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How to perform revision lumbar decompression at the index level through a minimally invasive (MIS) approach
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Aaron Hillis, Christoph Wipplinger, Sertac Kirnaz, Franziska A. Schmidt, Roger Härtl
An appropriate patient selection for minimally invasive (MIS) revision surgery is critical to achieving good clinical outcomes. The indications for revision surgery are related, but not limited to, residual or recurrent radicular symptoms (Table 24.1). A thorough physical examination is mandatory and plays an important role in assessing symptoms caused by recurrent disc herniation or lumbar stenosis symptoms. A detailed history is also crucial to properly evaluate whether a patient's neurological symptoms are persistent, recurrent, or new after primary spinal surgery, which may guide the surgeon's decision-making process. A pain-free period of at least several months after discectomy, severely reduced walking capacity, radicular pain distribution consistent with previously operated disc level, radiating leg pain, and positive straight leg raising-test of more than 30 degrees increases the likelihood for true symptomatic ipsilateral recurrent disc herniation. If the primary surgery was not performed on the contralateral side of the disc, the clinical symptoms of the contralateral radiation leg pain often resemble symptomatic first-time disc herniation.
Lumbar Disc Herniation: A Controlled, Prospective Study with 10 Years of Observation
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
A lumbar disc herniation resulting in sciatica is a common cause of discomfort and disability in patients. The natural history of lumbar disc prolapse is typically resolution over time,1 but there remains debate over the short- and long-term outcomes of surgical treatment. In 2005, Atlas et al.2 published the long-term results of a prospective cohort series of 400 patients comparing surgical and nonsurgical management of sciatica secondary to lumbar disc herniation. At 10-year follow-up, 69% of patients who underwent discectomy and 61% of patients initially treated nonsurgically (p = 0.2) exhibited improvement in their symptoms. There was no difference in work and disability status between the two groups. Nevertheless, there was a statistically higher proportion of surgical patients who reported more complete relief of pain as well as greater satisfaction with their treatment.
Intervertebral Disc Degeneration in Clinics
Published in Raquel M. Gonçalves, Mário Adolfo Barbosa, Gene and Cell Delivery for Intervertebral Disc Degeneration, 2018
Pedro Santos Silva, Paulo Pereira, Rui Vaz
Lumbar discectomy is the standard surgical treatment for disc herniation. There is general agreement to indicate surgery in patients with good correlation between clinical picture and imaging studies, with progressive neurologic deficits or selected patients with persistent sciatica. There is still some controversy about the effectiveness of surgery in relation to conservative management. Studies that compared the two forms of treatment concluded that early surgery can offer a better short-term relief of sciatica (6–12 weeks) and there were no significant differences between surgery and conservative care at 1 and 2 years, but the evidence for this is of very low quality (Jacobs et al. 2011). The fast recovery and return to work can make the option for surgery cost-effective compared to prolonged conservative care (van den Hout et al. 2008). On the other hand, aggressive discectomy can exacerbate the degeneration process (Fakouri, Shetty, and White 2015), leading to more disability and increased healthcare costs in the long-term.
The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial
Published in Neurological Research, 2023
Alireza Abdi, Seyed Reza Bagheri, Zahra Shekarbeigi, Soheila Usefvand, Ehsan Alimohammadi
The literature review showed that both exercises have some positive effects on outcomes of patients with low back pain [12,18,19]. While the impact of these two groups of home-based cost-beneficial exercises on the clinical outcomes of patients with lumbar disk herniation has been demonstrated, there is not a comprehensive study comparing two protocols on a wide range of outcomes. Even though some studies showed improvements in pain and muscle strength of patients after discectomy following early and aggressive exercises [15,20], there is a lack of studies upon comparing the effects of these two protocols on patients’ outcome after surgery. Therefore, this study was designed to evaluate the effects of early postoperative flexion-based and extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery and to investigate if one therapy is superior to another or no intervention.
Outcome and negative events in thoracic disc herniation surgery: a Danish registry study
Published in British Journal of Neurosurgery, 2021
Thea Overgaard Wichmann, Mindaugas Bazys, Gudrun Gudmundsdottir, Jakob Gram Carlsen, Peter Duel, Kestutis Valancius, Niels Katballe, Mikkel Mylius Rasmussen
In this retrospective study of 71 patients undergoing thoracic discectomy, the probability of clinical improvement regardless surgical approach was good. No statistically significant difference was observed between the two approaches in regard to clinical outcome; however, the lateral approach showed a statistically non-significant trend towards higher odds of clinical improvement regardless of time point. Adjusting for time, the odds of clinical improvement at short-term follow-up was twice as high for the lateral than for the posterior approach; however, the trend seems to fade away over time. Given the lack of comparative studies that address clinical improvement between these approaches, comparison is limited. A recent systematic review reports no statistically significant difference in clinical improvement between anterior and posterior approaches. This review included both open and minimal invasive techniques.7 An accurate comparison of this review and our study is hampered by the inclusion of different surgical approaches and clinical outcome measures. A clear conclusion cannot be established.
Expert review with meta-analysis of randomized and nonrandomized controlled studies of Barricaid annular closure in patients at high risk for lumbar disc reherniation
Published in Expert Review of Medical Devices, 2020
Larry E. Miller, R. Todd Allen, Brad Duhon, Kris E. Radcliff
Lumbar discectomy is the preferred method of surgical management for persistent sciatica arising from lumbar intervertebral disc herniation. Lumbar discectomy involves surgical removal of the intervertebral disc material that herniated through the annulus fibrosus into the extradiscal space. Traditional aggressive (or subtotal) lumbar discectomy involves near-complete excision of the intervertebral disc. While this procedure effectively reduces the risk of future reherniation, complete disc excision alters spinal kinematics and increases the risk of painful degenerative disc disease [6,7]. Consequently, lumbar disc surgery techniques have evolved over time to favor limited discectomy (or sequestrectomy), which aims to remove only the herniated disc material while leaving the intradiscal contents intact. While a limited surgical approach maintains disc height and spinal kinematics, the risk of reherniation of residual disc material is increased [8]. Reoperations for lumbar herniation are more costly [9] and less effective [10,11] than primary procedures. Therefore, identification of patient characteristics and surgical techniques that contribute to this excess risk is crucial to minimize patient morbidity due to symptomatic reherniation and associated reoperations.