Aims. To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar
Aim. To compare outcomes of revision lumbar
Background: The usefulness of open (fenestration/ laminotomy)
Aims: The aim of this study was to compare the results of Micro Endoscopic
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
Aims. Open
Introduction. This study was performed to investigate the efficacy of steroid and local anaesthesia (LA) in reducing post-operative pain in lumbar
Aims. Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. Methods. We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them. Results. In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision
Aims. The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. Methods. We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty,
Although interlaminar endoscopic lumbar
We have studied 180 patients (128 men and 52 women) who had undergone lumbar
Single level
Aims. The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans. Methods. Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared. Results. A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093). Conclusion. The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient’s symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform
Objectives: A retrospective study of patients undergoing second operation after initial lumbar
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
This paper describes the relationship between post-myelographic symptoms and the timing of a subsequent spinal operation. A prospective study was performed comparing the post-operative symptoms of patients who underwent
Purpose: Persistent radiculopathy secondary to lumbar disc herniation is a common problem that greatly compromises quality of life. In North America, lumbar
Purpose: Since 1990, we have used specific material, presented to us by T. Tajima (Japan) during his visit in 1989 for percutaneous surgical cervical
We performed a prospective study to examine the
influence of the patient’s position on the location of the abdominal
organs, to investigate the possibility of a true lateral approach
for transforaminal endoscopic lumbar
Introduction: Repetitive undertaking of a physical tasks results in an innate memory for that task. Development of this memory is an important component of surgical training and the ease and safety with which these changes are incorporated into a smoothly flowing procedure is represented by the so-called “learning curve”. Changes in equipment and technology may radically alter the paradigm used by surgeons for completing the task of an operation. An example of this is the integration of endoscopy. The hand-eye orientation, field of view, angle of approach, binocularity of vision and skew of the visual field are all altered in lumbar micro-endoscopic
INTRODUCTION: Repetitive undertaking of a physical task results in an innate memory for that task. Development of this memory is an important component of surgical training and the ease and safety with which these changes are incorporated into a smoothly flowing procedure is represented by the so-called “learning curve”. Changes in equipment and technology may radically alter the paradigm used by surgeons for completing the task of an operation. An example of this is the integration of endoscopy. The hand-eye orientation, field of view, angle of approach, binocularity of vision and skew of the visual field are all altered in lumbar microendoscopic
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
Background: Traditionally, lumbar
Aim of the present study was to investigate clinical outcomes and quality of life after standard
The indications for lumbar
The optimum timing of lumbar
Introduction: Following surgical
Study Design: Retrospective review. Objectives: Rugby union has recently become a highly-paid professional sport. Players requiring anterior cervical
Objective: To extend the follow up period of previous studies undertaken by the senior author, looking at the clinical outcome and radiological changes observed in patients with either myelopathy or radiculopathy, following anterior cervical
Recurrence of back or leg pain after discectomy
is a well-recognised problem with an incidence of up to 28%. Once conservative
measures have failed, several surgical options are available and
have been tried with varying degrees of success. In this study,
42 patients with recurrent symptoms after
Introduction. Degeneration of the cervical spine can lead to neurological symptoms that require surgical intervention. Often, an anterior cervical
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
Introduction Minimally invasive lumbar
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
Introduction: Anterior cervical
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
Introduction Far lateral disc prolapse (also known as foraminal or extreme lateral prolapse) make up 10% of all disc herniations. In addition, far lateral disc prolapses tend to affect more proximal levels more frequently than do prolapses in the posterolateral location and they are often associated with greater radicular symptoms than typical posterolateral herniations, most likely due to involvement of the dorsal root ganglion. Surgery for far lateral disc protrusions has been associated with a less favourable outcome, perhaps due to delays in diagnosis, inadequate preoperative imaging, and postoperative instability as a result of excessive bony and facet resection during the surgical approach. Methods Twelve patients with far lateral disc herniations operated on by the senior author (RPW) fulfilled the criteria of having both pre- and postoperative Oswestry Disability Index (ODI) scores recorded at each clinic visit. Results of these cases and those of a cohort of age and sex matched patients undergoing standard posterolateral
We present a review of 553 patients who underwent surgery for intractable sciatica ascribed to prolapsed lumbar intervertebral disc. One surgeon in one institution undertook or supervised all the operations over a period of 16 years. The total number of primary
Lumbar disc herniations are quite common pathology in orthopedics. Percutaneous
Objective: Anterior cervical
We treated 137 patients with symptomatic lumbar disc prolapse by automated percutaneous lumbar
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
It is recognised that those patients who present sciatica and significant preceding back pain will be disappointed, following
Background. Percutaneous endoscopic interlaminar
Introduction Lumbar
The aim of this study was to determine how the short- and medium-
to long-term outcome measures after total disc replacement (TDR)
compare with those of anterior cervical discectomy and fusion (ACDF),
using a systematic review and meta-analysis. Databases including Medline, Embase, and Scopus were searched.
Inclusion criteria involved prospective randomized control trials
(RCTs) reporting the surgical treatment of patients with symptomatic
degenerative cervical disc disease. Two independent investigators
extracted the data. The strength of evidence was assessed using
the Grading of Recommendations, Assessment, Development and Evaluation
(GRADE) criteria. The primary outcome measures were overall and
neurological success, and these were included in the meta-analysis. Standardized
patient-reported outcomes, including the incidence of further surgery
and adjacent segment disease, were summarized and discussed.Aims
Patients and Methods
We used gadolinium-enhanced fat-suppressed MRI to investigate 67 patients with persistent pain after lumbar
Lumbar
Background: To assess the clinical and radiological results of motion-segment sparing anterior cervical partial
Aim: Evaluate the preoperative prognostic factors of a poor result in conventional surgery of lumbar disc herniation. Methods: From November 1995 to November 2001, we performed 113 standard