Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis

Chen, Binglin; Guo, Jiamei; Zhang, Hongwei; Zhang, Yajun; Zhu, Yi; Zhang, Juan; Hu, Hongpu; Zheng, Yili; Wang, Xueqiang

doi:10.1177/0269215517719952

Cited by 98 publications

(84 citation statements)

References 26 publications

(79 reference statements)

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“…10,27,40 Several studies have focused on patient-reported outcomes (PROs) as metrics of patient satisfaction. 9,43,44 Surveys like the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) were developed to objectify patient satisfaction, but that instrument's 29 questions target broader patient experiences that lack applicability to surgical specialties. 14 In their article on the evolution of HCAHPS in spine surgery, Malpani et al concluded that the metric links hospital remuneration to patient satisfaction.…”

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confidence: 99%

Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery

Macki¹,

Alvi

Kerezoudis

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEAs compensation transitions from a fee-for-service to pay-for-performance healthcare model, providers must prioritize patient-centered experiences. Here, the authors’ primary aim was to identify predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery.METHODSThe Michigan Spine Surgery Improvement Collaborative (MSSIC) was queried for all lumbar operations at the 1- and 2-year follow-ups. Predictors of patients’ postoperative contentment were identified per the North American Spine Surgery (NASS) Patient Satisfaction Index, wherein satisfied patients were assigned a score of 1 (“the treatment met my expectations”) or 2 (“I did not improve as much as I had hoped, but I would undergo the same treatment for the same outcome”) and unsatisfied patients were assigned a score of 3 (“I did not improve as much as I had hoped, and I would not undergo the same treatment for the same outcome”) or 4 (“I am the same or worse than before treatment”). Multivariable Poisson generalized estimating equation models were used to report adjusted risk ratios (RRadj).RESULTSAmong 5390 patients with a 1-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by higher body mass index (RRadj =1.07, p < 0.001), African American race compared to white (RRadj = 1.51, p < 0.001), education level less than high school graduation compared to a high school diploma or equivalent (RRadj = 1.25, p = 0.008), smoking (RRadj = 1.34, p < 0.001), daily preoperative opioid use > 6 months (RRadj = 1.22, p < 0.001), depression (RRadj = 1.31, p < 0.001), symptom duration > 1 year (RRadj = 1.32, p < 0.001), previous spine surgery (RRadj = 1.32, p < 0.001), and higher baseline numeric rating scale (NRS)–back pain score (RRadj = 1.04, p = 0.002). Conversely, an education level higher than high school graduation, independent ambulation (RRadj = 0.90, p = 0.039), higher baseline NRS–leg pain score (RRadj = 0.97, p = 0.013), and fusion surgery (RRadj = 0.88, p = 0.014) decreased dissatisfaction.Among 2776 patients with a 2-year follow-up, 22% reported dissatisfaction postoperatively. Dissatisfaction was predicted by a non-white race, current smoking (RRadj = 1.26, p = 0.004), depression (RRadj = 1.34, p < 0.001), symptom duration > 1 year (RRadj = 1.47, p < 0.001), previous spine surgery (RRadj = 1.28, p < 0.001), and higher baseline NRS–back pain score (RRadj = 1.06, p = 0.003). Conversely, at least some college education (RRadj = 0.87, p = 0.035) decreased the risk of dissatisfaction.CONCLUSIONSBoth comorbid conditions and socioeconomic circumstances must be considered in counseling patients on postoperative expectations. After race, symptom duration was the strongest predictor of dissatisfaction; thus, patient-centered measures must be prioritized. These findings should serve as a tool for surgeons to identify at-risk populations that may need more attention regarding effective communication and additional preoperative counseling to address potential barriers unique to their situation.

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confidence: 99%

Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery

Macki¹,

Alvi

Kerezoudis

et al. 2020

Journal of Neurosurgery: Spine

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“…[ 1 , 2 ] About 80% of the patients suffered from sciatica caused by LDH, which imposes heavy burden on society, families, and individuals. [ 3 , 4 ] In these cases, 10% to 20% of the patients received conservative treatment, but the pain continued, and surgery should be considered. [ 5 ] Compared with open lumbar microdiscectomy, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of remarkable preservation of paravertebral structures, less bleeding, shorter operation time, and fewer complications, it is a common method for the treatment of LDH.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of bilateral intervertebral foramen block for pain management in percutaneous endoscopic lumbar discectomy

Sang

Shan²,

Hu³

et al. 2020

Medicine

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Background: Compared with open lumbar microdiscectomy, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of remarkable preservation of paravertebral structures, less bleeding, shorter operation time and fewer complications, it is a common method for the treatment of lumbar disc herniation (LDH). Local anesthesia is recommended during PELD. However, intraoperative pain is sometimes difficult to control satisfactorily. The efficacy of bilateral intervertebral foramen block (IFB) for pain management in PELD remains unclear. Therefore, this regimen is utilized in a randomized controlled trial for the assessment the safety and effectiveness of bilateral IFB for PELD pain control. Method: This is a single center and randomized controlled trial which will be implemented from September 2020 to September 2021. This research protocol is in accordance with the items of the Standard Protocol for Randomized Trials, which was authorized through the Ethics Committee of Huzhou Central Hospital & Affiliated Centre Hospital of Huzhou University (HZCH0465-0864). 100 participants who undergo PELD will be analyzed. Inclusion criteria contains patients diagnosed with LDH undergoing PELD; people between the ages of 18 and 75; consistent imaging evidence of herniation at a same level (CT or MRI); receive conservative treatment for 2 months. The exclusion criteria contains: patients with the history of severe renal and hepatic dysfunction; more than 1 responsible level LDH combined with other spinal diseases needing advanced surgical treatment (such as fracture, spondylolisthesis, lumbar spinal stenosis, tumor, etc.); Patients have mental illness that will prevent their willingness to participate in the study. Patients will be randomly divided into bilateral IFB group (with 50 patients) and local infiltration analgesia group (with 50 patients). Primary outcomes are pain score at different time points. The secondary outcomes are the operative time, radiation exposure time, length of hospital stay and postoperative complications. All the analysis is implemented through applying the IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, NY, USA). Results: The clinical outcome variables between groups are illustrated in the Table 1. Conclusion: This investigation can offer a reliable basis for the effectiveness and safety of IFB in treating the PELD pain. Trial registration: This study protocol is registered in Research Registry (researchregistry5985).

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“…Lumbar disc herniation is the most common diagnosis among degenerative disorders of the lumbar spine, affecting 2 to 3% of the population, and is the main cause of spinal surgery in the adult population [1][2][3]. Wiltse et al [4] reported that the lateral lumbar spinal canal can be subdivided into three regions: the subarticular (lateral recess), foraminal (pedicle), and extraforaminal (far lateral) zone.…”

Section: Introductionmentioning

confidence: 99%

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

Wang

Zhang

Tang

et al. 2020

Preprint

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Background Surgical management of lumbar disc herniation in the hidden zone is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce a safe and effective technique named microscopic extra-laminar sequestrectomy (MELS) for treatment of hidden zone lumbar disc herniation and present clinical outcomes within a two year follow-up period. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with hidden zone lumbar disc herniation were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and herniated fragment were visually exposed using this extra-laminar approach. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 months, ranging from 18 to 24 months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is a safe and effective method in the management of hidden zone lumbar disc herniation. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis

Abstract: Low-quality evidence suggested that surgical treatment is more effective than non-operative treatment in improving physical functions; no significant difference was observed in adverse events. No firm recommendation can be made due to instability of the summarized data.

Cited by 98 publications

References 26 publications

Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery

Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery

The efficacy of bilateral intervertebral foramen block for pain management in percutaneous endoscopic lumbar discectomy

Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

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