Herniated discs: when is surgery necessary?

Yoon, Wai Weng; Koch, Jonathan E. J.

doi:10.1302/2058-5241.6.210020

Cited by 38 publications

(24 citation statements)

References 29 publications

(46 reference statements)

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“…Periradicular CT-guided infiltrations with local anesthetics and corticosteroids can confirm a diagnosis when foraminal disc herniation is present, and the patient is suffering predominantly from radicular pain. A long-lasting therapeutic effect was not seen in our case, and decompressive surgery was performed [9] .…”

Section: Clinical Discussioncontrasting

confidence: 54%

Spinal surgery for gallstones disease – Case report of a rare differential diagnosis

Linke

Schoen

Fourie

et al. 2022

International Journal of Surgery Case Reports

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Section: Clinical Discussioncontrasting

confidence: 54%

Spinal surgery for gallstones disease – Case report of a rare differential diagnosis

Linke

Schoen

Fourie

et al. 2022

International Journal of Surgery Case Reports

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“…Lumbar disc herniation (LDH) is a primary cause of back pain and sciatica, affecting 1% to 5% of the population annually [ 1 ]. Although nonsurgical care remains the mainstay of initial treatment, discectomy surgery is applied to effectively alleviate symptoms that persist for prolonged periods of time [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

et al. 2022

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Background Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. Methods The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. Results The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. Conclusions Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.

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“…To manage cervical pain, the transformation from conservative to surgical intervention remains controversy, due to the lack of high-quality clinical evidence 22 . Consequently, about two thirds of patients reported intolerant pain and incapacity after conservative treatment 23 .…”

Section: Discussionmentioning

confidence: 99%

Feasibility study of ultrasound-guided percutaneous laser discectomy for cervical radicular pain

Zhu

Zhou

et al. 2022

Sci Rep

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Percutaneous laser discectomy is one common and effective treatment for cervical radicular pain. Currently, the surgery is performed with blind cannulation technique, mainly relies on the experience of surgeon. However, it still remains unsafe and difficult to reach the target. As an alternative, ultrasound-guided cannulation provides visualization of important structures, thus increasing the precision and safety. The primary goal of this study is to report the detail of the ultrasound-guided technique in the percutaneous laser cervical discectomy. The secondary purpose is to evaluate the feasibility of the novel therapy. This is a single center, feasibility study conducted in one teaching hospital. Thirteen intervertebral discs in 9 patients presented with cervical radicular pain. Accuracy of the cannulation with ultrasonic guidance was confirmed by the anterior–posterior and lateral view of fluoroscopy. We compared the pain severity pre- and post-treatment with Visual Analogue Score (VAS), and functional improvement was assessed with the modified Macnab Criteria and Neck Disability Index (NDI) respectively. Ultrasonic short-axis was used to scan the cervical nerve root, and its transition was used to identify the distinct intervertebral space. Following the recognition of targeted cervical level, the ultrasound probe was moved medially for the visualization of the surface of the cervical vertebrae. In plane cannulation was then applied to avoid the injury of the vessels. The location of cannula was confirmed by the fluoroscopic imaging. Low-power laser was set for the cervical disc ablation in this cohort. The majority of the surgical sites maintained in the C5/6 level (38%), and 31% for the C6/7 level respectively. Despite the distinct cervical level, the tip of needle was properly placed near by the targeted intervertebral disc in all participants, which was confirmed by the imaging of fluoroscopy. We did not observe any obvious complications during the procedure. The mean VAS decreased from 7.6 ± 1.1 to 2.3 ± 2.7 one month after discharge, and 2.1 ± 2.6 at the last follow-up (median duration of nine months). All patients reported significant improvement of NDI up to last follow-up (p = 0.011). Meanwhile, the good to excellent rate was reported in 8 of 9 patients (89%) according to the modified Macnab Criteria. The finding of this feasibility assessment indicates the ultrasound-based cannulation technique is capable of guiding the cannulation for the percutaneous laser discectomy. It may facilitate identifying the corresponding site of cervical intervertebral disc and prevent the damage of vessel.

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Herniated discs: when is surgery necessary?

Cited by 38 publications

References 29 publications

Spinal surgery for gallstones disease – Case report of a rare differential diagnosis

Spinal surgery for gallstones disease – Case report of a rare differential diagnosis

Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

Feasibility study of ultrasound-guided percutaneous laser discectomy for cervical radicular pain

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