Central Lumbar Disc Herniation

Bärlocher, Christian B.; Krauss, Joachim K.; Seiler, Rolf W.

doi:10.1007/s007010070007

Cited by 22 publications

(24 citation statements)

References 17 publications

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“…Studies related to outcomes of central large herniations are a mixed bag without any emphasis on symptomatology. 1,[6][7][8] The results of discectomy in these studies are associated with a low satisfaction rate. 1,[6][7][8] This could be a result of varied inclusion criteria in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…1,[6][7][8] Postoperative outcomes of CLDH is not only poorer than the other more common forms of disc herniation, but they also differ remarkably among different studies. 1,[6][7][8] This could be due to varied inclusion and exclusion criteria and varied treatment options, making it a mixed bag where oranges were compared with apples. Maybe there is a need for classification of patients with CLDH based on their dominant presenting symptoms and the delineation of factors associated with poor outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

Kulkarni

Tapashetti

2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Discectomy alone or discectomy with fusion have been 2 polarized options in the management of large lumbar disc herniations presenting with leg-dominant pain in young patients. The objective of the study was to evaluate the outcomes of discectomy in young patients with large central lumbar disc herniation (CLDH) presenting with predominant leg pain. Material and Methods: Young patients (<45 years) presenting with predominant leg pain and MRI confirmed diagnosis of CLDH between April 2007-January 2017 were included in the study. All patients underwent tubular microdiscectomy. Outcomes of surgery were evaluated using visual analogue score (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Macnab’s criteria. Results: Ninety patients fulfilled the inclusion criteria. The mean age of patients was 34.9 years (range 19-45 years). Mean follow-up was 5.09 years (range 2-10 years). The incidence of CLDH in young adults was 30% and incidence among all “operated” lumbar disc herniations was 15.9%. The mean VAS for leg pain improved from 7.48 ± 0.9 to 2.22 ± 0.84 ( P < .05) and the mean ODI changed from 60.53 ± 7.84 to 18.33 ± 6.20 ( P < .05). Fifty-nine patients (65.6%) reported excellent, 25 patients (27.8%) reported good, 3 patients each (3.3%) as fair and poor outcomes respectively. Conclusion: Discectomy alone for CLDH with predominant leg pain is associated with high success rate and low need for a secondary surgical procedure. Patient selection in terms of leg-dominant pain may be the main attribute for lower incidence of recurrence, postoperative back-pain, and instability needing a secondary procedure. Minimally invasive discectomy may provide an added advantage of preserving normal spinal anatomy, thus minimizing the need for primary spinal fusion in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

Kulkarni

Tapashetti

2019

Global Spine Journal

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“…Other factors are related to the surgeon, such as experience or the use of the microscope. [15][16][17] The emergency situation is challenging because the surgeon must decide whether it is necessary to perform the operation immediately or whether it is safe to delay surgery to perform the operation during regular working hours. It has been reported that emergency surgery can present a risk factor by itself in other surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Emergency Lumbar Disk Operation: How Safe Is it?

Al-Afif¹,

Schwabe²,

Jabarin³

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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It was suggested that emergency operations could represent a risk factor for complications. The purpose of this study was to evaluate whether complication rates are higher in emergency lumbar disk operations compared with elective lumbar disk surgery. Patient data sets from 575 microscopic lumbar disk surgeries performed within a 5-year period were evaluated in a retrospective study design. There were 498 patients after excluding those who had surgery for recurrent disk herniation. Overall, 460 patients (92.4%) underwent elective surgery (nonemergency group), and 38 patients (7.6%) were operated on in an emergency setting (emergency group). The incidence of dural tears, the frequency of intra- and perioperative complications, the rate of recurrent disk herniation, and the length of hospital stay were evaluated. No statistically significant differences between the two groups were found with regard to the incidence of dural tears (7.9% in the emergency group, 4.3% in the nonemergency group; = 0.32), the rate of complications (2.6% in the emergency group, 2.8% in the nonemergency group; = 0.95), the rate of recurrent disk herniation (8.9% versus 10.5%; = 0.74), and the length of hospital stay ( = 0.22). Emergency lumbar disk surgery has a similar safety profile as elective surgery. Patients who present with acute or progressive neurologic deficits and need emergency surgery are not exposed to a higher risk of surgery.

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“…During surgery, patients were in the prone position and localized under a C-arm X-ray apparatus (Siemens, Berlin, Germany) (1). Body surface projections in the central line of processus spinosus of vertebra lumbalis and all horizontal lines at the upper edge of the target intervertebral disk were marked.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical symptoms of central lumbar disc herniation (CLDH) are varied (1). Pain symptoms typically occur on one or both sides of lower limbs.…”

Section: Introductionmentioning

confidence: 99%

Effects of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy on patients with central lumbar disc herniation

Qiang-jun

Cheng

et al. 2017

Experimental and Therapeutic Medicine

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The clinical effects and safety of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy (PTED) while treating patients with central lumbar disc herniation (CLDH) were explored. Patient cases of lumbar and leg pain treated in Bethune International Peace Hospital from July 2013 to October 2015 were collected retrospectively. The patients in these cases received imaging examinations such as computed tomography and magnetic resonance imaging. Among these cases, 37 CLDH patients with no other complications were selected for this study. A total of 22 males and 15 females aged 28–54 years, with an average age of 36.8±1.5 years, were the subjects of the study. Their disease course was from 1 month to 3 years, with a median course time of 1.5 years. Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scoring and the MacNab method were used to evaluate treatment effects. After permission from patients or their family members, release and decompression techniques of nerve roots were performed through PTED. All patients had successful surgery. Their average surgery time was 41.3 (25.5–57.1) min. A physician followed-up each patient from 0 to 18 months after surgery, with the average follow-up period of 12.1 months. VAS scoring of lower limbs was 7.95±0.82 before surgery and 2.28±0.35, 3 months after surgery. VAS scoring of lower limbs was 2.06±0.58, 1 year after surgery and 2.12±0.23 at the last follow-up appointment. JOA scoring was 12.6±0.72 before surgery and 20.4±1.08, 3 months after surgery. JOA scoring was 21.1±0.82 1 year after surgery and 21.2±0.36 at the last follow-up. Differences are of statistical significance (P<0.05). There were no complications for any of the cases. One patient did not improve after surgery, so a laminectomy and bone grafting internal fixation were performed. Two patients relapsed after surgery and received laminectomy and bone grafting internal fixation. The total percentage of excellent and good rates was 83.5%. In conclusion, release and decompression techniques on nerve roots using PTED while treating CLDH resulted in a safe, effective and less traumatic outcome with fewer complications and quicker pain relief than alternative treatments. Due to the results of this study, the use of these techniques in treating CLDH should be more widely considered.

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Central Lumbar Disc Herniation

Cited by 22 publications

References 17 publications

Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

Emergency Lumbar Disk Operation: How Safe Is it?

Effects of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy on patients with central lumbar disc herniation

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