Introduction: This study is performed to investigate the efficacy of steroid, local anaesthesia (LA) or combination of both in reducing post operative pain in lumbar discectomy. Materials and Methods: The study was ethically approved. Patients undergoing primary single level lumbar discectomy were randomised by a closed envelope system into 4 groups of 1ml of steroid and 1ml of LA, 1ml of steroid and 1ml of saline, 1ml of LA and 1ml of saline and 2mls of saline as control. 10mg of adcortyl in 1ml and 1ml of 0.5% marcaine were used. Combinations of above were applied topically over the nerve root prior to closure. Preoperative, day 1 and eight weeks post operative visual analogue pain score were recorded. 10cm visual analogue pain score chart was used. 24 hours post operative opiate analgesia requirements and duration of inpatient stay were recorded. Data was analysed using Student t-test and Fisher exact t-test. Results: No significant differences seen in the mean pre operative pain score between all groups. Mean Day 1 post operative pain and analgesia requirement in steroid and LA, steroid only, LA only and control group were 0.9, 2.5, 2.1 and 3.3 respectively. Mean opiate analgesia requirement 24 hours post operatively were 32.4mg, 54mg, 32.4mg and 56.8mg respectively. Mean inpatient stay were 2.2day, 3.91day, 4.62day and 3.63day respectively. At 8 weeks post operatively, no significant differences in the pain score in all groups. Conclusions: Significant post operative pain reduction was achieved in the steroid and local anaesthesia group compared with other groups (p< 0.05). The results are reflected as well in significant reduction in the post operative analgesia requirement (p< 0.05) and the significant reduction in inpatient stay. (p< 0.05) We recommended the use of perioperative steroid and LA infiltration in lumbar discectomy. Improved post operative pain control reduces post operative opiate analgesia requirement and reduced inpatient stay

Introduction. This study was performed to investigate the efficacy of steroid and local anaesthesia (LA) in reducing post-operative pain in lumbar discectomy. Materials and methods. The study was ethically approved. Patients undergoing primary single level lumbar discectomy were randomised by a closed envelope system into 4 groups, which were (Group 1) 10mg of adcortyl in 1ml and 1ml of 0.5% marcaine, (Group 2) 10mg of adcortyl and 1ml of normal saline, (Group 3) 1ml of 0.5% marcaine and 1ml of normal saline and (Group 4) 2mls of normal saline as control. Combinations of the above were applied topically over the nerve root prior to closure. Pre-operative, day 1 and eight weeks post-operative pain scores were recorded. 24 hours post-operative opiate analgesia requirements and duration of inpatient stay were recorded. Data were analysed using student t-test for statistical significance. Results. 100 patients were recruited into the study. There were no significant differences seen in the mean age, gender and the mean pre-operative pain score between all groups. Mean day one pain score in groups 1,2,3 and 4 was 0.9,2.5, 2.1 and 3.3 respectively. Mean 24 hours post-operative opiate requirement was 32.4mg, 54mg, 48.8mg and 56.4mg respectively. Mean inpatient stay was 2.2 days, 3.9 days, 4.62 days and 3.63 days respectively. A significant different (p<0.05) was noted in day one post-operative mean pain score, mean 24 opiate requirement and mean inpatient stay in the corticosteroid and LA group. At 8 weeks post-operatively, no significant differences were seen in the pain score in all groups. Conclusions. Significant early post-operative pain reduction was achieved in the steroid and local anaesthesia group compared with other groups (p<0.05). A significant reduction in the 24-post operative analgesia requirement (p<0.05) and in inpatient stay (p<0.05) was also observed

Objectives: A retrospective study of patients undergoing second operation after initial lumbar discectomy, to investigate the reasons associated. Methods: In a period of three years a total number of 30 patients had a reoperation after lumbar discectomy. The initial operation performed before one month to five years. There is a evaluation of intraoperative findings and of a short period of follow up. Data were obtained from Spine Unit of Errikos Dunan Hospital. Results: Among 30 patients, 60% were recurrent disc herniations, 18% were fusions and 22% were decompressions. The follow up is from two months to three years for 25 patients, 4 patients had further spinal surgery. Very satisfied, satisfied were 80% of patients. Conclusion: Although reoperation after lumbar discectomy is uncommon, it is very possible to face it because of the increasing number of initial discectomies performed

Purpose: Persistent radiculopathy secondary to lumbar disc herniation is a common problem that greatly compromises quality of life. In North America, lumbar discectomies are among the most common elective surgical procedures performed. There is still much debate about when conservative or surgical treatments should be offered to patients. Although the related literature is comprehensive, there are limited systematic reviews on the prognostic factors predicting the outcome of lumbar discectomy. The purpose of this review is to define the preoperative factors predicting clinical outcome after lumbar discectomy. Method: We conducted a computerized literature search using Ovid Medline and the Cochrane Central Register of Controlled Trials. We included randomized controlled trials or prospective studies dealing with lumbar disc surgery. The preoperative predictors had to be clearly identified and correlated with outcome measures in terms of pain, disability, work capacity, analgesia consumption, or a combination of these measures. We assessed the articles as high or low quality studies using the Newcastle-Ottawa Quality Assessment Scale, and summarized the results of High Quality Studies. Results: A total of 39 articles were included. The two most prominent negative predictors were Workers’ Compensation status and depression according to 6 studies. Poor predictors reported in 4 articles were female gender, increasing age, and prolonged duration of leg or back pain. Lower education level, smoking, and higher levels of psychological complaints were negative predictors in 3 articles. A positive Lasègue sign was a positive predictor in 7 articles. Absence of back pain, positive patient expectations, and higher income were good prognostic factors in 3 studies. Patients with contained herniations did worse than those who had uncontained disc extrusions and sequestrations according to 4 studies. The level of herniation was not a predictive factor in 7 studies. Conclusion: Workers’ Compensation, depression, greater back versus leg pain, increasing age, female gender, contained herniations, and prolonged symptoms predict unfavourable postoperative outcomes after lumbar discectomy. Positive Lasègue sign, higher income, uncontained herniations, and positive patient expectations predict favourable postoperative outcomes. The level of herniation is not an established prognostic factor. The results of this review provide a preliminary framework for patient selection for lumbar disc surgery

Background: Traditionally, lumbar discectomy is performed under general anaesthesia because of ability to perform operations of long duration in prone position with a secure airway. Some recent reports suggest better outcomes with regional anaesthesia. Aim: The aim of this study was to compare the intra-operative and short-term post-operative outcome variables in patients undergoing primary single-level lumbar discectomy with epidural and general anaesthesia. Methods: This was a prospective randomized trial involving sixty patients over a two-year period in a tertiary hospital in India. Patients were allocated into two groups: Group A (n=30) patients received general anaesthesia and Group B (n=30) patients received epidural anaesthesia. Baseline and intra-operative haemodynamic parameters, surgical duration, surgical onset time, intra-operative blood loss, cost incurred by patient, nausea and vomiting and post-operative pain score were also recorded. Results: The groups were comparable for demographic data and baseline hemodynamic observations. Patients in the epidural anaesthesia group had significantly lower blood loss (p< 0.001), lower peak pain scores (p< 0.001), lesser surgical time (p< 0.001),and significantly reduced post-operative nausea and vomiting (p< 0.01) as compared to the general anaesthesia group. The cost incurred for epidural anaesthesia was two third of that incurred in general anaesthesia (p< 0.001). Epidural group had significantly more surgical onset time (p< 0.001). Conclusion: Lumbar discectomy can be safely performed using epidural anaesthesia. The intra-operative blood loss, surgical duration, cost incurred by the patient, postoperative nausea, vomiting and pain are significantly reduced in patients receiving epidural anaesthesia, thereby leading to a significantly higher patient satisfaction. In the present climate of NHS, where any initiative to cut down the cost of resources consumed is welcomed as long as the patient safety is not compromised, epidural anaesthetic may provide an effective alternative to general anaesthetic for lumbar discectomy

Autologous chondrocyte transplantation is technically feasible and biologically relevant to repairing disc damage and retarding disc degeneration in animal models. Prospective clinical trials with open discectomy, cultivation of disc cells and transplantation by a minimally invasive procedure are ongoing (co.don chondro-transplant DISC). We used the decompressor (Stryker) for percutaneous lumbar discectomy to harvest disc cells for cultivation. A cannula was placed in the degenerated disc. The 1,5mm decompressor was introduced through the cannula. 0,5–1,5 millilitres of disc material was aspirated. In the laboratory the material was cultured using the patients serum. The cells were expandable. The capacity of the cells to produce matrix molecules was proven in vitro. The percutaneous discectomy of contained discs with signes of early degeneration, the expansion and the transplantation of autologous chondrocytes to the disc might be a possibility of repairing disc damage and retarding disc degeneration

Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post surgical management of these cases. The studies that have been reported compared one exercise regime to another. This study compares an exercise group with a true control group involving no exercise or formal rehabilitation. This is a randomized controlled trial comparing post surgical lumbar discectomy management regimes. Ninety three lumbar discectomy patients were randomized to two groups. Group A; the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B; undertook a six month supervised non aggravating gym rehab programme. Both groups were followed for a one year period using validated outcome measures and a questionnaire. The results are based on an intention-to-treat analysis. Patients in both groups improved during the one year follow up period (P=0.001). However there was no statistical difference between groups at the clinical end point (Roland Morris P=0.83, Oswestry Low back index P=0.90). Group B patients returned to work seven days earlier than group A patients and had fewer days off work in the one year follow up period but this difference was not statistically significant. There was no statistical advantage gained by the patients who performed the gym rehabilitation programme after one year follow up. These are the preliminary one year results of a three year follow up study

Design of study: Prospective, observational. Purpose of the study: Obese and morbidly obese patients undergoing lumbar surgery can be a challenge to the operating surgeon. Reports on the perioperative data in this group of patients are scarce. The purpose of the study is to prospectively compare the perioperative data in patients with normal and high BMI, undergoing lumbar spine surgery. Method: We conducted a prospective audit of 50 consecutive patients who underwent primary discectomy or single level decompression under the care of single spine surgeon. Initial Low Back Outcome Score, length of incision, distance from skin to spinous process, distance from skin to lamina, length of hospital stay, blood loss and complications were studied in detail. Results: We used student t test to compare the two groups and Pearson Correlation to correlate the data against high BMI. We were unable to demonstrate a statistically significant difference between those with normal BMI and high BMI in any of the above parameters analysed. Conclusion: A high BMI was not associated with an increased perioperative morbidity in this patient group. Contrary to other areas of orthopaedic surgery, there is no statistically significant difference in the Initial Low Back Outcome Score and perioperative data between patients with normal and high BMI undergoing lumbar discectomy and single level decompression. Conflict of Interest: None. Source of Funding: None

Objective: To assess the clinical effectiveness of dexamethasone wound infiltration post lumbar discectomy. Design: A prospective, double blind, randomised study comparing morphine consumption in two groups of patients in elective lumbar spine surgery via the posterior approach. Subjects: There were forty patients divided into two randomly selected groups, one received postoperative wound infiltration with dexamethasone, the other with saline. Their morphine usage was measured. Outcome measures: These included levels of morphine use postoperatively, pain scores and length of hospital stay. Results: There was no statistically significant difference between postoperative morphine consumption in the two groups or in the length of hospital stay. There appeared to be improvement in pain scores with dexamethasone. There were no complications. Conclusion: Postoperative wound infiltration with dexamethasone may result in some subjective improvement in pain, but none in analgesic consumption. Despite the lack of complications the subjective benefits do not outweigh the risks in the absence of objective improvement in pain

We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural rupture during surgery and CSF hypovolemia are thought to be the main contributing factors, one can postulate on the effects of anti-psychiatirc medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and therefore should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases were the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible eplieptogenic medication. Conflict of Interest: None. Source of Funding: None

Microdiscectomy is the most commonly performed spine surgery in the world. Due to its technical simplicity and low complication rate, this was the first spine surgical procedure transitioning for one-day surgery. However, the economic assessment of this outpatient transition was never performed and the question on the real impact in the burden of spine care remains.

This economic study aims to access the cost-utility of outpatient lumbar microdiscectomy when compared with the inpatient procedure.

To do so, a cost-utility study was performed, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy, from a in a Portuguese NHS hospital. Utilities were calculated with quality-adjusted life-years were derived from Oswestry Disability Index values (ODI). ODI was assessed prospectively in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. both probabilistic and deterministic sensitivity analyses were performed and incremental cost-effectiveness ratio (ICER) calculated. A willingness to pay (WTP) threshold of €60000/QALY gained with inpatient procedure was defined.

Out results showed that inpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from €135753 to €345755/QALY, higher than the predefined WTP. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group. The mean admission time in inpatient group was 2.5 days. Since there is an overall agreement among spine surgeons that an uncomplicated inpatient MD would only need a one-day admission, an analysis reducing inpatient admission time for one day was also performed and outpatient remained cost-effective.

In conclusion, as the first economic study on cost-utility of outpatient lumbar microdiscectomy, this study showed a significant reduction in costs, with a similar clinical outcome, proving this outpatient transition as cost-effective

Method: We reviewed the hospital notes of 45 patients who underwent a lumbar discectomy over a 30month period. The care pathway was divided into three components: Pre-Hospital Wait (time from GP referral to first outpatient appointment), Hospital Wait (first out-patient appointment to being listed for surgery) and the Waiting List period. The patients were divided into three groups: those following a standard pathway (group I), patients referred with an MRI scan (group II) and emergency admissions to hospital (group III). Results: The groups I, II and III comprised of 18, 12 and 7 patients respectively. The mean Pre-Hospital Wait in weeks was 16 (group I) and 14 (group II). The Hospital Wait was 12 (group I), 3 (group II) and 1 (group III). The Waiting List period was 26 (group I), 18 (group II) and 1 (group III). The difference in The Hospital Wait between groups I and II reached significance. Discussion: The Waiting List Period is often blamed as the causa principale for a delay in treatment. This review shows that a considerable time is spent in the Hospital Wait period and draws attention to a recognised delay in the care pathway, which requires a multidisciplinary approach to reduce its effect

Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post surgical management of these cases. The studies that have been reported compare one exercise regime to another. The aim of this study was to compare long term outcomes of usual surgical advice, involving no formal post-surgical rehabilitation, with a non-aggravating six month gym rehabilitation programme post lumbar discectomy. This study is a prospective randomised controlled trial using a cohort followed for three years. The patients were computer randomised into two groups. Group A, the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B, undertook the gym rehabilitation programme. Inclusion criteria were: age 17 to 65 years, good health and no major medical problems. The surgical level had to be L3, L4, or L5. Patients were excluded if they had central neurological disorders, communication difficulties, any condition making gym-based exercises unsafe, or if the surgery was indicated for spinal infection, tumour or inflammatory disease. Patients were followed for a three year period using validated outcome measures (Roland-Morris Questionnaire and Oswestry Low Back Pain Index) and an annual Quality of Life (QoL) questionnaire. The annual questionnaire reported information on number of GP visits, other therapist visits, medication levels and time off work. Ninety three participants were randomised; Control n=46 and trial n=47. Eighty nine participants completed the study. Randomisation achieved a balance of confounding factors, with the exception of work heaviness, where there were a greater number of participants in the very heavy and heavy categories in the trial group (P< 0.01). Functional outcome measures did not achieve statistical difference over the three year period. Other studies have shown these measures to be reliable for short term follow up but their reliability diminishes with time (. 1. ,. 2. ). Key findings of cumulative three year data for the QoL questionnaire were in the intent-to-treat analysis: fewer GP visits in the trial group p< 0.008; and per protocol: fewer episodes off work p< 0.01 (49% versus 15%), fewer days off p< 0.053 and fewer GP visits p< 0.009. The results reveal an advantage in terms of episodes off work and GP visits for participants in Group B who completed the programme. Time off work is a significant consideration for funding providers. These results suggest that surgeons should consider referral of discectomy patients to appropriate post-surgical rehabilitation programmes

Purpose of the study: Evaluate the impact of an information brochure on residual functional incapacity after lumbar discectomy for common lumbosciatic pain. Material and methods: A biopsychosocial information brochure on the management of chronic pain was developed on the basis of evidence-based medicine. A prospective randomised controlled trial was conducted to assess its impact. One hundred twenty-nine patients were included. The intervention group (GI) was given the biopsychosocial brochure entitled “You have had a back operation” (Vous venez d’être opéré du dos) while the control group was given a biomedical brochure. The information content was the only difference between the two groups; the patients were not informed of their randomisation group. The main outcome was functional incapacity at two months (Quebec scale). The duration of return to usual daily and occupational activities was noted at two months. Secondary outcomes were fears and beliefs measured by the FABQ and the BBQ before and after information delivery and at two months. Radicular and low back pain were evaluated using a numerical scale. Satisfaction with information received was determined. All demographic and clinical data were collected with self-administered questionnaires. Results: Functional incapacity at two months declined more in GI: 32.4±22.8 versus 36.1±18.7 in the control group (p=0.36). The biopsychosocial brochure favoured resumption of usual physical activity: since 2.38±2.47 weeks in GI versus 1.00±1.28 weeks in the control group (p=0.0006) and of occupational activity: 2.35±1.17 weeks in GI versus ±Discussion: in the control group and for significantly more patients in GI (p=0.02). Fears and beliefs measured by the FABQPhys declined significantly in GI: from 15.9±6.3 to 8.0±7.14 versus from 14.1±5.6 to 11.23±6.34 in the control group; this score remained lower in GI at two months: 8.64±7.6 versus 10.63±7.2 (p=0.18). The patients in GI were significantly more satisfied with the information received. Discussion: Reading the biopsychosocial brochure had a significant impact on functional incapacity in terms of time to resumption of physical and occupational activities and enabled a reduction in fears and beliefs. Conclusion: This information brochure is an interesting tool for healthcare professionals and contributes to therapeutic education of patients

Introduction: Lumbar discectomy is now the operation of choice for lumbosacral radicular syndrome. Few studies of high quality have been performed on the post surgical management of these cases. The studies that have been reported compare one exercise regime to another. The aim of this study was to compare long term outcomes of usual surgical advice, involving no formal post-surgical rehabilitation, with a non-aggravating six month gym rehabilitation programme post lumbar discectomy. This study is a prospective randomized controlled trial using a cohort followed for three years. Methods: The patients were computer randomised into two groups. Group A, the control group followed usual surgical advice which was to resume normal activity as soon as pain allowed. Group B, undertook the gym rehabilitation programme. Inclusion criteria were: Age 17 to 65 years, good health and no major medical problems. The surgical level had to be L3, L4, or L5. Patients were excluded if they had central neurological disorders, communication difficulties, any condition making gym-based exercises unsafe, or if the surgery was indicated for spinal infection, tumour or inflammatory disease. Patients were followed for a three year period using validated outcome measures (Roland-Morris Questionnaire and Oswestry Low Back Pain Index) and an annual Quality of Life (QoL) questionnaire. A sample of 40 per group provided the study with 80% power (P< 0.05) to detect a 3.5 point change in the RMQ and a 10% change in the ODI. The annual questionnaire reported information on number of GP visits, other therapist visits, medication levels and time off work. Results: Ninety three participants were randomised; Control n=46 and trial n=47. Eighty nine participants completed the study. Randomisation achieved a balance of confounding factors, with the exception of work heaviness, where there were a greater number of participants in the very heavy and heavy categories in the trial group (P< 0.01). Thirty nine of 47 participants completed the gym programme (83%). Functional outcome measures did not show statistically significant differences between groups over the three year period. Key findings of cumulative 3 year data for the QoL questionnaire are: on intent-to-treat analysis; fewer patients having GP visits in the trial group P=0.048 (18% vs 5%). In the per protocol subset; fewer episodes off work P=0.074 (range control 0–3 vs trial 0–2), GP visits P= 0.089 (range control 0–12 vs trial 0–3) and in the per-protocol minus re-operation group; GP visits P< 0.008 (range control 0–3 vs trial 0–2), patients requiring medication use P=0.05 (37% control vs 17% trial) days off work P=0.099 (range control 0–30 vs trial 0–3). Discussion: The results reveal an advantage in terms of episodes off work, GP visits and medication use for participants in the trial group who completed the programme. Time off work is a significant consideration for funding providers. These results suggest that surgeons should consider referral of discectomy patients to appropriate post-surgical rehabilitation programmes

The recent NICE guidelines on management of osteoarthritis outline weight loss as first line treatment in degenerative joint disease in the obese. There is little data surrounding the effects of obesity on the outcomes in spinal surgical interventions. Intervertebral discectomy is one treatment for prolapse of a lumbar vertebral disc. We aim to investigate the effect of obesity on outcomes for discectomy.

Demographic details including age, sex, weight and BMI were recording with a pre-operative Oswestry Disability Index (ODI). The fat thickness was measured at L5/S1 using calibrated MRI scans. Outcome measures included complications, length of surgery and change in ODI at 1 year following surgery. Obesity was defined as a body mass index of over 30. The units Serial patients undergoing discectomy were recruited into the study. Patients with bony decompression, instrumentation, revision surgery or multilevel disease were excluded.

Fifty patients with a single level uncomplicated disc prolapse were entered into the study. Sixteen patients had a BMI over 30 and so were obese, whilst 34 had a BMI of less than 30. The mean pre-operative ODI was 46.5 in the obese group and 52 in the normal group this difference was not significant (p> 0.05). The mean post operative ODI was statistically improved in the high BMI group at 28 (18.5 point improvement) and 25.2 (29.1 point improvement) in the normal group. The ODI improvement was significantly better in the low BMI group (p=0.036). There was no significant difference in operative time (p=0.24). Only a single patient had a complication (dural leak), so no valid comparison could be made.

The outcomes of spinal surgery in the obese are mixed.

We found no increase in the complication rate or intra-operative time associated with an increased BMI. However, the improvement in ODI was significantly better in the normal BMI group.

It is recognised that those patients who present sciatica and significant preceding back pain will be disappointed, following discectomy, with the relief of the sciatica alone, as considerable degenerate disc will remain.

Though a bilateral fenestration exposure as much disc possible was removed right down to the back of the anterior longitudinal ligament. Intervertebral fusion was not used.

Of 25 patients, with a mean follow up of 20 months, 59% reported a significant improvement in pain (p< 0. 05) and function (p< 0. 05) following surgery. Post-operative radiography did not reveal malalignment or instability.

Prolo D et al. Toward uniformity results of lumbar spine operation. A paradigm applied to posterior lumbar interbody fusions. Spine, 1986: 11:601–6.

Purpose: The advent of lapaoscopic disectomy has made it possible to cure discal herniation with minimal trauma and no limitations on indications. We have adopted the technique described by J. Destandau since June 1998. The purpose of this work was to report our early results.

Material and methods: Forty patients were included in a period from June 1998 to August 2000. There were 24 men and 16 women, mean age 43 years (24–78). Eleven patients had an associated stenosis of the spinal canal. Accelerated rehabilitation was employed. Sitting and driving were allowed early.

Results: Mean follow-up was 13 months (2–27 months). Mean operative time was 63 minutes (30–150 min). Mean hospital stay was 3.92 days (2–10). There were 29 patients without stenosis of the lumbar canal. In this subgroup, outcome was excellent in 69%, good in 21% (six patients), fair in 3% (one patient), and poor in 7% (two patients). For the PROLO score, three patients were who were retreated were not included in the analysis. Outcome was excellent in 73% (19 patients), good in 12% (three patients), fair in 12% (three patients, and poor in 4% (one patient). In patients with lumbar canal stenosis, (eleven patients), three were reoperated for wider decompression; there was no haematoma. One patient was reoperated for deep infection. For the other patients the WADDELL score was excellent in five and good; in two the PROLO score was excellent in six and poor in one.

Discussion: The technique favoured a narrow approach. Shorter exposure preserved the anatomy, but for the three patients with an associated stenosis, reoperation was necessary for decompression. For the cases without complications, we noticed that recovery was very rapid, a finding which is exceptional with the conventional technique.

Conclusion: Our early experience with this technique has demonstrated that laparoscopic discectomy is feasible and safe. An associated stenosis is a limitation; we recommend systematic decompression in association with the discectomy.

Objective: To identify risk factors associated with patients that required revision surgery for sciatica.

Design: A retrospective study of 580 patients who underwent surgery for intractable sciatica attributable to pro-lapsed lumbar intervertebral disc from 1986 to 2000 inclusive.

Subjects: The study included a total of 580 patients. Of these seven patients had an operation at two levels, 25 patients had had a primary operation elsewhere and were therefore excluded; four sets of notes remain missing. The total number of primary operations analysed was therefore 558.

Outcome measures: Parameters such as gender, age, level and side of discectomy were entered into a database for analysis. Diagnostic and clinical parameters were also entered; these included the value of the angle of the straight leg raise recorded and absence or presence of neurological deficit (altered sensation, reduced motor power, and absent or diminished reflexes). Operative findings recorded and entered were the type of disc at operation (i. e. protrusion, extrusion and sequestration) and the presence of free cerebrospinal fluid (CSF), however minor, indicating a dural tear.

Results: The total number of primary discectomies was 558 of which 43 went on to require a second operation, giving a revision rate of 7.71%. Of the primary discectomies, 356 were protrusions, 92 extrusions and 110 sequestration. Of the 43 that went onto revision surgery, 35 were protrusions, two extrusion and six sequestration. A significant association was found with primary disc protrusions, this type of disc prolapse was almost three times more likely to go on to need revision surgery compared to extruded or sequestrated discs. Data analysed on primary protrusions showed these patients had a significantly greater straight leg raise angle and reduced incidence of positive neurological findings and so could be identified clinically.

Conclusions: This lead us to conclude that the group of patients with primary protrusions could be selected out and treated conservatively since they are three times more likely to require revision surgery.

Study design: A prospective comparison of MRI findings with surgical findings in patients presenting to our spinal triage service with a prospective diagnosis of a lumbar disc herniation.

Objective: To investigate consistency between Radiologists’ interpretation of MRI scans, and comparison between MRI and surgical findings, in an attempt to identify those patients suitable for percutaneous treatment.

Background: MRI has assumed a pre-eminent position in the diagnosis of lumbar disc prolapse.

Methods: 87 consecutive patients presenting with signs and symptoms suggestive of a lumbar disc prolapse that underwent an MRI and based on that a discectomy.

Results Reliability tests show only fair agreement (k=0.36) between the Radiologists and at best only moderate agreement (=0.41) between the Radiologists and surgical findings.

Conclusion: MRI is an excellent tool for diagnosis of a disc prolapse. MRI is poor at defining the character of a disc prolapse, and does not appear to help in classifying discs suitable for percutaneous treatment.