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European Spine Journal : Official... Jun 2024To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.
PURPOSE
To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.
METHODS
Patients ≥ 18 years who underwent a single-level lumbar microdiscectomy from 2014 to 2021 at a single academic institution were retrospectively identified. Patient-reported outcomes (PROMs) were collected at preoperative, three-month, and one-year postoperative time points. PROMs included the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS Back and VAS Leg, respectively), and the mental and physical component of the short form-12 survey (MCS and PCS). The minimum clinically important differences (MCID) were employed to compare scores for each PROM. Patients were categorized as having worse mental health or better mental health based on a MCS threshold of 50.
RESULTS
Of 210 patients identified, 128 (61%) patients had a preoperative MCS score ≤ 50. There was no difference in 90-day surgical readmissions or spine reoperations within one year. At 3- and 12-month time points, both groups demonstrated improvements in all PROMs (p < 0.05). At three months postoperatively, patients with worse mental health had significantly lower PCS (42.1 vs. 46.4, p = 0.004) and higher ODI (20.5 vs. 13.3, p = 0.006) scores. Lower mental health scores were associated with lower 12-month PCS scores (43.3 vs. 48.8, p < 0.001), but greater improvements in 12-month ODI (- 28.36 vs. - 18.55, p = 0.040).
CONCLUSION
While worse preoperative mental health was associated with lower baseline and postoperative PROMs, patients in both groups experienced similar improvements in PROMs. Rates of surgical readmissions and reoperations were similar among patients with varying preoperative mental health status.
Topics: Humans; Diskectomy; Male; Female; Middle Aged; Adult; Retrospective Studies; Patient Reported Outcome Measures; Treatment Outcome; Lumbar Vertebrae; Aged; Mental Health
PubMed: 38630247
DOI: 10.1007/s00586-023-08090-9 -
World Neurosurgery Apr 2023Postoperative recurrence of percutaneous endoscopic lumbar disc increases the physical damage and financial burden on patients and negatively affects physicians'... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Postoperative recurrence of percutaneous endoscopic lumbar disc increases the physical damage and financial burden on patients and negatively affects physicians' treatment decisions. We conducted this meta-analysis to explore the risk factors for postoperative recurrence of percutaneous endoscopic lumbar disc for lumbar disc herniation.
METHODS
We conducted article search in the PubMed, EMBASE and Cochrane Library databases. PRISMA guidelines were followed in this review. The data are statistically analyzed by the Roundup Manager (version 3.6.1). The results of the meta-analysis are presented in the form of forest-like plots.
RESULTS
We included 13 articles and identified 7524 cases. Patients with older age (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.18-1.40), higher body mass index (OR = 1.16, 95% CI: 1.05-1.28), smoker (OR = 1.73, 95% CI: 0.95-3.15), degenerative grades ≥3 (OR = 6.07, 95% CI: 2.81-13.11), and postoperative sagittal motion ≥10° (OR = 2.42, 95% CI: 1.63-3.58) have a higher recurrence rate.
CONCLUSIONS
A thorough preoperative evaluation is essential to prevent postoperative recurrence of percutaneous endoscopic lumbar discectomy. The study addresses several factors of preoperative evaluation, which is hopeful to provide a reference for neurosurgeons.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Treatment Outcome; Lumbar Vertebrae; Diskectomy; Endoscopy; Risk Factors; Retrospective Studies
PubMed: 36764451
DOI: 10.1016/j.wneu.2023.02.009 -
Revista Espanola de Cardiologia... Dec 2022
Topics: Humans; Diskectomy; Dyspnea; Treatment Outcome
PubMed: 35809891
DOI: 10.1016/j.rec.2022.07.001 -
World Neurosurgery Dec 2022Endoscopic lumbar discectomy has been an alternative for treating lumbar disc herniation. Evidence-based study for the benefit zone of full-endoscopic lumbar discectomy... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Endoscopic lumbar discectomy has been an alternative for treating lumbar disc herniation. Evidence-based study for the benefit zone of full-endoscopic lumbar discectomy (FELD) is necessary. The study compared the complication risks between the FELD and open discectomy or microdiscectomy.
METHODS
The literature search was from 4 online databases for randomized controlled trials (RCTs) and cohort studies. The meta-analysis of different study designs was conducted separately. Complication rates were considered primary outcomes, and the recurrence and revision rates were considered secondary outcomes.
RESULTS
Six RCTs and thirteen cohort studies met the eligibility criteria. The meta-analysis was conducted separately. From the pooled RCT meta-analysis, the overall complication rates of FELD and open discectomy/microdiscectomy were 5.5% and 10.4%, respectively. The moderate-quality evidence suggested that FELD had a lower risk of overall complications (risk ratio [RR] = 0.55, 95% confidence interval [CI] = 0.31-0.98). There was no significant difference in specific complications and recurrence. The analysis of cohort studies revealed no significant difference in overall complications, but there was significant heterogeneity in the results. The risk of dural injury was significantly lower for FELD (RR = 0.46, 95% CI = 0.22-0.96). The pooled meta-analysis from cohort studies suggested a higher risk of transient dysesthesia (RR = 3.70, 95% CI = 1.54-8.89), residual fragment (RR = 5.29, 95% CI = 2.67-10.45), and revision surgeries (RR = 1.53, 95% CI = 1.12-2.08) for FELD.
CONCLUSIONS
The current evidence showed a lower risk of overall complications for FELD. The quality of evidence was moderate to low, and the risk of bias from the primary literature should be concerned.
Topics: Humans; Lumbar Vertebrae; Diskectomy; Intervertebral Disc Displacement; Endoscopy; Reoperation; Diskectomy, Percutaneous; Treatment Outcome
PubMed: 36527213
DOI: 10.1016/j.wneu.2022.06.023 -
Spine Jan 2021Retrospective database analysis.
STUDY DESIGN
Retrospective database analysis.
OBJECTIVE
This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older.
SUMMARY OF BACKGROUND DATA
Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined.
METHODS
The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared.
RESULTS
The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement.
CONCLUSION
Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates.
LEVEL OF EVIDENCE
3.
Topics: Aged; Aged, 80 and over; Cohort Studies; Comorbidity; Databases, Factual; Decompression, Surgical; Diskectomy; Female; Humans; Laminectomy; Lumbar Vertebrae; Lumbosacral Region; Male; Medicare; Middle Aged; Postoperative Complications; Reoperation; Retrospective Studies; Spinal Fusion; United States
PubMed: 32925688
DOI: 10.1097/BRS.0000000000003686 -
European Spine Journal : Official... Mar 2023Various factors have been examined in relation to cage subsidence risk, including cage material, cage geometry, bone mineral density, device type, surgical level, bone... (Review)
Review
PURPOSE
Various factors have been examined in relation to cage subsidence risk, including cage material, cage geometry, bone mineral density, device type, surgical level, bone graft, and patient age. The present study aims to compare and synthesize the literature of both clinical and biomechanical studies to evaluate and present the factors associated with cage subsidence.
METHODS
A comprehensive search of the literature from January 2003 to December 2021 was conducted using the PubMed and ScienceDirect databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Following the screening for inclusion and exclusion criteria, a total of 49 clinical studies were included. Correlations between clinical and biomechanical studies are also discussed.
RESULTS
Patients treated with the cage and plate combination had a lower subsidence rate than patients with the stand-alone cage. Overall, Polyetheretherketone material was shown to have a lower subsidence rate than titanium and other materials. The subsidence rate was also higher when the surgery was performed at levels C5-C7 than at levels C2-C5. No significant correlation was found between age and cage subsidence clinically.
CONCLUSIONS
Cage subsidence increases the stress on the anterior fixation system and may cause biomechanical instability. Severe cage subsidence decreases the Cobb angle and intervertebral height, which may cause destabilization of the implant system, such as screw/plate loosening or breakage of the screw/plate. Various factors have been shown to influence the risk of cage subsidence. Examining clinical research alongside biomechanical studies offers a more comprehensive understanding of the subject.
Topics: Humans; Diskectomy; Polyethylene Glycols; Ketones; Bone Plates; Bone Screws
PubMed: 36708398
DOI: 10.1007/s00586-023-07530-w -
Journal of Neurological Surgery. Part... Nov 2019The insertion of available cervical retractor systems is relatively complex for the limited exposure required for single-level anterior cervical diskectomy.
BACKGROUND
The insertion of available cervical retractor systems is relatively complex for the limited exposure required for single-level anterior cervical diskectomy.
OBJECTIVE
To introduce a novel cervical retractor system and report the initial experience of its application.
METHODS
A simple retractor system was designed that is fixed to the vertebral body through Caspar pins. The design allows the retractor to move with the vertebrae during distraction via the traditional Caspar distractor system. The advantages and limitations of the device based on the initial experience are discussed.
RESULTS
The author has used the current version of the retractor on 32 single-level anterior cervical diskectomies. The insertion of the retractor is easy, and its application provides safe and satisfactory anterior cervical exposure. There have not been related complications, although transient dysphagia has not been prevented.
CONCLUSION
This newly designed retractor system is simple and efficient for a single-level anterior cervical diskectomy, and its insertion is relatively easy.
Topics: Cervical Vertebrae; Diskectomy; Humans; Spinal Fusion; Surgical Instruments
PubMed: 31408888
DOI: 10.1055/s-0039-1685182 -
Operative Neurosurgery (Hagerstown, Md.) Nov 2021
Topics: Diskectomy; Foraminotomy; Humans
PubMed: 34634108
DOI: 10.1093/ons/opab362 -
Pain Physician Nov 2023Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery... (Clinical Trial)
Clinical Trial
Comparison of Percutaneous Endoscopic Transforaminal and Interlaminar Approaches in Treating Adjacent Segment Disease Following Lumbar Decompression Surgery: A Clinical Retrospective Study.
BACKGROUND
Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery (PELD) has been used to treat ASD through either a transforaminal or interlaminar approach. However, to our limited knowledge there are no reports comparing the 2 approaches for treating ASD.
OBJECTIVE
To evaluate clinical outcomes of PELD in treating ASD and comparing the surgical results and complications between the 2 approaches. This may be helpful for spinal surgeons when decision-making ASD treatment.
STUDY DESIGN
A clinical retrospective study.
SETTING
This study was conducted at the Department of Orthopedics of the Affiliated Hospital of Qingdao University.
METHODS
From January 2015 through December 2019, a total of 68 patients with ASD who underwent PELD after lumbar posterior decompression with fusion surgery were included in this study. The patients were divided into a percutaneous endoscopic transforaminal decompression (PETD) group and a percutaneous endoscopic interlaminar decompression (PEID) group according to the approach used. The demographic characteristics, radiographic and clinical outcomes, and complications were recorded in both groups through a chart review.
RESULTS
Of the 68 patients, 40 underwent PEID and 28 patients underwent PETD. Compared with their preoperative Visual Analog Scale (VAS) pain score and Oswestry Disability Index (ODI) score, all patients had significant postoperative improvement at 3 months, 6 months, one year and at the latest follow-up. There were no significant statistical differences in the VAS and ODI scores between PETD and PEID groups with a P value > 0.05. There was a significant statistical difference in the average fluoroscopy times between the PETD and PEID groups with a P value = 0.000. Revision surgery occurred in 8 patients: 6 patients who underwent PETD and 2 patients who underwent PEID. The revision rate showed a significant statistical difference between the 2 approaches with a P value = 0.039.
LIMITATIONS
Firstly, the number of patients included in this study was small. More patients are needed in a further study. Secondly, the follow-up time was limited in this study. There is still no conclusion about whether the primary decompression with instruments will increase the reoperation rate after a PELD, and a longer follow-up is needed in the future. Thirdly, this study was a clinical retrospective study. Randomized or controlled trials are needed in the future in order to achieve a higher level of evidence. Fourthly, there were debates about PELD approach choices for ASDs, which may affect the comparison results between PETD and PEID. In our study, the approaches were mainly determined by the level and types of disc herniation, and the surgeons' preference. More patients with an ASD with different levels and types of disc herniation and surgical approaches are needed in the future to eliminate these biases.
CONCLUSION
Percutaneous endoscopic lumbar decompression surgery is a feasible option for ASD following lumbar decompression surgery with instruments. Compared with PETD, PEID seems to be a better approach to treat symptomatic ASDs.
Topics: Humans; Decompression; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 37976490
DOI: No ID Found -
Neurosurgical Review Jul 2023Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic... (Meta-Analysis)
Meta-Analysis Review
Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic lumbar discectomy (PELD). There are reports in the literature on the identification of risk factors associated with rLDH; however, the results are controversial. Therefore, we conducted a meta-analysis to identify risk factors for rLDH among patients following spinal surgery. PubMed, EMBASE, and the Cochrane Library were searched without language restrictions from inception to April 2018 for studies reporting risk factors for LDH recurrence after PELD. MOOSE guidelines were followed in this meta-analysis. We used a random effects model to aggregate odds ratios (ORs) with 95% confidence intervals (CIs). The evidence of observational studies was classified into high quality (class I), medium quality (class II/III), and low quality (class IV) based on the P value of the total sample size and heterogeneity between studies. Fifty-eight studies were identified with a mean follow-up of 38.8 months. Studies with high-quality (class I) evidence showed that postoperative LDH recurrence after PELD was significantly correlated with diabetes (OR, 1.64; 95% CI, 1.14 to 2.31), the protrusion type LDH (OR, 1.62; 95% CI, 1.02 to 2.61), and less experienced surgeons (OR, 1.54; 95% CI, 1.10 to 2.16). Studies with medium-quality (class II or III) evidence showed that postoperative LDH recurrence was significantly correlated with advanced age (OR, 1.11; 95% CI, 1.05 to 1.19), Modic changes (OR, 2.23; 95% CI, 1.53 to 2.29), smoking (OR, 1.31; 95% CI, 1.00 to 1.71), no college education (OR, 1.56; 95% CI, 1.05 to 2.31), obesity (BMI ≥ 25 kg/m) (OR, 1.66; 95% CI, 1.11 to 2.47), and inappropriate manual labor (OR, 2.18; 95% CI, 1.33 to 3.59). Based on the current literature, eight patient-related and one surgery-related risk factor are predictors of postoperative LDH recurrence after PELD. These findings may help clinicians raise awareness of early intervention for patients at high risk of LDH recurrence after PELD.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Lumbar Vertebrae; Diskectomy; Risk Factors; Cohort Studies
PubMed: 37392260
DOI: 10.1007/s10143-023-02041-0