discs 4 weeks after the condoliase injection. Disc height (DH) was radiographically monitored biweekly from the day of condoliase injection to 16 weeks post-injection. Changes in DH were expressed as percentage DH (%DH) normalized to the baseline DH. Sixteen weeks after condoliase injection, all rabbits were euthanized, and subjected to MRI and histological analyses. RESULTS Intradiscal injection of condoliase induced a significant decrease in %DH (L2-L3 and L4-L5) to 52.0% at week 4. However, the %DH began to return to normal after saline injection and reached 76.3% at week 16. In the PRPr group, %DH began to recover to normal after the PRPr injection and was restored to 95.5% at week 16. The MRI-modified Pfirrmann grade of the PRPr group was significantly lower than that of the saline group (P < 0.01). Histological analyses showed progressive degenerative changes, including reduction of the NP area and condensation of the matrix in the saline and PRPr groups. The histological score of the PRPr group was significantly lower than that of the saline group (P < 0.01). CONCLUSIONS PRPr has great potential to enhance the regeneration of degenerated rabbit IVDs induced by condoliase. The results of this preclinical study suggest that PRPr injection therapy may be indicated for patients with LDH who have poor recovery from disc degeneration after chemonucleolysis treatment with condoliase.
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Affiliation(s)
- Takahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Koki Kawaguchi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Takahiro Natsume
- Hamamatsu Pharma Research, Inc., Pharmacology, Hamamatsu, Shizuoka, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Tsuchiya K, Kobayashi R, Okano I, Taketomi A, Kudo Y, Toyone T, Inagaki K. Effectiveness of Pulsed Radiofrequency Based on the Minimum Clinically Important Differences in Lumbar Spine-Related Pain in Patients without Recent Lumbar Surgery. World Neurosurg 2023; 179:e75-e80. [PMID: 37595839 DOI: 10.1016/j.wneu.2023.08.003] [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: 06/20/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) has been used for treatment of chronic pain in several body regions, including axial and radicular pain. However, a limited number of reports have specifically demonstrated the effectiveness of PRF for spine-related pain among nonsurgical patients. Therefore, we evaluated the effectiveness of PRF for lumbar spine-associated pain in patients without recent spine surgery, and identified the factors associated with clinically meaningful improvement in pain and quality of life. METHODS Records of patients who underwent PRF for lumbar spine-related pain and were followed up over 6 months between 2019 and 2022 were retrospectively reviewed. Data on patient demographics, interventional factors, and patient-reported outcomes, such as the numerical rating scale (NRS) and EuroQol Group 5 Dimension 5-Level Quality of Life (EQ-5D-5 L), were collected. Patients were divided into 2 groups (responsive and nonresponsive) based on the NRS and EQ-5D-5 L scores using the previously reported minimal clinically important difference values of the NRS and EQ-5D-5 L as cutoffs, and baseline parameters were compared to identify contributing factors. RESULTS Forty-three patients were included in the final analysis. The NRS and EQ-5D-5 L scores improved significantly at 3 and 6 months after PRF compared to baseline. The groups with NRS and EQ-5D-5 L improvement over the minimal clinically important difference had significantly higher baseline NRS and EQ-5D-5 L scores. CONCLUSIONS Our results demonstrated that PRF improved pain and patient-reported outcomes for spine-related pain for at least 6 months in our patient cohort. PRF may be a good option for treating lumbar spine-related issues, even with severe pain and/or dysfunction.
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Affiliation(s)
- Koki Tsuchiya
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Reon Kobayashi
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Ichiro Okano
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Asae Taketomi
- Department of Anesthesiology, Showa University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kudo
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomoaki Toyone
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Wang T, Wang A, Zang L, Fan N, Wu Q, Lu X, Yuan S. Reoperations After Percutaneous Endoscopic Transforaminal Decompression for Treating Lumbar Spinal Stenosis: Incidence and Predictors. Global Spine J 2023; 13:2327-2335. [PMID: 35225015 PMCID: PMC10538338 DOI: 10.1177/21925682221081030] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The main purpose of the present study was to report the incidence and identify predictors of reoperation in patients with lumbar spinal stenosis (LSS) treated with percutaneous endoscopic transforaminal decompression (PETD). METHODS This study retrospectively reviewed consecutive patients with LSS who underwent PETD at our center between January 2016 and July 2020. The incidence of reoperations was calculated. We then designed a surgical period-matched case-control study to identify predictors among demographic data, clinical baseline data, and imaging parameters. RESULTS This study identified 496 eligible patients. 33 (6.7%) patients underwent reoperation with a mean follow-up of 3 years, consisting 22 (4.4%) at the index level and 11 (2.2%) at the adjacent levels. There were significant differences in age and age-adjusted Charlson comorbidity index (AACCI) between the two groups, with younger age (P = .004) and lower AACCI (P = .019) in reoperation group. Age was identified as the sole independent predictor (P = .006). The duration of symptoms ≥12 months (P = .034) and the presence of heart problems (P = .012) were recognized as specific predictors among patients younger than 65 years. CONCLUSIONS In a mean follow-up of 3 years, the incidence of reoperation in LSS treated with PETD was 6.7%. A younger age was the independent predictor for reoperation. Younger patients with the duration of symptoms ≥12 months or without heart problems were more likely to undergo a second operation. Prospective randomized controlled trials are required to confirm these findings.
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Affiliation(s)
- Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xuanyu Lu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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11
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Kang MS, Park HJ, You KH, Choi DJ, Park CW, Chung HJ. Comparison of Primary Versus Revision Lumbar Discectomy Using a Biportal Endoscopic Technique. Global Spine J 2023; 13:1918-1925. [PMID: 35176889 PMCID: PMC10556890 DOI: 10.1177/21925682211068088] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To compare the clinical outcomes of the biportal endoscopic technique for primary lumbar discectomy (BE-LD) and revision lumbar discectomy (BE-RLD). METHODS Eighty-one consecutive patients who underwent BE-LD or BE-RLD, and could be followed up for at least 12 months were divided into two groups: Group A (BE-LD; n = 59) and Group B (BE-RLD; n = 22). Clinical outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab's criteria. Perioperative results included operation time (OT), length of hospital stay (LOS), amount of surgical drain, and kinetics of serum creatine phosphokinase (CPK) and C-reactive protein (CRP). Clinical and perioperative outcomes were assessed preoperatively and postoperatively at 2 days and at 3, 6, and 12 months. Postoperative complications were noted. RESULTS Both groups showed significant improvement in pain (VAS) and disability (ODI) compared to baseline values at postoperative day 2, which lasted until the final follow-up. There were no significant differences in the improvement of the VAS and ODI scores between the groups. According to the modified MacNab's criteria, 88.1 and 90.9% of the patients were excellent or good in groups A and B, respectively. OT, LOS, amount of surgical drain, and kinetics in serum CRP and CPK levels were comparable. Complications in Group A included incidental durotomy (n = 2), epidural hematoma (n = 1), and local recurrence (n = 1) and in Group B incidental durotomy (n = 1) and epidural hematoma (n = 1). CONCLUSION BE-RLD showed favorable clinical outcomes, less postoperative pain, and early laboratory recovery equivalent to BE-LD.
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Affiliation(s)
- Min-Seok Kang
- Department of Orthopedic Surgery,
Spine Center, Bumin Hospital Seoul, Seoul, Korea
| | - Hyun-Jin Park
- Department of Orthopedic Surgery,
Spine Center, Kangnam Sacred Heart
Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ki-Han You
- Department of Orthopedic Surgery,
Spine Center, Kangnam Sacred Heart
Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae-Jung Choi
- Department of Orthopedic Surgery, Himnaera Hospital, Busan, Korea
| | - Chang-Won Park
- Department of Orthopedic Surgery,
Spine Center, Kangnam Sacred Heart
Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hoon-Jae Chung
- Department of Orthopedic Surgery,
Spine Center, Bumin Hospital Seoul, Seoul, Korea
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12
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Aljohani AK, Khalid Bin Yunus M, Fallatah AA, Kheder OM, Almolki KS, Alawad H, Talal Halawani R, Abdelaziz AA, Sherif A. Inferior Mesenteric Artery Injury in Post-lumbar Microdiscectomy: A Case Report. Cureus 2023; 15:e42998. [PMID: 37671208 PMCID: PMC10476926 DOI: 10.7759/cureus.42998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Iatrogenic vascular injury during lumbar microdiscectomy is a rather rare complication, but it can have fatal consequences. Here, we report a patient who underwent an L5-S1 microdiscectomy, which was complicated by inferior mesenteric artery injury. The patient presented in the recovery room with symptoms of hypotension and tachycardia after the operation which was successfully managed by endovascular embolization. The patient was positioned in a prone position, which may have contributed to the development of vascular injury. To prevent potential complications, we advised using the Jackson table rather than a standard surgical table and thoroughly inspecting the abdomen and pelvis prior to the operation.
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Affiliation(s)
| | | | | | | | | | - Hani Alawad
- Neurosurgery, King Fahad Hospital, Medina, SAU
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13
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Liu C, Ferreira GE, Abdel Shaheed C, Chen Q, Harris IA, Bailey CS, Peul WC, Koes B, Lin CWC. Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. BMJ 2023; 381:e070730. [PMID: 37076169 PMCID: PMC10498296 DOI: 10.1136/bmj-2022-070730] [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] [Accepted: 03/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To investigate the effectiveness and safety of surgery compared with non-surgical treatment for sciatica. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform from database inception to June 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing any surgical treatment with non-surgical treatment, epidural steroid injections, or placebo or sham surgery, in people with sciatica of any duration due to lumbar disc herniation (diagnosed by radiological imaging). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data. Leg pain and disability were the primary outcomes. Adverse events, back pain, quality of life, and satisfaction with treatment were the secondary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Data were pooled using a random effects model. Risk of bias was assessed with the Cochrane Collaboration's tool and certainty of evidence with the grading of recommendations assessment, development, and evaluation (GRADE) framework. Follow-up times were into immediate term (≤six weeks), short term (>six weeks and ≤three months), medium term (>three and <12 months), and long term (at 12 months). RESULTS 24 trials were included, half of these investigated the effectiveness of discectomy compared with non-surgical treatment or epidural steroid injections (1711 participants). Very low to low certainty evidence showed that discectomy, compared with non-surgical treatment, reduced leg pain: the effect size was moderate at immediate term (mean difference -12.1 (95% confidence interval -23.6 to -0.5)) and short term (-11.7 (-18.6 to -4.7)), and small at medium term (-6.5 (-11.0 to -2.1)). Negligible effects were noted at long term (-2.3 (-4.5 to -0.2)). For disability, small, negligible, or no effects were found. A similar effect on leg pain was found when comparing discectomy with epidural steroid injections. For disability, a moderate effect was found at short term, but no effect was observed at medium and long term. The risk of any adverse events was similar between discectomy and non-surgical treatment (risk ratio 1.34 (95% confidence interval 0.91 to 1.98)). CONCLUSION Very low to low certainty evidence suggests that discectomy was superior to non-surgical treatment or epidural steroid injections in reducing leg pain and disability in people with sciatica with a surgical indication, but the benefits declined over time. Discectomy might be an option for people with sciatica who feel that the rapid relief offered by discectomy outweighs the risks and costs associated with surgery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021269997.
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Affiliation(s)
- Chang Liu
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Giovanni E Ferreira
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Christina Abdel Shaheed
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Qiuzhe Chen
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christopher S Bailey
- Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada
| | - Wilco C Peul
- Neurosurgical Center Holland, Leiden University Medical Center and Haaglanden MC and Haga Teaching Hospital, The Hague-Leiden, Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Netherlands
| | - Chung-Wei Christine Lin
- Sydney Musculoskeletal Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
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14
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Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes. 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 2023; 32:1254-1264. [PMID: 36867252 DOI: 10.1007/s00586-023-07595-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates. METHODS Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed. RESULTS We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)-dural tear (1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%); epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI 0.1-3.4%). CONCLUSION Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.
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15
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Ramachandran K, Meena J, Anand KSSV, Shetty AP, Shanmuganathan R. Breakage of a Pituitary Rongeur Tip: An Unforeseen Complication of Lumbar Microdiscectomy: A Case Report and Review of Literature. JBJS Case Connect 2023; 13:01709767-202303000-00033. [PMID: 36763709 DOI: 10.2106/jbjs.cc.22.00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
CASE A 46-year-old man with left leg radiculopathy due to a left L4-5 disc extrusion had a lumbar microdiscectomy that was complicated by the pituitary rongeur tip breaking in the L4-5 disc space. The rongeur tip was successfully retrieved by widening the entry access without damaging the adjoining facet and utilizing a blunt nerve hook and probe dissector. CONCLUSION Breakage of the pituitary rongeur tip is an unforeseen complication of lumbar microdiscectomy. Surgeons should be aware of this potential complication, ideally confirm the rongeur is intact prior to wound coverage, and understand the risks versus benefits of attempting to retrieve a broken rongeur tip.
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Affiliation(s)
- Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
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16
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[Early effectiveness of unilateral biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1186-1191. [PMID: 36310453 PMCID: PMC9626276 DOI: 10.7507/1002-1892.202205095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation (LDH). METHODS The clinical data of 19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed. There were 12 males and 7 females with an average age of 39.1 years (range, 26-59 years). The operative segment was L 4, 5 in 13 cases, and L 5, S 1 in 6 cases. The mean disease duration was 6.7 months (range, 3-15 months). Preoperative neurological examination showed that muscle strength, sensation, and tendon reflex weakened or disappeared in varying degrees. Single annulus fibrosus suture (14 cases) or anchor assisted annulus fibrosus suture (5 cases) was selected according to the location of annulus fibrosus tears. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) was used to evaluate the function recovery of lumbar spine before operation and at 3 days, 3 months, and 6 months after operation. At 3 days and 3 months after operation, MRI was used to examine the removal of nucleus pulposus and decompression of nerve root. MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded. RESULTS All operations were successfully completed with a mean operation time of 52.7 minutes (range, 40-75 minutes). There was no complication such as nerve injury, spinal cord hypertension syndrome, or dural sac tear during operation, and no complication such as infection, aggravation of nerve damage, or cerebrospinal fluid leakage after operation. All the patients were followed up 6-10 months (mean, 8.2 months). Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed. During the follow-up, there was no recurrence of disc herniation. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and those at 6 months after operation further improved than those at 3 days and 3 months after operation, all showing significant differences ( P<0.05). At 6 months after operation, MacNab standard was used to evaluate the effectiveness, and the results were excellent in 14 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation ( P<0.05); the recovery of tendon reflex was not obvious, showing no significant difference when compared with that before operation ( P>0.05). CONCLUSION UBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.
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17
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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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18
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Ramola M, Aggarwal A, Singh R. A simple new cost-effective retractor system for exposure in lumbar microdiscectomy:1 year outcome analysis. World Neurosurg 2022; 165:133-140. [PMID: 35760328 DOI: 10.1016/j.wneu.2022.06.096] [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: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A new technique for retraction in lumbar microdiscectomy called as Rubber band technique (RT) is introduced and its 1year clinical outcomes results are compared to standard microdiscectomy (SM). METHODS This study was retrospective analysis of 81 consecutive patients who underwent lumbar microdiscectomy by Rubber band technique (RT group) and standard microdiscectomy (SM) group for single level lumbar disc herniation. The primary outcome was Oswestry Disability Index (ODI) score after 1 year of surgery. Secondary outcomes included were Short form health survey Physical function (SF 36-PF), Short- form health survey bodily pain (SF36-BP), visual analogue scale (VAS) for back pain and leg pain. Other parameters included were operative time, hospital stay, skin incision, complications, and redo surgery. RESULTS Of the total 81 patients, 93% (76 patients) had complete database up to 1 year follow up. RT group comprised 39 patients (20 males, 19 females) and standard microdiscectomy (SM Group, 37 patients, 19 males 18 females). Primary & secondary outcomes like ODI score, SF 36- PF, SF 36 -BP score, VAS score back and leg pain, complications & redo surgery did not differ significantly between the treatment groups at follow-up periods (p>0.05). Skin incision was smaller in RT as compared to SM group (p=.0001). CONCLUSIONS Over the 1year follow-up period, clinical outcome of patients treated with Rubber band technique (RT) was comparable to patients treated with standard microdiscectomy group (SM). RT appears to provide alternative safe, effective, and economical approach for lumbar microdiscectomy.
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Affiliation(s)
- Mahesh Ramola
- Department of Neurosurgery, SGRR Institute of Medical & Health Sciences, Dehradun, Uttarakhand. India.
| | - Amulya Aggarwal
- Department of Surgery, SGRR Institute of Medical & Health Sciences, Dehradun, Uttarakhand. India
| | - Ritu Singh
- Department of Community medicine, SGRR Institute of Medical & Health Sciences, Dehradun, Uttarakhand. India, Current affiliation of Dr. Ritu Singh - Community health center, Raipur, Dehradun, Uttarakhand. India
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Wang Y, Xu Y, Tian G, Dai G. Pediatric lumbar disc herniation: a report of two cases and review of the literature. Eur J Med Res 2022; 27:82. [PMID: 35659297 PMCID: PMC9164894 DOI: 10.1186/s40001-022-00696-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is not a common condition in children. Most reports on pediatric LDH concern the outcomes of surgeries performed in children in whom nonsurgical treatment failed while the outcome of nonsurgical treatment of LDH in children was rarely reported. CASES PRESENTATION Case 1: a 10-year-old girl presented with back pain and sciatica in her left leg for over 3 months. The physical examination revealed exacerbation of back pain by waist extension or flexion, and a positive Lasegue's sign was revealed in her left leg. Magnetic resonance imaging (MRI) revealed lumbar disc herniation at the L5/S1 level. She was diagnosed with LDH. After receiving nonsurgical treatment of traditional Chinese medicine (TCM) for 30 days, the girl had mild low back pain and sciatica and the symptoms had resolved completely at the 3-month follow-up. There was no recurrence within the following 2 years. MRI performed 30 months later revealed that the herniated disc did not shrink significantly. However, she was totally asymptomatic at the follow-up performed 30 months later. Case 2: a 13-year-old boy presented with sciatica in his left leg for over 3 months. The physical examination revealed that Lasegue's sign was positive in the left leg, the level of muscle strength in the left ankle plantar flexors was grade 4. MRI revealed a lumbar disc herniation at the L5/S1 level. He was diagnosed with LDH. The boy underwent 2 weeks of TCM treatment, and exhibited a favorable outcome: only mild pain was noticed in his left buttocks after walking for more than 15 min. He was asymptomatic at the 3-month follow-up and there was no recurrence within the next 3 years. MRI scan performed at 40 months later showed no significant resorption of the herniated disc. However, he was totally asymptomatic at the follow-up performed 40 months later. CONCLUSIONS For the nonsurgical treatment of pediatric LDH, resorption of herniated discs is not necessary for favorable long-term outcomes, and children with symptomatic LDH may become asymptomatic without resorption.
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Affiliation(s)
- Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China.
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, Xindu District, 783 Xindu Avenue, Chengdu, Sichuan, China
| | - Guogang Tian
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan, China
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20
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Kelekis A, Bonaldi G, Cianfoni A, Filippiadis D, Scarone P, Bernucci C, Hooper DM, Benhabib H, Murphy K, Buric J. Intradiscal oxygen-ozone chemonucleolysis versus microdiscectomy for lumbar disc herniation radiculopathy: a non-inferiority randomized control trial. Spine J 2022; 22:895-909. [PMID: 34896609 DOI: 10.1016/j.spinee.2021.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain with or without radicular leg pain is an extremely common health condition significantly impacting patient's activities and quality of life. When conservative management fails, epidural injections providing only temporary relief, are frequently utilized. Intradiscal oxygen-ozone may offer an alternative to epidural injections and further reduce the need for microdiscectomy. PURPOSE To compare the non-inferiority treatment status and clinical outcomes of intradiscal oxygen-ozone with microdiscectomy in patients with refractory radicular leg pain due to single-level contained lumbar disc herniations. STUDY DESIGN / SETTING Multicenter pilot prospective non-inferiority blocked randomized control trial conducted in three European hospital spine centers. PATIENT SAMPLE Forty-nine patients (mean 40 years of age, 17 females/32 males) with a single-level contained lumbar disc herniation, radicular leg pain for more than six weeks, and resistant to medical management were randomized, 25 to intradiscal oxygen-ozone and 24 to microdiscectomy. 88% (43 of 49) received their assigned treatment and constituted the AS-Treated (AT) population. OUTCOME MEASURES Primary outcome was overall 6-month improvement over baseline in leg pain. Other validated clinical outcomes, including back numerical rating pain scores (NRS), Roland Morris Disability Index (RMDI) and EQ-5D, were collected at baseline, 1 week, 1-, 3-, and 6-months. Procedural technical outcomes were recorded and adverse events were evaluated at all follow-up intervals. METHODS Oxygen-ozone treatment performed as outpatient day surgeries, included a one-time intradiscal injection delivered at a concentration of 35±3 μg/cc of oxygen-ozone by a calibrated delivery system. Discectomies performed as open microdiscectomy inpatient surgeries, were without spinal instrumentation, and not as subtotal microdiscectomies. Primary analyses with a non-inferiority margin of -1.94-point difference in 6-month cumulative weighted mean leg pain NRS scores were conducted using As-Treated (AT) and Intent-to-Treat (ITT) populations. In post hoc analyses, differences between treatment groups in improvement over baseline were compared at each follow-up visit, using baseline leg pain as a covariate. RESULTS In the primary analysis, the overall 6-month difference between treatment groups in leg pain improvement using the AT population was -0.31 (SE, 0.84) points in favor of microdiscectomy and using the ITT population, the difference was 0.32 (SE, 0.88) points in favor of oxygen-ozone. The difference between oxygen-ozone and microdiscectomy did not exceed the non-inferiority 95% confidence lower limit of treatment difference in either the AT (95% lower limit, -1.72) or ITT (95% lower limit, -1.13) populations. Both treatments resulted in rapid and statistically significant improvements over baseline in leg pain, back pain, RMDI, and EQ-5D that persisted in follow-up. Between group differences were not significant for any outcomes. During 6-month follow-up, 71% (17 of 24) of patients receiving oxygen-ozone, avoided microdiscectomy. The mean procedure time for oxygen-ozone was significantly faster than microdiscectomy by 58 minutes (p<.0010) and the mean discharge time from procedure was significantly shorter for the oxygen-ozone procedure (4.3±2.9 hours vs. 44.2±29.9 hours, p<.001). No major adverse events occurred in either treatment group. CONCLUSIONS Intradiscal oxygen-ozone chemonucleolysis for single-level lumbar disc herniations unresponsive to medical management, met the non-inferiority criteria to microdiscectomy on 6-month mean leg pain improvement. Both treatment groups achieved similar rapid significant clinical improvements that persisted and overall, 71% undergoing intradiscal oxygen-ozone were able to avoid surgery.
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Affiliation(s)
- Alexis Kelekis
- University General Hospital Attikon, Athens, Haidari 12462, Greece
| | - Giuseppe Bonaldi
- Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Lombardia 24127, Italy
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland; Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern, Bern 3008, Switzerland
| | | | - Pietro Scarone
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano 6900, Switzerland; Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital of Bern, Bern 3008, Switzerland
| | - Claudio Bernucci
- Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Lombardia 24127, Italy
| | | | - Hadas Benhabib
- Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Kieran Murphy
- Toronto Western Hospital, University Health Network, Toronto, Canada.
| | - Josip Buric
- Casa di Cura San Camillo, Forte dei Marmi, Lucca 55042, Italy
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Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. Int J Surg 2022; 101:106616. [PMID: 35427798 DOI: 10.1016/j.ijsu.2022.106616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess the safety of minimally invasive surgery (MIS) for orthopedic spinal, upper limb and lower limb procedures, this systematic review of systematic reviews compared their complications with open procedures. MATERIALS AND METHODS A literature search was conducted electronically (PubMed, Cochrane library and Web of Science; May 8, 2021) without language restriction in the past five years. Reviews that consulted at least two databases, compared MIS with open orthopedic surgery, and reported the following: intraoperative, post-operative or total complications, function, ambulation, pain, hospital stay, reoperation rate and operation time were included. Article selection, quality assessment using AMSTAR-2, and data extraction were conducted in duplicate on predesigned forms. In each review, a subset analysis focusing on prospective cohort and randomized studies was additionally performed. PROSPERO CRD42020178171. RESULTS The search yielded 531 articles from which 76 reviews consisting of 1104 primary studies were included. All reviews were assessed as being low quality. Compared to open surgery, MIS had fewer total, postoperative and intraoperative complications in 2/10, 2/11 and 2/5 reviews of spinal procedures respectively, 1/3, 1/4 and 1/2 reviews of upper limb procedures respectively, and 4/6, 2/7 and 0/2 reviews of lower limb procedures respectively. CONCLUSIONS MIS had greater overall safety compared to open surgery in spinal procedures. In upper limb and lower limb procedures, MIS was not outright superior to open procedures in terms of safety hence a general preference of MIS is not justified on the premise of a better safety profile compared to open procedures.
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22
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Sigmundsson FG, Joelson A, Strömqvist F. Additional operations after surgery for lumbar disc prolapse : indications, type of surgery, and long-term follow-up of primary operations performed from 2007 to 2008. Bone Joint J 2022; 104-B:627-632. [PMID: 35491575 DOI: 10.1302/0301-620x.104b5.bjj-2021-1706.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. METHODS We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them. RESULTS In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision discectomy (43%; 385/906) and instrumented fusion (22%; 200/906). Degenerative spinal conditions other than disc prolapse became a more common reason for additional surgery with increasing length of follow-up. Most patients achieved the minimally important change (MIC) for the patient-reported outcomes after the index surgery. After the third additional spinal operation, only 20% (5/25) achieved the MIC in terms of leg pain, and 29% (7/24) in terms of the EuroQol five-dimension index questionnaire visual analogue scale. CONCLUSION More than one in five patients operated on for a lumbar disc prolapse underwent further surgery during the 13-year follow-up period. Recurrent disc prolapse was the most common reason for additional surgery, followed by spinal stenosis and segmental pain. This study shows that additional operations after primary disc surgery are needed more frequently than previously reported, and that the outcome profoundly deteriorates after the second additional operation. The findings from this study can be used in the shared decision-making process. Cite this article: Bone Joint J 2022;104-B(5):627-632.
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Affiliation(s)
- Freyr Gauti Sigmundsson
- Department of Orthopaedics, University Hospital of Örebro, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Joelson
- Department of Orthopaedics, University Hospital of Örebro, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fredrik Strömqvist
- Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
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23
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Lu H, Yao Y, Shi L. Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis. Indian J Orthop 2022; 56:983-995. [PMID: 35669028 PMCID: PMC9123128 DOI: 10.1007/s43465-022-00636-1] [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: 06/26/2021] [Accepted: 04/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation. METHODS Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods. RESULTS One RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, P < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, P = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, P = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, P = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, P = 0.861) between groups. CONCLUSIONS Endoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00636-1.
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Affiliation(s)
- Honghui Lu
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Haiyuncang, Dongcheng District, Beijing, 100700 China
| | - Yu Yao
- Department of Orthopaedics, Hospital of Chinese Armed Police Beijing Corps, Beijing, China
| | - Ligang Shi
- Department of Orthopaedics, Aerospace Center Hospital, Beijing, China
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Wang SF, Hung SF, Tsai TT, Li YD, Chiu PY, Hsieh MK, Kao FC. Better Functional Outcome and Pain Relief in the Far-Lateral-Outside-in Percutaneous Endoscopic Transforaminal Discectomy. J Pain Res 2022; 14:3927-3934. [PMID: 35002312 PMCID: PMC8722695 DOI: 10.2147/jpr.s342928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Even though percutaneous endoscopic transforaminal discectomy (PETD) has been widely used for the surgical treatment of lumbar herniated disc, there are only a few studies directly comparing the clinical outcomes between microdiscectomy (MD) and PETD. Therefore, further studies are needed in order to compare the clinical outcomes between PETD and MD on a single level more thoroughly. Methods We proposed a far-lateral-outside-in technique for PETD to get an entry point without complex planning and facet violation. From September 2017 to September 2019, a total of 155 patients (69 with PETD and 86 with MD) were enrolled for this retrospective study, with the inclusion criteria: single level between L2 and S1, clinical sciatica for at least 6 weeks, and failed attempts with non-surgical treatments. Patients were excluded due to cauda equina syndrome, progressive neurologic deficits, history of lumbar spinal surgery, endplate modic changes, severe disc degeneration and less than 24 months of follow-up. Results PETD showed significantly shorter surgery time and less intraoperative blood loss compared to MD. The difference between PETD and MD in VAS back pain (but not VAS leg pain) at follow-up time was significant. The ODI improvement in the follow-up time of 6 months between the 2 groups showed a significant difference (PETD: 31.23±6.59, MD: 39.85±7.81, p < 0.001). MD had a significantly higher chance of postoperative wound infection and poor healing, while PETD was more likely to have recurrence of the herniated disc. Conclusion MD has been the gold standard procedure for LDH. However, with the advanced endoscopic technology and surgical technique, PETD has emerged as an alternative method due to higher functional outcome and less wound problems.
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Affiliation(s)
- Sheng-Fen Wang
- Department of Anesthesiology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Feng Hung
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Kumar A, Copley P, Jamjoom A, Badran K, Barrett C. The morbidity of out-of-hours surgery for Cauda Equina Syndrome. Br J Neurosurg 2022:1-4. [PMID: 34974789 DOI: 10.1080/02688697.2021.2019193] [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: 08/23/2021] [Revised: 11/11/2021] [Accepted: 12/05/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND There is no literature specifically addressing the morbidity of out of hours surgery for Cauda Equina Syndrome (CES). Our paper rectifies this omission. This will assist the surgeon with real-time decision making with regards to timing of intervention in this rare but potentially disabling disease. METHODS A retrospective case series analysis. Individual cases were identified using local electronic theatre management systems in the four neurosurgical centres in Scotland in 2017. "Out of hours" surgery was defined as starting outside the times 0900-1700 Monday to Friday. RESULTS 86 patients underwent out of hours surgery for CES in Scotland in 2017. One patient sustained a nerve root injury without new deficit, giving an overall risk of 1.2%. Four patients had the intra-operative complication of CSF leak, giving an overall risk of 4.7%. Five patients underwent early revision surgery, equivalent to a re-operation risk of 5.8%. CONCLUSIONS The morbidity of out of hours surgery for CES is comparable to that of elective microdiscectomy. Operating out of hours for CES does not appear to have an increased risk of complications. Since increased surgical risk is not borne out by our study, this should not be used as a justification to delay operative treatment.
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Affiliation(s)
- Aditaya Kumar
- Department of Neurosurgery, The Institute of Neurological Sciences, Glasgow, UK
| | - Phil Copley
- Department of Neurosurgery, Western General Hospital, Edinburgh, UK
| | - Aimun Jamjoom
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Khaled Badran
- Department of Neurosurgery, Ninewells Hospital, Dundee, UK
| | - Christopher Barrett
- Department of Neurosurgery, The Institute of Neurological Sciences, Glasgow, UK
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Sun JM, Hsieh CT, Chen YH, Huang KC, Ko PC. Preliminary report on value of Wallis interspinous device for back pain following microdiscectomy: A prospective cohort study. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_98_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hamawandi SA, Sulaiman II, Abdulhameed AM. Effect of Duration of Symptoms on the Clinical and Functional Outcomes of Lumbar Microdiscectomy: A Randomized Controlled Trial. Orthop Surg 2021; 14:157-168. [PMID: 34866340 PMCID: PMC8755886 DOI: 10.1111/os.13114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/25/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives The objective is to determine whether the preoperative duration of symptoms can affect the clinical and functional outcomes after microdiscectomy. Method This study is a single blind randomized controlled trial with level 1 evidence. From 3 January 2016 to 15 February 2017, 122 adult patients with symptomatic lumbar disc herniation were divided randomly by computer system into three groups were treated by microdiscectomy at 6 weeks, 3 months and 6 months from onset of symptoms respectively. Ninety‐seven patients, age (19–47) years, 42 males and 55 females, were analyzed at the end of this study with 3 years of follow up. Primary outcome measures are Oswestry Disability Index (ODI), Roland‐Morris Questionnaire (RMQ) and Visual Analogue Scale (VAS) for back pain and leg pain. Secondary outcome measures are post‐operative complications, length of hospital stay and time of return to daily activities. Results There was significant difference in VAS for back pain among study groups (P = 0.002) at 2 weeks). There were significant differences in VAS for leg pain among study groups (P < 0.001) at 2 weeks and at 3 months (P = 0.003). There was significant difference in ODI among study groups at 2 weeks, 3, 6 months, 1, 2 and 3 years (P = 0.037 at 2 weeks and P < 0.001 at other periods of assessments) and we found that the mean of ODI in group 6 weeks was better than group 3 months and this was better than group 6 months in all periods of assessment. Group 6 weeks was better than group 3 months and this was better than group 6 months in postoperative improvements regarding RMQ with significant difference at 2 weeks postoperatively (P < 0.001) and at 3 months postoperatively (P < 0.001). Conclusion Duration of preoperative symptoms, in patients with lumbar disc herniation, can affect the clinical and functional outcomes after lumbar microdiscectomy as the shorter duration of symptoms resulted in better postoperative clinical and functional outcomes.
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Affiliation(s)
- Sherwan A Hamawandi
- Department of Orthopaedic Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Injam I Sulaiman
- Department of Neurosurgery, College of Medicine, Hawler Medical University, Erbil, Iraq
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28
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Sebben AL, Kulcheski ÁL, Graells XSI, Benato ML, Santoro PGD. Comparison of two endoscopic spine surgical techniques. Rev Assoc Med Bras (1992) 2021; 67:243-247. [PMID: 34406248 DOI: 10.1590/1806-9282.67.02.20200643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.
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Affiliation(s)
- André Luís Sebben
- Hospital de Clínicas da Universidade Federal do Paraná - Curitiba (PR), Brazil
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29
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Dou Y, Sun X, Ma X, Zhao X, Yang Q. Intervertebral Disk Degeneration: The Microenvironment and Tissue Engineering Strategies. Front Bioeng Biotechnol 2021; 9:592118. [PMID: 34354983 PMCID: PMC8329559 DOI: 10.3389/fbioe.2021.592118] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Intervertebral disk degeneration (IVDD) is a leading cause of disability. The degeneration is inevitable, and the mechanisms are complex. Current therapeutic strategies mainly focus on the relief of symptoms, not the intrinsic regeneration of the intervertebral disk (IVD). Tissue engineering is a promising strategy for IVDD due to its ability to restore a healthy microenvironment and promote IVD regeneration. This review briefly summarizes the IVD anatomy and composition and then sets out elements of the microenvironment and the interactions. We rationalized different scaffolds based on tissue engineering strategies used recently. To fulfill the complete restoration of a healthy IVD microenvironment, we propose that various tissue engineering strategies should be combined and customized to create personalized therapeutic strategies for each individual.
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Affiliation(s)
- Yiming Dou
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xun Sun
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xinlong Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
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30
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Prod'homme M, Grasset D, Lecocq M, Boscherini D. Intraoperative disc level marking with needle: a technical note and prospective study on 30 patients. JOURNAL OF SPINE SURGERY 2021; 7:190-196. [PMID: 34296031 DOI: 10.21037/jss-20-671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/18/2021] [Indexed: 11/06/2022]
Abstract
Background Wrong-level surgery is a rare but unresolved issue in spine surgery. Some proposed protocols with high success rates, but it remains a risk with potential complications for the patient. Surgical navigation offers more accurate surgery, without additional irradiation related to the imaging device, in order to optimize the surgical guidance. Methods We describe our institutional technique with a needle placed under fluoroscopy at 3 cm from the incision line at the disc level to be operated, in order to guide the surgical approach; and we report a prospective evaluation of all patients during a six-month period operated by microdiscectomy for symptomatic lumbar discus hernia, whose hernia level was landmarked with this technique. We collected demographic, clinical-such as visual analog scale (VAS) of pain and Oswestry disability index (ODI) scores-operative and irradiation data for effective dose calculation. Results Thirty patients were included in the study. No wrong-level procedure was performed. Mean time for landmarking was 2.22 [1-5] minutes. Average operative time was 54.5 [30-150] minutes. The effective dose related to the imaging device use was 0.032 (0.007-0.092) mSv. The effective dose was also correlated to body mass index and disc level (P=0.05). The operative duration, complication rate and postoperative VAS and ODI scores were similar to the current literature. Conclusions We advocate the use of percutaneous needle guidance, avoiding wrong-level microdiscectomy and helping the surgeon as a "navigation-like" device with minimal additional irradiation for the patient.
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Affiliation(s)
- Marc Prod'homme
- Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland
| | - Didier Grasset
- Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland
| | - Mélissa Lecocq
- Clinic La Source, Neuro Orthopedic Center, Lausanne, Switzerland
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Hua F, Xiong J, Zhang H, Xiang J, Huang S. Moxibustion therapy on lumbar disc herniation: An evidence-based clinical practice guideline. Medicine (Baltimore) 2021; 100:e24347. [PMID: 33655911 PMCID: PMC7939187 DOI: 10.1097/md.0000000000024347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH), as a disease with great disturbance to life and work, is known as the origin of the severe and disabling forms of nerve root pain. Recognized as an increasingly widely accepted treatment, the efficacy of moxibustion on LDH has been affirmed. However, clinical practice guidelines (CPG) for the treatment of LDH with moxibustion have not been developed. Therefore, we will carry out this work following the accepted methodological quality standards. METHODS The new CPG will be developed according to the Institute of Medicine (IOM), the Appraisal of Guidelines for Research & Evaluation II (AGREE II) and WHO guideline handbook. And then determine recommendations based on high-level evidence. We will set up a Guideline Working Group and define clinical issues according to the PICO principles (Population, Intervention, Comparison, Outcomes). After evidence syntheses and several rounds of Delphi process, we will reach the consensus. In making the guideline, Patient values or preferences, results of peer review, and interest statements are all within the bounds of what we must consider. RESULTS As the study is not yet complete, no results can be reported. CONCLUSION So far, we will develop the first CPG for moxibustion of LDH strictly based on systematic methodologies in China. This CPG will establish the standard of LDH in moxibustion therapy. REGISTRATION NUMBER IPGRP-2020CN034.
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Affiliation(s)
- Fanghui Hua
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Jun Xiong
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, P.R. China
| | - Haifeng Zhang
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, P.R. China
| | - Jie Xiang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Shouqiang Huang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
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32
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Chapman EK, Doctor T, Gal JS, Martini ML, Shuman WH, Neifert SN, Gilligan JT, Yuk FJ, Zimering JH, Schupper AJ, Caridi JM. Comparison of Surgical Outcomes of Microdiskectomy Procedures by Patient Admission Status. World Neurosurg 2021; 150:e38-e44. [PMID: 33610871 DOI: 10.1016/j.wneu.2021.02.039] [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: 12/02/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to compare the cost and in-hospital outcomes following lumbar microdiskectomy procedures by admission type. METHODS Patients undergoing lumbar microdiskectomy at a single institution from 2008 to 2016 following an elective admission (EL) were compared against those who were admitted from the emergency department (ED) or from elsewhere within or outside the hospital system (TR) for their perioperative outcomes and cost. Multivariable modeling controlled for age, sex, self-reported race, Elixhauser comorbidity score, payer type, number of segments, and procedure length. RESULTS Of the 1249 patients included in this study, 1116 (89.4%) were admitted electively while 123 (9.8%) were admitted from the ED and 10 (0.8%) were transferred from other hospitals. EL patients had significantly lower comorbidity burdens (P < 0.0001). Univariate and multivariable analyses revealed that transfer admission patients experienced significantly longer hospitalizations (ED: +1.7 days; P < 0.0001; TR: +5.3 days; P < 0.0001) and higher direct costs (ED: $1889; P < 0.0001; TR: $7001; P < 0.0001) compared with EL patients. Despite these risks, ED and TR patients only had increased odds of nonhome discharge compared with EL patients (ED: 3.4; P = 0.002; TR: 7.9; P = 0.02). CONCLUSIONS Patients admitted as transfers and from the ED had significantly increased hospitalization lengths of stay and direct costs compared with electively admitted patients.
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Affiliation(s)
- Emily K Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Tahera Doctor
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan S Gal
- Department of Anesthesia, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael L Martini
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sean N Neifert
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey T Gilligan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Frank J Yuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jeffrey H Zimering
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John M Caridi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Aydın AL, Sasani M, Sasani H, Üçer M, Hekimoğlu M, Öktenoğlu T, Özer AF. Comparison of Two Minimally Invasive Techniques with Endoscopy and Microscopy for Extraforaminal Disc Herniations. World Neurosurg 2020; 144:e612-e621. [DOI: 10.1016/j.wneu.2020.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
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Kang SH, Yang JS, Cho SS, Cho YJ, Jeon JP, Choi HJ. A Prospective Observational Study of Return to Work after Single Level Lumbar Discectomy. J Korean Neurosurg Soc 2020; 63:806-813. [PMID: 33181867 PMCID: PMC7671783 DOI: 10.3340/jkns.2020.0227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Lumbar disc herniation (LDH) is a common disease, and lumbar discectomy (LD) is a common neurosurgical procedure. However, there is little previous data on return to work (RTW) after LD. This study investigated the period until the RTW after LD prospectively. Clinically, the pain state at the time of RTW also checked. RTW failure rate 6 months after surgery also investigated. METHODS Patients with daily/regular jobs undergoing LD between September 2014 and December 2018 were enrolled. Pain was assessed by the Oswestri Disability Index (ODI) and the Numeric Rate Scale (NRS). Employment type was divided into self-employed, regular and contracted. Monthly telephone interviews were conducted to check RTW status and self-estimated work capability after surgery. RESULTS Sixty-seven patients enrolled in this study. Three patients failed to RTW, and three others resigned within 6 months after surgery. The preoperative NRS and ODI were 7.2±1.2 and 22.1±7.9, respectively. The average time to RTW was 5.1±6.0 weeks. At RTW, NRS was 1.5±1.8 and ODI was 6.3±3.9. Amongst patients that successfully returned to work were 16 self-employed workers, 42 regular employees, and three contracted workers. The time to RTW of self-employed, regular, and contracted workers were 5.9±8.8, 4.2±4.3 and 13.3±2.3 weeks, respectively (p=0.011). Thirty-six of the patients that returned to work self-reported a 22.8±15.6% reduction in work capability at 6 months. CONCLUSION RTW may vary depending on the employment status. In this study, we found that while employment type may affect the length to RTW, most patients were able to RTW and >40% of patients reported no loss of work capabilities 6 months postoperatively, hopefully alleviating some patient hesitation towards LD.
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Affiliation(s)
- Suk-Hyung Kang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seo Yang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | | | - Yong-Jun Cho
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon, Korea
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Chen CM, Sun LW, Tseng C, Chen YC, Wang GC. Surgical outcomes of full endoscopic spinal surgery for lumbar disc herniation over a 10-year period: A retrospective study. PLoS One 2020; 15:e0241494. [PMID: 33152001 PMCID: PMC7644033 DOI: 10.1371/journal.pone.0241494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Full endoscopic lumbar discectomy (FELD) for lumbar disc herniation (LDH) has become popular in recent years. Previous studies have proven the efficacy, but few have discussed the possible risk factors of poor outcome. In this study, we reviewed patients who underwent FELD at Changhua Christian Hospital in the past 10 years and sought to identify factors associated with poor surgical outcomes and re-operations. Methods We retrospectively reviewed records from mid-2009 to mid-2018. Patients had undergone FELD and follow-up for ≥1 year were included. Factors included in the outcome evaluations were age, sex, surgical time, body mass index, surgical methods, disc herniation type, extension of herniation, degree of canal compromised, disc degenerative grade, smoking and alcohol use, surgical lumbar level, symptom duration, Oswestry low back disability index, and visual analog scale score. We had evolved from inside-out methods to outside-in methods after 2016, thus, we included this factor in the analysis. The primary outcomes of interest were poor/fair MacNab score and re-operation. Results From mid-2009 to mid-2018, 521 patients met our criteria and were analyzed. The median follow-up was 1685 days (range, 523–3923 days). Thirty-one (6.0%) patients had poor surgical outcomes (fair/poor MacNab score) and 45 (8.6%) patients required re-operation. Prolapsed herniated disc (P < 0.001), higher disc degenerative grade (P = 0.047), higher lumbar level (P = 0.026), longer preoperative symptoms (P < 0.001), and surgery before 2017 (outside-in technique, P = 0.020) were significant factors associated with poor outcomes in univariate analyses. In multivariate analyses, prolapsed herniated disc (P < 0.001), higher disc degenerative grade (P = 0.030), and higher lumbar level (P = 0.046) were statistically significant. The most common adverse symptom was numbness. Factors possibly associated with higher re-operation rate were older age (P = 0.045), alcohol use (P = 0.073) and higher lumbar level (P = 0.069). Only alcohol use showed statistically significant re-operation rates in multivariate analyses (P = 0.035). Conclusions For treating LDH by FELD, we concluded that prolapsed disc, higher disc degenerative grade, higher lumbar level, and longer preoperative symptom duration were possibly associated with unsatisfactory surgical outcomes (poor/fair MacNab score). The outside-in technique might be superior to the inside-out technique. Older age and alcohol use might be associated with a higher re-operation rate.
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Affiliation(s)
- Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chun Tseng
- Department of Orthopaedic Surgery, China Medical University Beigang Hospital, Yunlin County, Taiwan
| | - Ying-Chieh Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Guan-Chyuan Wang
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- * E-mail:
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Li Ching Ng A, McRobb LS, White SJ, Cartmill JA, Cyna AM, Seex K. Consent for spine surgery: an observational study. ANZ J Surg 2020; 91:1220-1225. [PMID: 33021031 DOI: 10.1111/ans.16348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The tension between the ideal of informed consent and the reality of the process is under-investigated in spine surgery. Guidelines around consent imply a logical, plain-speaking process with a clear endpoint, agreement and signature yet surgeons' surveys and patient interviews suggest that surgeons' explanation is anecdotally variable and patient understanding remains poor. To obtain a more authentic reflection of practice, spine surgeons obtaining 'informed consent' for non-instrumented spine surgery were studied via video recording and risk/benefit discussions were analysed. METHODS A prospective observational study was conducted at a single neurosurgical institution. Twelve video recordings involving six surgeons obtaining an informed consent for non-instrumented spine surgery were transcribed verbatim and blindly analysed using descriptive quantification and linguistic ethnography. RESULTS Ten (83%) consultations discussed surgical benefit but less than half (41%) quantified the likelihood of benefit from surgery. The most discussed risks were nerve damage or paralysis (92%), bleeding (92%), infection (92%), cerebrospinal fluid leak (83%) and bowel and bladder dysfunction (75%). Surgeons commonly used a quantitative statement of risk (58%) but only half of the risks were explained in words patients were likely to understand. CONCLUSIONS This study highlights inconsistencies in the way spine surgeons explain risks and obtain informed consent for 'simple' spine procedures in a real-world setting. There are wide disparities in the provision of informed consent, which may be encountered in other surgical fields. Direct observation and qualitative analysis can provide insights into the limitations of current informed consent practice and help guide future practice.
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Affiliation(s)
- Angela Li Ching Ng
- Macquarie Neurosurgery, Macquarie University Clinic, Sydney, New South Wales, Australia
| | - Lucinda S McRobb
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah J White
- Department of Biomedical Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - John A Cartmill
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Allan M Cyna
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Kevin Seex
- Macquarie Neurosurgery, Macquarie University Clinic, Sydney, New South Wales, Australia
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Scipione R, Alfieri G, De Maio A, Panella E, Napoli S, Bianchi L, Pandaloro N, Bazzocchi A, Facchini G, Albisinni U, Spinnato P, Catalano C, Napoli A. STUDY PROTOCOL - pulsed radiofrequency in addition to transforaminal epidural steroid injection in patients with acute and subacute sciatica due to lumbosacral disc herniation: rationale and design of a phase III, multicenter, randomized, controlled trial. Expert Rev Med Devices 2020; 17:945-949. [PMID: 32880493 DOI: 10.1080/17434440.2020.1815529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lumbosacral disc herniation (LDH) represents the most common cause of sciatica. Currently, there is limited evidence about minimally invasive interventional therapies for the treatment of this condition. This paper presents the protocol for a multicenter, prospective, randomized, controlled, phase III trial evaluating if PRF in addition to TFESI leads to better outcomes in patients with sciatica due to LDH, compared to TFESI alone, during the first year after treatment (Pulsed Radiofrequency in Addition to TFESI for Sciatica [PRATS]). Eligible patients are between 18 and 75 years of age, suffer from sciatica of less than 12-week duration with pain intensity >4 on the Visual Analogue Scale (VAS) and have unilateral LDH compatible with symptoms at MRI. The Medical Ethics Committee of participating hospitals approved the study protocol. Patients will be randomized to receive either combined treatment (PRF and TFESI) or TFESI alone. The primary outcome will be the assessment of pain intensity with VAS at different timepoints from week-1 to 52 after treatment; secondary outcomes will include Roland Disability Questionnaire for sciatica and Oswestry Disability Index, evaluated at 4, 12 and 52 weeks. The follow-up will last 52 weeks for each patient. Statistical analysis will be performed on a per-protocol basis.
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Affiliation(s)
- Roberto Scipione
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome , Rome, Italy
| | - Giulia Alfieri
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome , Rome, Italy
| | - Alessandro De Maio
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome , Rome, Italy
| | | | - Simone Napoli
- Spine Unit, Centro SaNa Servizi Sanitari , Aprilia, Italy
| | - Luca Bianchi
- Spine Unit, Centro SaNa Servizi Sanitari , Aprilia, Italy
| | | | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli , Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli , Bologna, Italy
| | - Ugo Albisinni
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli , Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli , Bologna, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome , Rome, Italy
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I - Sapienza University of Rome , Rome, Italy.,Spine Unit, Centro SaNa Servizi Sanitari , Aprilia, Italy
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Fuquan J, Gang Z, Jianlin X, Yin R. Complete ureteral necrosis after injury sustained during lumbar disc surgery: A case report. Medicine (Baltimore) 2020; 99:e21727. [PMID: 32872054 PMCID: PMC7437836 DOI: 10.1097/md.0000000000021727] [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] [Received: 02/22/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection. PATIENT CONCERNS We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery. DIAGNOSIS The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods. INTERVENTION We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect. OUTCOMES Post-operative period was uneventful and the patient showed good recovery. CONCLUSION Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.
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Affiliation(s)
| | | | - Xiao Jianlin
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ruofeng Yin
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
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Wang Y, Dai G, Jiang L, Liao S. The incidence of regression after the non-surgical treatment of symptomatic lumbar disc herniation: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:530. [PMID: 32778091 PMCID: PMC7419225 DOI: 10.1186/s12891-020-03548-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although the regression of symptomatic lumbar disc herniation (SLDH) has been widely reported, little data exist regarding the generalized incidence of regression (IR). We aimed to review the varying IRs and to synthesize the pooled IR of non-surgically-treated SLDH. METHODS Four electronic databases were searched for relevant studies pertaining to the regression of SLDH after non-surgical treatment and for potential studies that may have reported morphological changes in lumbar disc herniation in the follow-up results of SLDH patients treated non-surgically. The main outcome was the regression of SLDH. A random effects model was used to determine the pooled IR of SLDH. RESULTS We identified 13,672 articles, 38 of which were eligible for analysis. Our analysis included 2219 non-surgically treated SLDH patients, 1425 of whom presented regression. The pooled IR was 63% (95% CI 0.49-0.77). In subgroup analyses, studies that quantitatively measured the regression of SLDH yielded statistically higher pooled IRs than those that used qualitative methods. The pooled IRs gradually increased in randomized controlled trials and prospective and retrospective studies. The pooled IR varied from 62 to 66% after the sequential omission of any single study. Meta-regression showed that study types, herniation levels and regression measurements caused heterogeneity. CONCLUSIONS We report an overall IR of 63% among non-surgically treated SLDH patients, thus providing clinical decision makers with quantitative evidence of IR. Based on our systematic review, we suggest a follow-up timeline with time points 4 and 10.5 months after onset when deciding whether to perform surgery for SLDH.
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Affiliation(s)
- Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedics Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan Province, China.
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedics Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan Province, China
| | - Ling Jiang
- College Hospital, Sichuan Agricultural University-Chengdu Campus, 211 Huimin Road, Wenjiang District, Cheng Du, Sichuan Province, China
| | - Shichuan Liao
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Provincial Orthopedics Hospital, 132 West First Section First Ring Road, Chengdu, 610041, Sichuan Province, China
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Choi G, Munoz-Suarez D. Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications. Neurospine 2020; 17:S58-S65. [PMID: 32746518 PMCID: PMC7410381 DOI: 10.14245/ns.2040250.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
For all the spine surgeons, thoracic disc herniations (TDHs) entrust a real challenge in terms of patient diagnosis, proper selection, surgical technique, and potential adverse events. TDHs are relatively uncommon compared to the lumbar and cervical levels. Literature reports a variable prevalence of TDHs around 6% to 40%, but less than 1% of all disk herniations are symptomatic TDHs, evidencing as a relatively unusual condition. Nowadays, transforaminal endoscopic thoracic discectomy (TETD) has been implemented as an alternative to classic open procedures with results that are as good as and, in some situations, better than those in traditional discectomy. However, the surgeon must be familiar with endoscopic lumbar spine surgery before opting to perform a TETD, considering that the learning curve is much harder. We describe all the steps and safety considerations during TETD based on the anatomic differences compared to lumbar endoscopic procedures. TETD is an effective and safe method that yields more benefits, provides a direct route to the lesion with less morbidity, and is performed in a minimally invasive way. Many severe complications related to the thoracic region could be avoided having the proper knowledge, adequate technique, and safety routes and considerations.
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Affiliation(s)
- Gun Choi
- Spine Surgery Department, Pohang Woori Spine Hospital, Pohang, Korea
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Clark DM, Fredericks DR, Wagner SC. A Case Report of Rapid Aseptic Intervertebral Disc Destruction After Lumbar Microdiscectomy: A Case Report. JBJS Case Connect 2020; 10:e1900566. [PMID: 32668140 DOI: 10.2106/jbjs.cc.19.00566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A previously healthy military recruit underwent routine microdiscectomy after lumbar disc herniation. After a period of improvement, he developed recurrent pain without repeat injury. Advanced imaging showing loss of marrow signal, and disc height was concerning for discitis. Inflammatory markers remained negative. Conservative treatment without antibiotics led to symptom resolution. CONCLUSION This case demonstrates an unusual complication after lumbar microdiscectomy in a healthy individual. The recurrent symptoms and imaging changes were likely secondary to aseptic discitis and rapid degeneration rather than infection. A stepwise approach is critical for determining the cause of pain exacerbation after spinal procedures.
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Affiliation(s)
- DesRaj M Clark
- 1Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
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Yin J, Jiang Y, Nong L. Transforaminal approach versus interlaminar approach: A meta-analysis of operative complication of percutaneous endoscopic lumbar discectomy. Medicine (Baltimore) 2020; 99:e20709. [PMID: 32569205 PMCID: PMC7310843 DOI: 10.1097/md.0000000000020709] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To systematically analyze the differences of complications between percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) in the treatment of lumbar disc herniation. METHODS We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analysis was performed using Review Manager Version 5.3. RESULTS A total of 15 articles with 1156 study subjects were included, with 550 patients in PTED group and 606 patients in PIED group. The results of the meta-analysis showed that postoperative dysesthesia (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.33-1.13), nerve root injury (OR = 1.22, 95% CI, 0.30-5.02), surgical site wound complications (OR = 1.26, 95% CI, 0.29-5.40), recurrence (OR = 1.09, 95% CI, 0.54-2.21), conversion to open surgery (OR = 1.26, 95% CI, 0.33-4.81), incomplete decompression (OR = 1.62, 95% CI, 0.43-6.09), and total complication (OR = 0.72, 95% CI, 0.49-1.06) showed no significant differences between the PTED group and the PIED group, while the PTED group had significantly better results in dural tear compared with the PIED group (OR = 0.31, 95% CI, 0.13-0.79). CONCLUSIONS Dural tear was significantly less occured in PTED compared with PIED. The postoperative dysesthesia, nerve root injury, surgical site wound complications, recurrence, conversion to open surgery, incomplete decompression, and total complication did not differ significantly between PTED and PIED in the treatment of lumbar disc herniation.
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Abstract
We report a case of a patient undergoing open microdiscectomy at L5-S1, wherein the distal tip of a pituitary rongeur became dislodged within the disc space. Complication management and avoidance of anterior advancement are paramount. A stepwise plan to retrieve the foreign body was entertained in a methodical fashion. Such device failure places the patient at greater risk of injury, extends operation time, and adds undue burden on the surgical team. This situation warrants discussing the complications from retained foreign bodies and measures taken for their removal.
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Zahrai A, Bhanot K, Mei XY, Crawford E, Tan Z, Yee A, Palda V. Surgeon clinical practice variation and patient preferences during the informed consent discussion: a mixed-methods analysis in lumbar spine surgery. Can J Surg 2020; 63:E284-E291. [PMID: 32437095 DOI: 10.1503/cjs.005619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Patients with lumbar disc herniation may greatly benefit from microdiscectomy. Although spine surgeons performing microdiscectomy routinely obtain informed consent, the potential adverse events they disclose often vary. Moreover, little is known about what disclosures are deemed most valuable by patients. The aim of this mixed-methods study was to determine practice variations among spine surgeons in regard to the disclosure of potential adverse events during informed consent discussions for lumbar microdiscectomy and to determine which topics patients perceived to be valuable in the consent discussion. Methods A survey evaluating the frequency with which spine surgeons disclose 15 potential adverse events related to lumbar microdiscectomy during informed consent discussions was distributed among Canadian Spine Society members. Additionally, semistructured interviews were conducted with preoperative patients, postoperative patients, attending spine surgeons, spine fellows and orthopedic residents. Interview transcripts were analyzed using thematic analysis with open coding. Results Fifty-one Canadian Spine Society members completed the survey. The number of potential adverse events not routinely discussed was greater among orthopedic surgeons than among neurosurgeons (relative risk 1.83; 95% confidence interval 1.22-2.73; p = 0.003). Three preoperative patients, 7 postoperative patients, 6 attending spine surgeons, 3 spine fellows and 5 orthopedic residents participated in the semistructured interviews. The interviews identified gaps in information provided to patients, particularly on topics relating to postoperative care such as expected recovery time, activity restrictions and need for a caregiver. Conclusion There is variation in the disclosure of potential adverse events during informed consent discussions for lumbar microdiscectomy among Canadian spine surgeons. Patients desire more information regarding their postoperative care. Further research should focus on developing guidelines to reduce practice variation and optimize the effectiveness of consent discussions.
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Affiliation(s)
- Ali Zahrai
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Kunal Bhanot
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Xin Y Mei
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Eric Crawford
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Zachary Tan
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Albert Yee
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
| | - Valerie Palda
- From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont
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La Torre D, Volpentesta G, Stroscio C, Bombardieri C, Chirchiglia D, Guzzi G, Pugliese D, De Bartolo E, Lavano A. Percutaneous intradiscal injection of radiopaque gelified ethanol: short- and long-term functional outcome and complication rate in a consecutive series of patients with lumbar disc herniation. Br J Pain 2020; 15:234-241. [PMID: 34055344 DOI: 10.1177/2049463720917182] [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] [Indexed: 12/12/2022] Open
Abstract
Lumbar disc herniation (LDH) is a common cause of low back pain (LBP) and/or radicular pain (RP). Over the years, different therapies have been proposed to treat symptomatic LDH, including different minimally invasive techniques and open surgical methods. Recently, percutaneous intradiscal injection of radiopaque gelified ethanol (RGE) DiscoGel® has emerged as an effective therapeutic option in patients with LDH. Nevertheless, only few studies addressed the reliability of this technique. The purpose of this study was to evaluate the efficacy and safety of this procedure. We analysed surgical and outcome data of patients with small or medium LDH treated by DiscoGel between 2012 to 2015. Outcome variables included pain relief, the limitation on physical activity and severity of depression status. Overall, complication rate was defined as the occurrence of any perioperative adverse events. A total of 94 consecutive patients were enrolled in the study. Pain relief was achieved in 90.6% and 88.8% of patients at 1- and 4-year follow-up, respectively. At the last follow-up, at least a satisfactory result was achieved in 92.5% of patients. Similar results were obtained in the limitation on physical activity. Depression status did not significantly change after treatment. There was no mortality, and no patients experienced permanent sequelae. In well-selected patients, DiscoGel has proved effective in maintaining excellent functional results in terms of pain relief and limitation on physical activity while minimizing the overall rate of complications related to these kinds of surgical procedures.
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Affiliation(s)
- Domenico La Torre
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Giorgio Volpentesta
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Carmelino Stroscio
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Caterina Bombardieri
- Neuroradiology Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Domenico Chirchiglia
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Giusy Guzzi
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Dorotea Pugliese
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Emilio De Bartolo
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
| | - Angelo Lavano
- Neurosurgery Department, AOU 'Mater Domini' - Università degli Studi 'Magna Greacia' di Catanzaro, Catanzaro, Italy
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Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: a systematic review and meta-analysis. 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 2020; 29:1752-1770. [DOI: 10.1007/s00586-020-06389-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/27/2020] [Accepted: 03/21/2020] [Indexed: 12/14/2022]
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Total Health Care Expenditure in Patients With a Herniated Lumbar Disk That Ultimately Require Surgery: A 3- and 6-month Cost Comparison of Maximum Nonoperative Treatment. Clin Spine Surg 2020; 33:E108-E115. [PMID: 31162185 DOI: 10.1097/bsd.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To compare the cost of maximum nonoperative therapy (MNT) in patients diagnosed with a herniated lumbar disk undergoing primary (1-3 mo) versus prolonged (4-6 mo) conservative management before microdiscectomy. SUMMARY OF BACKGROUND DATA Patients diagnosed with a herniated lumbar disk often attempt a 3-month trial of conservative management before microdiscectomy. A paucity of data exists characterizing the cost of a subsequent round of nonoperative therapies in patients who fail their initial trial, rather than undergo surgery. METHODS Clinical records from patients diagnosed with a herniated lumbar disk undergoing index microdiscectomy surgery from 2007 to 2017 were gathered from a large insurance database. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and generic drug codes. Two cohorts were established: patients undergoing primary (1-3 mo) versus prolonged (4-6 mo) courses of conservative management. Nonoperative therapy utilization was documented from initial herniation diagnosis to microdiscectomy surgery. "Utilization" encompassed cost billed to patients, prescriptions written, and quantity of units dispensed. RESULTS The 3-month MNT cohort included 4587 patients and the 6-month MNT cohort contained 1506 patients. A greater percentage of 6-month cohort patients utilized opioids (P=0.0052), muscle relaxants (P=0.0061), and lumbar steroid injections (P<0.0001). When considering the average amount spent on conservative management, 6-month patients ($1824/patient) spent 1.55 times more than 3-month patients ($1178/patient). The 6-month:3-month average spending ratio was <2.0 for all of the nonoperative therapies except nonsteroidal anti-inflammatory drugs (2.66) and epidural steroid injections (2.25). When normalized by the number of opioid users, the number of opioid medications dispensed was proportionally less in 3-month patients compared with 6-month patients, with a 6-month:3-month ratio of 1.52. CONCLUSIONS The costs associated with a subsequent course of nonoperative therapies for symptomatic lumbar disk herniation seem to be slightly less than that of the primary trial. Assuming a minimal clinical benefit after the initial trial of nonsurgical therapies, the incremental cost-effectiveness ratio of a subsequent trial versus surgery may be unfavorable. Future studies identifying patients likely to benefit from surgery earlier in the treatment course is required. LEVEL OF EVIDENCE Level III.
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Napoli A, Alfieri G, Scipione R, Andrani F, Leonardi A, Catalano C. Pulsed radiofrequency for low-back pain and sciatica. Expert Rev Med Devices 2020; 17:83-86. [PMID: 31973587 DOI: 10.1080/17434440.2020.1719828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alessandro Napoli
- Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy.,Spine Unit, Centro SANA Servizi Sanitari Privati Srl, Aprilia (LT), Italy
| | - Giulia Alfieri
- Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Roberto Scipione
- Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Fabrizio Andrani
- Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Andrea Leonardi
- Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Carlo Catalano
- Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
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