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Gornet MF, Eastlack RK, Peacock J, Schranck FW, Lotz JC. Magnetic resonance spectroscopy (MRS) identification of chemically painful lumbar discs leads to improved 6-, 12-, and 24-month outcomes for discogenic low back pain surgeries. Eur Spine J 2023:10.1007/s00586-023-07665-w. [PMID: 37014434 DOI: 10.1007/s00586-023-07665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE MRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We now report results based on more patients and longer follow-up. METHODS Disc MRS was performed in DLBP patients who subsequently received lumbar surgery. Custom post-processing (NOCISCAN-LS®; Aclarion Inc.) calculated disc-specific NOCISCORES® that reflect relative differences in degenerative pain biomarkers for diagnosing chemically painful discs. Outcomes in 78 patients were evaluated using Oswestry Disability Index (ODI) scores. Surgical success (≥ 15-point ODI improvement) was compared between surgeries that were "Concordant" (Group C) versus "Discordant" (Group D) with NOCISCORE-based diagnosis for painful discs. RESULTS Success rates were higher for Group C versus Group D: 6 months (88% vs. 62%; p = 0.01), 12 months (91% vs. 56%; p < 0.001), and 24 months (85% vs. 63%; p = 0.07). Success rates for Group C surgeries were also higher than Group D surgeries in a variety of sub-group comparisons. Group C had a greater reduction in ODI from pre-operative to follow-up than Group D [absolute change (% change), (p)]: 6 months: - 35 (- 61%) versus - 23 (- 39%), (p < 0.05); 12 months: - 39 (- 69%) versus - 22 (- 39%), (p < 0.01); and 24 months: - 38 (- 66%) versus - 26 (- 48%), (p < 0.05). CONCLUSION More successful, sustained outcomes were obtained when surgically treating chemically painful discs identified by NOCISCAN-LS post-processed disc MRS exams. Results suggest that NOCISCAN-LS provides a valuable new diagnostic tool to help clinicians better select treatment levels.
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Affiliation(s)
- Matthew F Gornet
- The Orthopedic Center of St. Louis, 14825 N. Outer Forty Road, Suite 200, St Louis, MO, 63017, USA.
| | - Robert K Eastlack
- Department of Orthopedic Surgery, Scripps Clinic, San Diego, CA, USA
| | | | | | - Jeffrey C Lotz
- University of California at San Francisco, San Francisco, CA, USA
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Asan Z. Early Postoperative Iatrogenic Neuropraxia After Lumbar Disc Herniation Surgery: Analysis of 87 Cases. World Neurosurg 2023; 170:e801-e805. [PMID: 36460197 DOI: 10.1016/j.wneu.2022.11.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Postoperative early neuropraxia after lumbar disc herniation surgery is common. The emergence of new paresthesia findings with increased sensory and motor deficits in the postoperative period suggests iatrogenic neuropraxia. This study aimed to discuss the causes and prognosis of iatrogenic neuropraxia detected in the early postoperative period in patients who have been operated on for lumbar disc herniation. METHODS Cases with postoperative iatrogenic neuropraxia were determined retrospectively. Deficits were evaluated at intervals of 0-2 hours, 2-12 hours, 12-24 hours, and 24-48 hours. The cases were evaluated in 2 groups as those who underwent aggressive discectomy and simple discectomy. In addition, the treatment results were compared between the 2 groups as the cases that were treated and not treated with methylprednisolone. RESULTS The iatrogenic neuropraxia rate was significantly higher in patients who underwent aggressive discectomy. Although it was observed that paresthesia findings improved more rapidly in cases treated with methylprednisolone, no difference was found between the 2 groups in terms of its effects on the motor deficit. CONCLUSIONS Iatrogenic neuropraxia is a finding whose cause cannot be determined by quantitative criteria. It is common in patients who underwent aggressive discectomy. Methylprednisolone treatment is effective in recovering the paresthesia finding faster and may show that the radicular injury is in the neuropraxia stage in the early period.
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Affiliation(s)
- Ziya Asan
- Department of Neurosurgery, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey.
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3
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Mehdorn AS, Mehdorn M, Mehdorn HM. Vascular Injury During Lumbar Disc Surgery: Case Report. Acta Neurochir Suppl 2023; 130:185-189. [PMID: 37548738 DOI: 10.1007/978-3-030-12887-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
A retroperitoneal organ injury-vascular injury or solid organ injury-that occurs during lumbar disc surgery needs to be dealt with adequately, because otherwise it could result in a poor (or, even, fatal) outcome of a "simple" procedure. Vascular injuries require special attention from the neurosurgical side (think of the possibility!) and cooperation between neurosurgeons and abdominal/vascular surgeons. In the presented case of a very obese female patient, a bite injury of the aorta during L3/4 disc surgery led to delayed intra-abdominal hemorrhage, which then required an emergency abdominal operation followed by major thromboembolic complication, and ultimately resulted in amputation of the patient's healthy leg. Pitfalls in intraoperative diagnosis and postoperative care are discussed, along with related medicolegal issues.
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Affiliation(s)
- Anne-Sophie Mehdorn
- Department of General, Abdominal, Thoracic, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Matthias Mehdorn
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - H Maximilian Mehdorn
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Agolia JP, Kasper EM. Wrong-Level Spine Surgery: Introduction of a Protocol for Avoidance of This Complication. Acta Neurochir Suppl 2023; 130:179-184. [PMID: 37548737 DOI: 10.1007/978-3-030-12887-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Wrong-level spine surgery, in which an operation is performed at a vertebral level different from the intended one, is a rare but serious complication with wide-ranging medical and legal effects. Although many protocols have been developed to prevent such a serious unfavorable event, the problem has not yet been eliminated. Research into the effectiveness of strategies to prevent wrong-level spine surgery is lacking. Herein, we describe a case of 44-year-old woman presented with neck pain and bilateral upper extremity weakness and numbness. Magnetic resonance imaging showed C5/6 and C6/7 disc herniations with spinal cord compression. The patient underwent anterior cervical discectomy and fusion; however, at the conclusion of the surgery, intraoperative radiographs showed that it was accomplished at C4/5 and C5/6-one level above the intended level. On the basis of this case and similar ones, a new protocol was developed that included implementation of a Spine Level Safety Checklist to document the reference point, the landmark, and the level of exposure that is marked on the intraoperative radiograph. Since implementation of this protocol, the incidence of wrong-level spine surgery at the senior author's institution has decreased from 4/7000 to 0/11,200. Adoption of this protocol by other centers is thus recommended to reduce the incidence of such complication.
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Affiliation(s)
| | - Ekkehard M Kasper
- DeGroote School of Medicine, McMaster University, Faculty of Health Sciences, Hamilton General Hospital, Hamilton, ON, Canada.
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Naouli H, Jiber H, Bouarhroum A. Iliac arteriovenous fistula following lumbar disc surgery. A case report. J Med Vasc 2022; 47:199-202. [PMID: 36344032 DOI: 10.1016/j.jdmv.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Iliac arteriovenous (AV) fistula after lumbar disc surgery are uncommon entities with limited reported cases. This report describes a 44-year-old man with history of L4-L5 spinal discectomy who complained of congestive heart failure symptoms four years later. Computed tomography angiography (CTA) revealed an AV fistula connecting the right common iliac artery and vein. AV closure with lateral suturing of common iliac artery and vein was performed through transperitoneal aorto-iliac approach. Postoperatively, the patient's symptoms of orthopnea resolved. Follow-up at six years was uneventful.
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Affiliation(s)
- H Naouli
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco.
| | - H Jiber
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco
| | - A Bouarhroum
- Faculty of medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University Boite Postale 1893 - KM 2.200, route Sidi Harazem Fès, 30070 Morocco; Vascular surgery department, UHC Hassan II Fez, Morocco
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Akyuz ME, Firidin MN. Bilateral ultrasound-guided erector spinae plane block for postoperative persistent low back pain in lumbar disc surgery. Eur Spine J 2022; 31:1873-1878. [PMID: 35420380 DOI: 10.1007/s00586-022-07212-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Persistent low back pain is an important disability after lumbar disc surgery. Erector spinae plane block (ESPB) is highly effective in providing post-surgical pain control, but its effectiveness in long-term persistent low back pain has not been investigated. The aim of this randomized controlled trial was to investigate the effect of ESPB on the reduction of persistent low back pain after surgery. METHODS 162 patients who were operated for lumbar disc herniation under spinal anaesthesia were divided into two groups according to the following criteria; ESPB block group (Group A); applied before surgery and 1 month after surgery and non-ESPB block group (Group B). The preoperative and postoperative 6th month Visual Analogue Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI) and Japan Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores of the patients were evaluated, and it was examined whether there was a difference. RESULTS In two groups with similar patient characteristics and no significant difference in preoperative pain scores, a significant improvement was observed in pain scores in Group A compared to Group B at the end of the 6th month. CONCLUSIONS ESPB, which has a low risk of complications and is simple to perform, has been found useful in the treatment of persistent low back pain after disc surgery.
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Affiliation(s)
- Mehmet Emin Akyuz
- Neurosurgery Department, Siirt Training and Research Hospital, Siirt, Turkey.
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Kim C, Hwang D, Yun WS. Endovascular Repair of an Ilio-Iliac Arteriovenous Fistula with Pseudoaneurysm after Lumbar Disc Surgery: A Case Report. Vasc Specialist Int 2021; 37:30. [PMID: 34580238 PMCID: PMC8479139 DOI: 10.5758/vsi.210043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Aortoiliac vascular injury during lumbar disc surgery is potentially life-threatening, but occasionally presents with delayed-onset symptoms. This is a case report of a fistulized pseudoaneurysm presenting with claudication. A 73-year-old female presented with swelling of the left leg and short-distance claudication. Two months prior, she had undergone discectomy for the management of right foot drop caused by an L4-L5 herniated lumbar disc. The left ankle-brachial index was 0.71. Computed tomography angiography revealed a 31 mm×20 mm pseudoaneurysm of the left common iliac artery fistulized to the left common iliac vein. The patient was successfully treated with stent graft placement.
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Affiliation(s)
- Choshin Kim
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Deokbi Hwang
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Woo-Sung Yun
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Hosseini S, Niakan A, Dehghankhalili M, Dehdab R, Shahjouei S, Rekabdar Y, Shaghaghian E, Shaghaghian A, Ghaffarpasand F. Effects of adhesion barrier gel on functional outcomes of patients with lumbar disc herniation surgery; A systematic review and meta-analysis of clinical trials. Heliyon 2021; 7:e07286. [PMID: 34189319 PMCID: PMC8220332 DOI: 10.1016/j.heliyon.2021.e07286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/21/2021] [Accepted: 06/07/2021] [Indexed: 11/09/2022] Open
Abstract
Failed Back Surgery Syndrome (FBSS) is persistent pain and disability following lumbar laminectomy which is associated with decreased quality of life and disability and has been reported in up to 40% of the patients undergoing lumbar laminectomy. Several approaches have been introduced to reduce the rate of the FBSS. Among these, applying anti-adhesive barrier gels have been studied with interest with controversial results. The aim of the current study was to determine the effects of anti-adhesive barrier gels on functional outcome and recurrence of patients undergoing lumbar disc surgery. We searched databases including EMBASE, PUBMED, Web of Science, Scopus, Cochrane Library, and scholar databases until November 2019. To assess the heterogeneity across included studies was used Cochran's Q and I-square (I2) statistics. Standardized mean difference (SMD) and 95% CI between were used to estimate pooled effect sizes. Out of 4507, 10 clinical trials found to be appropriate for current meta-analysis. The pooled results of included clinical trials indicated that adhesion barrier gel significantly decreased leg pain (LP) (SMD = −0.31; 95% CI, −0.60, −0.03; P = 0.032; I2: 59.2%) among patients with lumbar disc herniation surgery. Back pain (BP) (SMD = −0.03; 95% CI, −0.23, 0.16; P = 0.734; I2: 40.2%), and Oswestry disability index (ODI) (SMD = −0.11; 95% CI, −0.27, 0.05; P = 0.178; I2: 0.0%), were not significantly affected following adhesion barrier gel application. Application of adhesion barrier gel in single level lumbar disc surgery is associated with deceased leg pain. However, its application does not affect the low back pain, disability and gate. Further, larger randomized clinical trials are required.
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Affiliation(s)
- Seyedmorteza Hosseini
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Niakan
- Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Dehdab
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shima Shahjouei
- Neuroscience Institute, Geisinger Health System, Pennsylvania, USA
| | - Yasamin Rekabdar
- Young Researchers and Elite Club, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Elaheh Shaghaghian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
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Werner DAT, Grotle M, Småstuen MC, Gulati S, Nygaard ØP, Salvesen Ø, Ingebrigtsen T, Solberg TK. A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery. Acta Neurochir (Wien) 2021; 163:2567-80. [PMID: 34245366 DOI: 10.1007/s00701-021-04859-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/19/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. METHODS This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. RESULTS The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. CONCLUSION We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery.
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Burkhardt BW, Simgen A, Wagenpfeil G, Hendrix P, Reith W, Oertel JM. Adjacent segment disease following anterior cervical fusion and the presence of surgery for lumbar disc herniation and surgery at the musculoskeletal joints: are they related? Spine J 2020; 20:1925-33. [PMID: 32687981 DOI: 10.1016/j.spinee.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A potential correlation between surgery for symptomatic adjacent segment degeneration (sASD) and the development of degenerative disease of the lumbar spine or osteoarthritis of the musculoskeletal joints remains to be determined. PURPOSE To assess the rate of sASD following anterior cervical discectomy and fusion (ACDF), the rate of lumbar discectomy (LD), and rate of surgery performed for osteoarthritis at the joints of the musculoskeletal in a long term follow-up. STUDY DESIGN/SETTING Cohort study OUTCOME MEASURES: Repeat procedure for sASD, microsurgical LD (MSD), and/or the musculoskeletal joints (shoulder, knee, hip). PATIENT SAMPLE Retrospectively, a total of 833 consecutive patients who underwent ACDF for degenerative disorders ≥20 years ago were identified. Charts were reviewed for preoperative neurological status, smoking status, physical labor, and repeat procedures. Missing data lead to exclusion from follow-up assessment. METHODS At final follow-up the need for pain medication, Neck disability index (NDI), and Odoms criteria were evaluated. An MRI was performed to assess the grade of degeneration of the cervical spine via the segmental degeneration index (SDI). Patients without (group 1) and with (group 2) repeat procedure for sASD were compared. RESULTS Collectively, 313 patients met inclusion criteria and 136 patients were evaluated. The mean follow-up was 26 years. Clinical success rate according to Odoms was 85.3%, mean NDI was 14.4%, the rate of regular intake of pain medication was 14.7%, the rate of repeated procedure for sASD was 10.3%. MSD was performed in 23.5%, surgery for osteoarthritis of the shoulder, the hip, and the knee were performed in 11.8%, 6.9%, and 27.7%, respectively. The rate of MSD (p=.018) was significantly higher in group 2 compared to group 1. Gender, smoking status, surgery of the musculoskeletal joints, and the grade of degeneration of the cranial and caudal adjacent segments were similar between group 1 and group 2. CONCLUSION The overall clinical success following ACDF was 85.3%. The rate of repeat procedure for sASD was 10.3% within 26 years. Patients with sASD had a significantly higher rate of MSD and poorer clinical outcome compared to patients without sASD.
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Akhaddar A, Alaoui M, Turgut M, Hall W. Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review. Neurosurg Rev 2021; 44:821-42. [PMID: 32399729 DOI: 10.1007/s10143-020-01311-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/14/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4-L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4-L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients.
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Thaler M, Putzer D, Lindtner R, Krappinger D, Haid C, Obwegeser A, Lechner R. Brake reaction time before and after surgery for patients with sequestrectomy versus conventional microdiscectomy. J Clin Neurosci 2019; 72:214-218. [PMID: 31883813 DOI: 10.1016/j.jocn.2019.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy on breaking response time (BRT) for lumbar disc herniation (LDH). BRT is the key factor for return to drive recommendations after surgery. A prospective clinical study was conducted. Patients aged 25-65 years who underwent surgery for lumbar disc herniation and held a valid motorcar driving license were recruited in a single institution. The patients were assessed before surgery, immediately after the surgery and at the follow up examination 30 days post-surgery. BRT was measured using a driving simulator, a visual analogue scale (VAS) was used for pain assessment. BRT values were compared with BRT values of a healthy control group. In patients treated with microdiscectomy BRT reduced from 749 (±223) msec before surgery to 649 (±223) msec immediately after the surgery. In the sequestrectomy group BRT reduced from 852 (±561) msec before surgery to 693 (±173) msec immediately after the surgery. BRT at follow up was 610 (±145) msec for patients treated with microdiscectomy and 630 (±98) msec for patients operated with sequestrectomy. BRT for healthy controls was 487 (±116) msec. Pain improved significantly for both patient samples. Sequestrectomy and microdiscectomy were associated with similar effects on pain and BRT after surgery. There was no statistically significant difference between BRT of both patient samples at 30 days follow up examination. Both surgical techniques showed a positive effect on BRT. No statistically significant difference between sequestrectomy and microdiscectomy on BRT could be found.
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Affiliation(s)
- Martin Thaler
- Department of Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria.
| | - David Putzer
- Department of Orthopaedic Surgery, Experimental Orthopaedics, Medical University Innsbruck, Innsbruck, Austria
| | - Richard Lindtner
- Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Dietmar Krappinger
- Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Haid
- Department of Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria
| | | | - Ricarda Lechner
- Department of Orthopaedic Surgery, Medical University Innsbruck, Innsbruck, Austria
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Kayhan O, Akçıl EF, Dilmen ÖK, Tunalı Y. The Effects of Locally Administered Morphine Over the Dura on Postoperative Morphine Consumption and Pain After Lumbar Disc Surgery: A Prospective, Randomised, Double-Blind and Placebo-Controlled Study. Turk J Anaesthesiol Reanim 2019; 47:301-306. [PMID: 31380511 DOI: 10.5152/tjar.2019.77854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Effective pain management by avoiding side effects in the perioperative period is essential for patient outcome. Lumbar disc surgery is associated with moderate to severe postoperative pain, and opioids are widely used. The primary aim of the present study was to compare the effects of 1 mg and 2 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura on morphine consumption, and the secondary aims were to compare pain scores and opioid-related side effects during postoperative 24 h. Methods The study included 44 patients (American Society of Anesthesiologists I and II). After the discectomy procedure and before the closure, in Group A (n=15), 1 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura was used. In Group B (n=14), 2 mg morphine was used for the same technique, and in Group C (n=15) (control), normal saline was used. All patients used intravenous morphine patient-controlled analgesia pumps for 24 h following lumbar disc surgery. Morphine consumption, pain scores and opioid-related side effects were recorded at 10 min, 1, 2, 6, 12 and 24 h postoperatively. Results Morphine consumption, pain scores and opioid-related side effects were similar among the groups. Conclusion Morphine-impregnated absorbable cellulose haemostat material placement over the dura after single level lumbar discectomy did not reduce postoperative morphine consumption, pain scores and incidence of opioid-related side effects.
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Affiliation(s)
- Oğuzhan Kayhan
- Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Eren Fatma Akçıl
- Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Özlem Korkmaz Dilmen
- Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Yusuf Tunalı
- Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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Vasigh A, Najafi F, Jaafarpour M, Khajavikhan J, Khani A. The Effect of Sevoflurane Plus Propofol on Pain and Complications after Laminectomy: A Randomized Double Blind Clinical Trial. J Clin Diagn Res 2017; 11:UC05-UC08. [PMID: 28571236 DOI: 10.7860/jcdr/2017/23565.9643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pain is one of the most important reasons for the patients concern after surgery. The perfect sedative should have properties like rapid onset, least pain and adverse effects. AIM To assess the effect of sevoflurane plus propofol on postoperative pain, haemodynamic stability and complication after lumbar disc surgery. MATERIALS AND METHODS This was a randomized double- blind clinical trial. A total of 75 patients scheduled for elective lumbar disc surgery with simple random sampling design received sevoflurane (n=25, induced with Thiopentone and maintained with sevoflurane), propofol (n=25, induced and maintained with propofol) and sevoflurane plus propofol (n=25, induced with propofol and maintained with sevoflurane). Visual Analog Scale (VAS) was used to determine the intensity of postoperative pain. Complications after surgery and haemodynamic changes during surgery were recorded. RESULTS The mean pain intensity and morphine consumption in the sevoflurane plus propofol group was lower compared to the propofol and sevoflurane groups at different intervals (p<0.001). The prevalence of shivering, nausea and vomiting in the sevoflurane plus propofol group was 24%, 28%, 28% respectively vs sevoflurane group 32%, 60%, 48% respectively and propofol group 32%, 16%, 12% respectively with p-value > 0.05, <0.001, <0.05 respectively. The mean blood pressure and heart rate were significantly lower in the sevoflurane plus propofol group compared to the propofol and sevoflurane groups (p<0.001). CONCLUSION According to the effect on pain and complications after lumbar disc surgery sevoflurane plus propofol can be regarded as safe and alternative drug in general anaesthesia for these patients.
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Affiliation(s)
- Aminolah Vasigh
- Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science, Ilam, Iran
| | - Fatemeh Najafi
- MSc of Nursing, Department of Nursing and Midwifery Faculty, Ilam University of Medical Science, Ilam, Iran
| | - Molouk Jaafarpour
- MSc of Midwifery, Department of Nursing and Midwifery Faculty, Ilam University of Medical Science, Ilam, Iran
| | - Javaher Khajavikhan
- Anaesthesiologist, Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science, Ilam, Iran
| | - Ali Khani
- MSc of Nursing, Department of Nursing and Midwifery Faculty, Ilam University of Medical Science, Ilam, Iran
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Pichelmann MA, Atkinson JLD, Fode-Thomas NC, Yaszemski MJ. Total lumbar facetectomy without fusion: short and long term follow-up in a single surgeon series. Br J Neurosurg 2017; 31:531-537. [PMID: 28436275 DOI: 10.1080/02688697.2017.1319905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Total lumbar facetectomy may be advantageous for exposure or to completely free a constricted nerve root. OBJECTIVE We retrospectively reviewed a single surgeon series without fusion for short and long term outcomes regarding radicular pain relief, subsequent relevant surgeries, and any identifiable instability. METHODS All operations in which a single, total lumbar facetectomy was performed were reviewed. A total of 222 patients were identified with a minimal follow-up of 3 months; 187 (84.2%) were available for long term follow-up ≥1 year by continued accessible health care records, correspondence, or mailed questionnaire. RESULTS Short term success (3-month follow-up) for radicular pain relief in 222 patients found the following results: 176 patients (79.3%) had no pain or minimal pain, and 16 patients (7.2%) were improved, and thus resulting in 192 (86.5%) with no pain, or improved radicular pain. 30 patients (13.5%) were postoperative failures at 3 months. Long term follow-up ≥1 year was available for 187 patients (84.2%); (range 1-17 years; mean 7 years); found the following results: 23/30 (76.6%) short term surgical failures remained failures in long term follow-up with (7 patients) or without (16 patients) further surgery of any kind; 13/16 improved patients at long term follow-up remained improved (6), were pain free (6), or worse (1); 19/151 no or minimal pain patients at long term follow-up recurred or worsened by 1 year or longer, 12/19 pursued a second surgery with (9) or without (4) fusion and many improved. A total of 13 patients had a subsequent fusion operation (6.95%). DISCUSSION Most patients do well in the short term for radicular pain relief. Most patients continue to do well in long term follow-up. Surgically induced clinical instability is uncommon in this highly selected series.
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Affiliation(s)
- Mark A Pichelmann
- a Department of Neurosurgery , Mayo Clinic , Jacksonville , FL , USA
| | | | | | - Michael J Yaszemski
- c Department of Orthopedic Spine Surgery , Mayo Clinic , Rochester , MN , USA
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16
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Kim BJ, Ahn J, Cho H, Kim D, Kim T, Yoon B. Early individualised manipulative rehabilitation following lumbar open laser microdiscectomy improves early post-operative functional disability: A randomized, controlled pilot study. J Back Musculoskelet Rehabil 2016; 29:23-9. [PMID: 25792303 DOI: 10.3233/bmr-150591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbar open laser microdiscectomy has been shown to be an effective intervention and safe approach for lumbar disc prolapse. However early post-operative physical disability affecting daily activities have been sporadically reported. OBJECTIVE To evaluate the feasibility of using early individualised manipulative rehabilitation to improve early post-operative functional disability following lumbar discectomy. METHODS Randomised controlled pilot trial. Setting at a major metropolitan spine surgery hospital. Twenty-one patients aged 25-69 years who underwent lumbar microdiscectomy were randomised to either the manipulative rehabilitation treatment group or the active control group. Rehabilitation was initiated 2-3 weeks after surgery, twice a week for 4 weeks. Each session was for 30 minutes. Primary outcomes were the Roland-Morris disability questionnaire and the visual analogue pain scale. Outcome measures were assessed at baseline and post-intervention. RESULTS Early post-operative physical disability was improved with a 55% reduction by early individualised manipulative rehabilitation, compared to that of control care with a 5% increase. Early post-operative residual leg pain decreased with rehabilitation (55%) and control care (9%). CONCLUSION This pilot study supports the feasibility of a future definitive randomised control trial and indicates this type of rehabilitation may be an important option for post-operative management after spinal surgery.
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Affiliation(s)
- Byungho J Kim
- Department of Health Science, Graduate School of Korea University, Seoul, Korea
| | - Junghoon Ahn
- Department of Health Science, Graduate School of Korea University, Seoul, Korea.,Department of Spinal Surgery, Seoul Chuck Hospital, Seoul, Korea
| | - Heecheol Cho
- Department of Spinal Surgery, Seoul Chuck Hospital, Seoul, Korea
| | - Dongyun Kim
- Department of Spinal Surgery, Seoul Chuck Hospital, Seoul, Korea
| | - Taeyeong Kim
- Department of Health Science, Graduate School of Korea University, Seoul, Korea
| | - Bumchul Yoon
- Department of Health Science, Graduate School of Korea University, Seoul, Korea.,Department of Physical Therapy, Korea University, Seoul, Korea
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17
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Pieber K, Salomon N, Inschlag S, Amtmann G, Resch KL, Ebenbichler G. Predictors of an unfavorable outcome 1.5 and 12 years after a first, uncomplicated lumbar disc surgery. Eur Spine J 2016; 25:3520-3527. [PMID: 27421281 DOI: 10.1007/s00586-016-4700-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/20/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify predictors of both intermediate and long-term unfavorable outcomes after first time, uncomplicated lumbar disc surgery. METHODS Patients (n = 120) who had undergone lumbar disc surgery were followed up 1.5 and 12 years thereafter. Baseline assessments were carried out 5-8 days after surgery. Clinical outcome was assessed in both follow-ups using the Low Back Pain Rating Scale. Statistical analysis included binary logistic and linear regression. RESULTS Unfavorable outcomes were found in 50.5 % (1.5 years) and 52.6 % (12 years) of patients available for follow-up examination. Low pre-operative physical activity and severe pain in the first week after surgery were predictive of an unfavorable post-operative outcome at both follow-ups. CONCLUSIONS Identified predictors suggest that particular emphasis should put on comprehensive post-operative care at large and encouragement to adapt a physically active lifestyle in particular in rehabilitation concepts after first time uncomplicated lumbar disc surgery.
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Affiliation(s)
- Karin Pieber
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Nora Salomon
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Silke Inschlag
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gabriele Amtmann
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Gerold Ebenbichler
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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18
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Ben Jemaa H, Maalej A, Lazzez K, Jemal H, Karray S, Ben Mahfoudh K. [Endovascular repair of iliocaval arteriovenous fistula complicating lumbar disc surgery]. ACTA ACUST UNITED AC 2016; 41:205-9. [PMID: 26920402 DOI: 10.1016/j.jmv.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/19/2015] [Indexed: 11/16/2022]
Abstract
Vascular complications of lumbar disc surgery are rare. Few cases have been reported. Arteriovenous fistulas are the most common. They are due to anatomical relationships between the last lumbar vertebrae, the corresponding discs, and the iliac vessels; degenerative lesions of the intervertebral discs facilitate instrumental vessel perforation, and operative difficulty. Computed tomography is particularly accurate for making the diagnosis. Treatment strategies consist in surgery or endovascular management. Percutaneous endovascular treatment using a stent-graft is a reasonable option for treating arteriovenous fistula. We describe the case of a 50-year-old patient who developed an iliocaval arteriovenous fistula following lumbar disc hernia surgery. The lesion was excluded by a stent-graft. The postoperative period was uneventful.
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Affiliation(s)
- H Ben Jemaa
- Service de chirurgie cardio-vasculaire et thoracique, CHU Habib Bourguiba, avenue Majida Boulila, 3027 Sfax, Tunisie
| | - A Maalej
- Service d'imagerie médicale, CHU Habib Bourguiba, avenue Majida Boulila, 3027 Sfax, Tunisie.
| | - K Lazzez
- Service d'imagerie médicale, CHU Habib Bourguiba, avenue Majida Boulila, 3027 Sfax, Tunisie
| | - H Jemal
- Service de chirurgie cardio-vasculaire et thoracique, CHU Habib Bourguiba, avenue Majida Boulila, 3027 Sfax, Tunisie
| | - S Karray
- Service de chirurgie cardio-vasculaire et thoracique, CHU Habib Bourguiba, avenue Majida Boulila, 3027 Sfax, Tunisie
| | - K Ben Mahfoudh
- Service d'imagerie médicale, CHU Habib Bourguiba, avenue Majida Boulila, 3027 Sfax, Tunisie
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Järvimäki V, Kautiainen H, Haanpää M, Alahuhta S, Vakkala M. Obesity has an impact on outcome in lumbar disc surgery. Scand J Pain 2016; 10:85-89. [PMID: 28361778 DOI: 10.1016/j.sjpain.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the effect of obesity on outcome in lumbar discectomy. METHODS A cross-sectional postal survey; a self-made questionnaire, Beck depression inventory IA (BDI IA) and the Oswestry low back disability questionnaire (ODI) were sent to the patients, who had undergone lumbar disc surgery in the Oulu University Hospital between June 2005 and May 2008. Patients were divided into three groups according to BMI: normal, pre-obese and obese. The ODI was also examined in the framework of the international classification of functioning, disability and health (ICF) to investigate its ability to describe various dimensions of functioning (body structure and functions, activities and participation). RESULTS The postal survey was sent to 642 patients, of whom 355 (55%) replied. Males dominated in the pre-obese (66%) and obese (62%) groups (p=0.01). Normal-weighted and pre-obese patients had lower BDI scores compared to obese patients (mean BDI: 8.0, 7.6, 11.2, respectively, p=0.035). Total ODI score was highest in the obese group compared to normal-weighted or pre-obese (20.3, 18.6, 26.4, respectively, p=0.011). When ODI was linked to the ICF there were significant differences in all activity domains (mobility, self-care and interpersonal interactions and relationships) and the mobility component of the participation domain between the weight groups. CONCLUSIONS AND IMPLICATIONS Obesity has an impact on outcome in lumbar discectomy. Obese patients had higher scores in BDI and ODI indicating mild mood disturbances and moderate functional disability. According to ICF, functional disability of obese patients was observed to some extent in all activity domains. Obese patients will be more frequently present for disc surgery and increased morbidity risk must be recognized. We need a strategy to rehabilitate and activate obese patients pre- and postoperatively.
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Affiliation(s)
- Voitto Järvimäki
- Department of Anaesthesiology, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Hannu Kautiainen
- Department of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Maija Haanpää
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Mutual Insurance Company Etera, Helsinki, Finland
| | - Seppo Alahuhta
- Department of Anaesthesiology, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Merja Vakkala
- Department of Anaesthesiology, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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20
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Thaler M, Lechner R, Foedinger B, Haid C, Kavakebi P, Galiano K, Obwegeser A. Driving reaction time before and after surgery for disc herniation in patients with preoperative paresis. Spine J 2015; 15:918-22. [PMID: 23993038 DOI: 10.1016/j.spinee.2013.06.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 03/28/2013] [Accepted: 06/15/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of many types of surgeries on driving reaction time (DRT) has been reported. Although lumbar disc herniation is one of the most common spinal diseases, the effect on DRT has not been investigated. PURPOSE To assess the effect of left- and right-sided pareses caused by lumbar disc herniation on DRT before and after surgery. STUDY DESIGN Controlled prospective clinical trial. PATIENT SAMPLE Patients undergoing disc surgery. OUTCOME MEASURES Impact of paresis caused by lumbar disc herniation and disc surgery on DRT. METHODS Forty-two consecutive patients (mean age, 50.3 years) were tested for DRT 1 day before surgery, postoperatively before hospital discharge, and 5 weeks after surgery. Visual analogue scale (VAS) for back and leg pain as well as pain medication and patients' driving frequency were recorded. RESULTS Significant improvement of DRT after surgery was seen in patients with left- and right-sided pareses (p<.005). For the right-sided paresis group, the preoperative DRT was 761 ms (median, interquartile range [IQR]: 490), 711 ms (median, IQR: 210) immediately postoperatively, and 645 ms (median, IQR: 150) at follow-up (FU). For the left-sided paresis group, DRT was 651 ms (median, IQR: 270) preoperatively, 592 ms (median, IQR: 260) postoperatively, and 569 ms (median, IQR: 140) at FU. Significant differences between right- and left-sided pareses were identified preoperatively and at FU testing (p<.005). No correlation was found between VAS for leg or back pain and DRT. Historical control subjects had a DRT of 487 (median, IQR: 116), which differed significantly at all three test times (p<.001). CONCLUSIONS A significant reduction in DRT in patients with right- and left-sided pareses was found after surgery, indicating a positive effect of surgery. The improvement in DRT seen immediately postoperatively and the lack of a generally accepted threshold for DRT would suggest that for both patient samples, it is safe to continue driving after hospital discharge. However, patients should be informed accordingly.
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Affiliation(s)
- Martin Thaler
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | - Ricarda Lechner
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Foedinger
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christian Haid
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Pujan Kavakebi
- Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Klaus Galiano
- Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Alois Obwegeser
- Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Kizilay Z, Yilmaz A, Ismailoglu O. Symptomatic Pneumocephalus after Lumbar Disc Surgery: a Case Report. Open Access Maced J Med Sci 2015; 3:143-5. [PMID: 27275212 PMCID: PMC4877774 DOI: 10.3889/oamjms.2015.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 11/05/2022] Open
Abstract
Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.
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Affiliation(s)
- Zahir Kizilay
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ali Yilmaz
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ozgur Ismailoglu
- Süleyman Demirel University, Neurosurgery, 32260 Isparta, Turkey
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Park HK, Choe WJ, Koh YC, Park SW. Endovascular management of great vessel injury following lumbar microdiscectomy. Korean J Spine 2014; 10:264-7. [PMID: 24891863 PMCID: PMC4040641 DOI: 10.14245/kjs.2013.10.4.264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/25/2013] [Accepted: 11/28/2013] [Indexed: 11/19/2022]
Abstract
Great vessel injury is a rare but well-known complication of lumbar disc surgery, which may result in acute or fatal outcomes of delayed diagnosis. Thus, early detection and proper management is vital. The authors report a case of retroperitoneal hemorrhage with arteriovenous fistula and pseudoaneurysm after lumbar microdiscectomy. The patient was successfully managed by endovascular intervention using a stent graft. Endovascular repair is a minimally invasive and efficient treatment modality with considerably low morbidity and mortality.
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Affiliation(s)
- Hee-Kwon Park
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Woo Jin Choe
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Young-Cho Koh
- Department of Neurosurgery, Konkuk University College of Medicine, Seoul, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University College of Medicine, Seoul, Korea
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23
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Jin SC, Park SW, Cho DS. Management of Proximal Iliac Artery Injury during Lumbar Discectomy with Stent Graft. J Korean Neurosurg Soc 2012; 51:227-9. [PMID: 22737304 PMCID: PMC3377881 DOI: 10.3340/jkns.2012.51.4.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 05/31/2011] [Accepted: 04/17/2012] [Indexed: 11/30/2022] Open
Abstract
Iatrogenic vascular injuries during lumbar disc surgery may occur rarely but they are serious complications, which can be fatal without appropriate management. Prompt diagnosis and management of these complications are imperative to prevent a desperate outcome. A 72-year-old female with proximal left common iliac artery iatrogenic injury during lumbar discectomy was successfully treated by percutaneous deployment of a stent graft in an emergency setting. Postprocedural angiogram demonstrated complete exclusion of the iliac artery laceration. The patient became hemodynamically stable. Two weeks later she complained of vascular claudication. Follow-up angiography revealed decreased arterial flow in the opposite common iliac artery. An additional kissing stent was inserted into the right common iliac artery and the symptoms of vascular claudication disappeared. Endovascular stenting offers a safe and effective method for the treatment of an iatrogenic arterial laceration, particularly in a critical condition. But, the contralateral iliac arterial flow should be kept intact in case of proximal iliac artery injury. Otherwise, additional treatments may be needed.
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Affiliation(s)
- Sung Cheol Jin
- Department of Neurosurgery, College of Medicine, Inje University, Busan, Korea
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Abstract
Vascular complications during posterior lumbar disc surgery are rare and its presentation with varicose veins is even rarer. A 23 year-old male patient presented with large varicose veins in right lower limb. He underwent a posterior lumbar spine discectomy surgery. He noticed mild swelling of the distal third right lower limb 3 months after index surgery and reported 6 months later when he developed varicose veins. Duplex Doppler confirmed varicose veins of the long saphenous vein and its tributaries with a patent deep venous system. A digital subtraction angiogram demonstrated a large right common iliac artery (CIA) false aneurysm with an arteriovenous fistula between right common iliac vessels. He had a right CIA covered stent insertion with good results. Varicose veins were later managed with sapheno-femoral junction ligation and a below knee long saphenous vein stripping. At six month follow-up the lower limb swelling had completely recovered and duplex ultrasound did not show any recurrence of varicose veins.
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Affiliation(s)
- Thanyani V Mulaudzi
- Medi-Clinic Unit of Peripheral Vascular Disease, Department of General Surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa,Address for correspondence: Dr. TV Mulaudzi, Department of General Surgery, Vascular Surgery Unit, University of Pretoria, PO Box 667, Pretoria, South Africa. E-mail:
| | - Mbokeleng H Sikhosana
- Medi-Clinic Unit of Peripheral Vascular Disease, Department of General Surgery, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
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Nam TK, Park SW, Shim HJ, Hwang SN. Endovascular treatment for common iliac artery injury complicating lumbar disc surgery : limited usefulness of temporary balloon occlusion. J Korean Neurosurg Soc 2009; 46:261-4. [PMID: 19844629 DOI: 10.3340/jkns.2009.46.3.261] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/11/2009] [Accepted: 08/17/2009] [Indexed: 11/27/2022] Open
Abstract
Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.
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Affiliation(s)
- Taek-Kyun Nam
- Department of Neurosurgery, Chung-Ang University Yongsan Hospital, Seoul, Korea
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