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Journal of Orthopaedic Science :... Jul 2023Chemonucleolysis with condoliase significantly improved clinical symptoms in patients with lumbar disc herniation. We evaluated the surgical intervention rate and...
BACKGROUND
Chemonucleolysis with condoliase significantly improved clinical symptoms in patients with lumbar disc herniation. We evaluated the surgical intervention rate and outcomes for >1 year after condoliase treatment.
METHODS
This was a follow-up study of patients who received condoliase or placebo in two previous randomized, placebo-controlled clinical trials with 1-year follow-ups. A post-treatment surgery survey and on-site examination were administered and patients' data from the clinical trial records and additional interview data were analyzed to evaluate the surgical intervention rate. Patients' lumbar disease symptoms, Oswestry Disability Index, and imaging features were evaluated.
RESULTS
Among the patients (condoliase, n = 228; placebo, n = 128) enrolled in the clinical trials, additional post-treatment surgery data were available for 231 patients after the clinical trials ended, and 179 patients underwent post-trial examinations, at least 5 years and 17 months after the end of the clinical trials. The surgical intervention rate in the placebo and condoliase groups was 20.7% (95% confidence interval: 14.2-29.7) and 13.4% (95% confidence interval: 8.8-20.2), respectively. The mean change in Oswestry Disability Index score from pre-injection in placebo and condoliase groups was -24.7 ± 15.0 and -32.7 ± 18.6 (between-group difference: -8.0 ± 17.3; 95% confidence interval: -13.2 to -2.7). Modic Type 2 changes were observed, particularly in the condoliase group. No relationship between lumbar disease symptoms and change in imaging features was found.
CONCLUSIONS
This follow-up study more than 1 year revealed no new safety concerns of condoliase. However, because the study had several limitations, such as large loss of follow-up, further research is needed.
Topics: Humans; Intervertebral Disc Displacement; Intervertebral Disc Chemolysis; Follow-Up Studies; Diskectomy; Physical Examination; Lumbar Vertebrae; Treatment Outcome
PubMed: 35534364
DOI: 10.1016/j.jos.2022.04.003 -
BMC Musculoskeletal Disorders Jan 2024Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We...
BACKGROUND
Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years' follow-up.
METHODS
We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits.
RESULTS
Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6).
CONCLUSIONS
This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture.
REGISTRATION
Open Science Framework ( https://osf.io/vgrwz ).
Topics: Adult; Humans; Middle Aged; Reoperation; Prospective Studies; Retrospective Studies; Manipulation, Spinal; Diskectomy
PubMed: 38200469
DOI: 10.1186/s12891-024-07166-x -
Nursing Open Mar 2024Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them.... (Review)
Review
AIM
Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy.
DESIGN
This qualitative study was conducted in 2022 using content analysis.
METHODS
Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi-structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation.
RESULTS
The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine-based practice in the healthcare system, futile attempt for team-based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery.
Topics: Humans; Nursing Care; Qualitative Research; Hospitals; Physicians; Diskectomy
PubMed: 38488403
DOI: 10.1002/nop2.2137 -
Orthopaedic Surgery Mar 2024The floating calcified tissue in floating calcified lumbar disc herniation (FCLDH) is hard and often adheres to the dura mater, which can easily cause nerve root damage...
OBJECTIVE
The floating calcified tissue in floating calcified lumbar disc herniation (FCLDH) is hard and often adheres to the dura mater, which can easily cause nerve root damage during surgery, making the operation challenging. We proposed the classification of FCLDH and a new technique for removing floating calcified tissue and reported the clinical efficacy and safety of this new technique in clinical practice.
METHODS
From January 2019 to October 2021, 24 patients (13 males and 11 females, 46.4 ± 7.72 years) with L5-S1 floating calcified lumbar disc herniation were treated with percutaneous endoscopic interlaminar discectomy (PEID). According to FCLDH classification, a total of Type Ia: nine cases, Type Ib: five cases, Type IIa: four cases, and Type IIa: six cases were included. The visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded pre-operatively and 3 days postoperatively, 6 months postoperatively, and at the last follow-up. The postoperative curative effect was evaluated according to the modified MacNab criteria. Computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine were performed 3 days after surgery to evaluate the efficacy of the surgery.
RESULTS
All patients successfully underwent PEID. The VAS and ODI scores at 3 days postoperatively, 6 months postoperatively, and at the last follow-up were significantly improved and statistically significant compared to those of the preoperative period (p < 0.05). All the patients were followed up for 12-24 months (mean, 16.6 ± 4.6 months). At the last follow-up, according to the modified MacNab criteria, 15 cases were excellent, eight were good, and one was fair. The combined excellent and good rate was 95.83% (23/24). Postoperative review revealed that all floating calcified tissues were effectively removed and the nerve roots were adequately decompressed without complications such as cerebrospinal fluid leakage and lumbar spine infection.
CONCLUSION
The classification of FCLDH we proposed can well guide the selection of surgical plans. PEID combined with floating calcified tissue removal technology has good efficacy in the treatment of L5-S1 FCLDH, ensuring accurate removal of calcified tissue, reducing complications and improving the quality of life of affected individuals.
Topics: Male; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Quality of Life; Retrospective Studies; Endoscopy; Diskectomy, Percutaneous; Diskectomy; Treatment Outcome
PubMed: 38316417
DOI: 10.1111/os.14007 -
Surgical Neurology International 2024The literature documents that laminoforaminotomy (CLF), whether performed open, minimally invasively, or microendoscopically, is safer than anterior cervical... (Review)
Review
BACKGROUND
The literature documents that laminoforaminotomy (CLF), whether performed open, minimally invasively, or microendoscopically, is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease.
METHODS
ACDF for lateral cervical disc disease and/or spondylosis exposes patients to multiple major surgical risk factors not encountered with CLF. These include; carotid artery or jugular vein injuries, esophageal tears, dysphagia, recurrent laryngeal nerve injuries, tracheal injuries, and dysphagia. CLF also exposes patients to lower rates of vertebral artery injury, dural tears (DT)/cerebrospinal fluid fistulas, instability warranting fusion, adjacent segment disease (ASD), plus cord and/or nerve root injuries.
RESULTS
Further, CLF vs. ACDF for lateral cervical pathology offer reduced tissue damage, operative time, estimated blood loss (EBL), length of stay (LOS), and cost.
CONCLUSION
CLFs', whether performed open, minimally invasively, or microendoscopically, offer greater safety, major pros with few cons, and decreased costs vs. ACDF for lateral cervical disease.
PubMed: 38468654
DOI: 10.25259/SNI_61_2024 -
Journal of Neurological Surgery. Part... May 2024Thoracic disk herniations (TDHs) are relatively rare compared with their cervical and lumbar counterparts. Posterior approaches allow for a simpler and less invasive...
BACKGROUND
Thoracic disk herniations (TDHs) are relatively rare compared with their cervical and lumbar counterparts. Posterior approaches allow for a simpler and less invasive surgery than anterior and lateral approaches. A pedicle-sparing transfacet approach was initially described in 1995, and modified in 2010. A few clinical series have reported the outcome of this procedure in patients with TDH. This study aimed to evaluate the outcomes and complications of pedicle-sparing transfacet diskectomy with interbody fusion and segmental instrumentation in patients with TDH.
METHODS
Twenty-one consecutive patients with symptomatic TDH referred to our tertiary care center were included in this retrospective study. All patients underwent a pedicle-sparing transfacet diskectomy with polyetheretherketone (PEEK) cage interbody fusion and short segmental instrumentation. Distribution of TDH, operative duration, blood loss, Visual Analog Scale (VAS) pain scores, Nurick grades, modified Japanese Orthopaedic Association (mJOA) scores, and fusion rate were assessed.
RESULTS
All patients had single-level herniations. The most common location was T12-L1 (38.1%), followed by T11-T12 (33.3%). All patients were successfully operated on with no cerebrospinal fluid (CSF) leaks or wrong-level surgery. The VAS scores significantly diminished from 4.9 (preoperatively) to 2 (18 months after surgery). The average mJOA score increased from 4.6 to 8.5, and the average Nurick grade decreased from 3.1 to 1.6. All patients reported significant improvement in quality of life relative to their preoperative status.
CONCLUSION
A modified pedicle-sparing transfacet diskectomy combined with PEEK cage interbody fusion and segmental instrumentation offers a safe and less invasive approach for the treatment of TDHs.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Quality of Life; Diskectomy; Spinal Fusion; Polyethylene Glycols; Ketones; Treatment Outcome; Lumbar Vertebrae; Benzophenones; Polymers
PubMed: 36584877
DOI: 10.1055/a-2005-0620 -
The Journal of International Medical... Aug 2023Unilateral biportal endoscopic (UBE) discectomy is a reliable endoscopic technique in the treatment of lumbar disc herniation. However, UBE discectomy involves a... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Unilateral biportal endoscopic (UBE) discectomy is a reliable endoscopic technique in the treatment of lumbar disc herniation. However, UBE discectomy involves a single-handed manipulation, which may compromise the utility of the procedure. The present study was performed to examine the efficacy and safety of a novel pin-assisted retraction technique.
METHODS
This single-center retrospective cohort study involved 57 consecutive patients who underwent UBE lumbar discectomy from July 2021 to May 2022. The patients were randomly divided into the pin-assisted UBE discectomy group (P-UBE group) and the traditional UBE discectomy group (T-UBE group). The patients' perioperative data, clinical outcomes, and radiologic outcomes were collected and compared between the two groups.
RESULTS
The operative time, intraoperative blood loss, endoscopic irrigation volume, and overall complication rate were significantly lower in the P-UBE group than in the T-UBE group. There were no significant differences in the clinical outcome data between the two groups.
CONCLUSION
P-UBE discectomy may have superior safety and efficacy over the traditional technique, and it has the potential to serve as an optional method in UBE lumbar surgery.
Topics: Humans; Retrospective Studies; Lumbar Vertebrae; Endoscopy; Diskectomy; Intervertebral Disc Displacement; Treatment Outcome
PubMed: 37548213
DOI: 10.1177/03000605231164006 -
Pain Physician Mar 2024Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established.
OBJECTIVES
We aimed to find, via a network meta-analysis, the best treatment for low back pain in younger patient populations.
STUDY DESIGN
Network meta-analysis.
METHODS
The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data quality was evaluated using RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration), while STATA 14.0 (StataCorp LLC) was used for the network meta-analysis and to merge data on the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, complication, blood loss, reoperation rate, and function score.
RESULTS
We included 50 randomized controlled trials, involving 7 interventions; heterogeneity and inconsistency were acceptable. Comparatively, microendoscopic discectomy and percutaneous endoscopic lumbar discectomy were the best surgical procedures from the aspects of VAS score and ODI score, while standard open discectomy was the worst one from the aspect of ODI score. Regarding complications, tubular discectomy was preferred with the fewest complications. Additionally, microendoscopic discectomy outperformed other surgical procedures in reducing blood loss and reoperation rate.
LIMITATIONS
First, follow-up data were not reported in all included studies, and the follow-up time varied from several months to 8 years, which affected the results accuracy of our study to some extent. Second, there were some nonsurgical factors that also affected the self-reported outcomes, such as rehabilitation and pain management, which also brought a certain bias in our study results.
CONCLUSIONS
Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.
Topics: Humans; Intervertebral Disc Displacement; Network Meta-Analysis; Diskectomy, Percutaneous; Low Back Pain; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Diskectomy
PubMed: 38506677
DOI: No ID Found -
European Review For Medical and... Sep 2023To explore the lumbar spine biomechanics of graded ventral facetectomy and determine the appropriate extent of resection for foraminoplasty.
OBJECTIVE
To explore the lumbar spine biomechanics of graded ventral facetectomy and determine the appropriate extent of resection for foraminoplasty.
PATIENTS AND METHODS
We retrospectively measured several radiological parameters of superior articular process (SAP) and bony intervertebral foramen in computed tomography scans of 170 lumbar vertebral discs. The intact finite element (FE) spine of L2-sacrum was modified to simulate foraminoplasty with two typical graded ventral facetectomy methods (Method Ⅰ: basal part resection of SAP; Method Ⅱ: apical part resection of SAP) to explore the biomechanical effects under different physiological motions.
RESULTS
Examination of the radiological parameters of the bony intervertebral foramen indicated that they were generally narrower than the diameters of commercially available working cannulas. Some of these parameters showed gender differences. The biomechanical evaluation indicated that the range of motion increased gradually with the expansion of the resection extent, and the differences compared to the intact spine at the same level were greater in Method I than in Method Ⅱ.
CONCLUSIONS
The appropriate ventral resection extent of the basal part of the SAP (Method I) was 4 mm, 3 mm, and 3 mm on the lateral view at L3-L4, L4-L5, and L5-S1, respectively. The appropriate ventral resection extent of the apical part of the SAP (Method II) were 10 mm, 6 mm and 6 mm on the lateral view at L3-L4, L4-L5, and L5-S1, respectively. Extensive resection of foraminoplasty may destabilize lumbar motion segments.
Topics: Humans; Diskectomy, Percutaneous; Lumbar Vertebrae; Intervertebral Disc Displacement; Retrospective Studies; Diskectomy; Biomechanical Phenomena; Range of Motion, Articular
PubMed: 37782160
DOI: 10.26355/eurrev_202309_33769 -
The Journal of the American Academy of... Jun 2024Patients with myelopathy or radiculopathy commonly undergo anterior cervical fusion surgery (ACFS), which has a notable failure rate on occasion. The goal of this study...
INTRODUCTION
Patients with myelopathy or radiculopathy commonly undergo anterior cervical fusion surgery (ACFS), which has a notable failure rate on occasion. The goal of this study was to compare revision and nonrevision surgery patients in cervical sagittal alignment (CSA) subsequent to ACFS; additionally, to identify the best CSA parameters for predicting clinical outcome after ACFS; and furthermore, to create an equation model to assist surgeons in making decisions on patients undergoing ACFS.
METHODS
The data of 99 patients with symptomatic cervical myelopathy/radiculopathy who underwent ACFS were analyzed. Patients were divided into group A (underwent revision surgery after the first surgery failed) and group B (underwent only the first surgery). We measured and analyzed both preoperative and postoperative CSA parameters, including C2 slope, T1 slope, cervical lordosis C2-C7 (CL), C2-C7 sagittal vertical axis (C2C7 SVA), occiput-C2 lordosis angle (C0-C2), and chin brow vertical angle, and we further computed the correlation between the CSA parameters and created a prediction model.
RESULTS
The (T1S-CL)-C2S mismatch differed significantly between groups A and B ([9.95 ± 9.95] 0 , [3.79 ± 6.58] 0 , P < 0.05, respectively). A significant correlation was observed between C2 slope and T1CL in group B relative to group A postoperatively (R 2 = 0.42 versus R 2 = 0.09, respectively). Compared with group B, patients in group A had significantly higher C2C7SVA values, more levels of fusion, and more smokers. The sensitivity, specificity, accuracy, and discrimination of the model were, respectively, 73.5%, 84%, 78.8%, and 85.65%.
CONCLUSION
The causes of revision surgery in cervical myelopathic patients after anterior cervical corpectomy and fusion/anterior cervical diskectomy and fusion are multifactorial. (T1S-CL)-C2S mismatch and high C2C7SVA are the best cervical sagittal parameters that increase the odds of revision surgery, and the effect is more enhanced when comorbidities such as smoking, low bone-mineral density, and increased levels of fusion are taken into account.
Topics: Humans; Spinal Fusion; Cervical Vertebrae; Female; Reoperation; Male; Middle Aged; Spinal Cord Diseases; Aged; Radiculopathy; Lordosis; Adult; Retrospective Studies
PubMed: 38595101
DOI: 10.5435/JAAOS-D-23-00565