Intra- and Postoperative Complications in Lumbar Disc Surgery

Stolke, D.; Sollmann, Wolf-Peter; Seifert, Volker

doi:10.1097/00007632-198901000-00011

Cited by 282 publications

(123 citation statements)

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“…Incidence figures for dural lesions in disc surgeries seem to be in the region of 2-6% [13,16,20] with previous surgery being a strong predictor of the complication. In spinal stenosis surgery higher figures should be expected to be encountered due to the wider exposure of the dural sac and to the difficulties created by ligamentous hypertrophy and osteophytes on the facet joints in decompression especially afflicting the nerve roots but also the central cauda.…”

Section: Discussionmentioning

confidence: 99%

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

2011

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Introduction Decompression for lumbar spinal stenosis is one of the most frequent operations on the spine today. The most common complication seems to be a peroperative dural lesion. There are few prospective studies on this complication regarding incidence and effect on long-term outcome; this is the background for the current study. Materials and methods Swespine, the Swedish Spine Register documents the majority ([80%) of lumbar spine operations in Sweden today. Within the framework of this register, totally 3,699 operations for spinal stenosis during a 5-year period were studied regarding complications and 1-year postoperative outcome. Mean patient age was 66 (37-92) years and 44% were males. Fourteen percent were smokers and 19% had undergone previous lumbar spine surgery. Results The overall incidence of a peroperative dural lesion was 7.4%, 8.5% of patients undergoing decompressive surgery only and 5.5% of patients undergoing decompressive surgery ? fusion (p \ 0.001). A logistic regression analysis demonstrated that (high) age (p \ 0.0004), previous surgery (p \ 0.036) and smoking (p \ 0.049) were significantly predictive factors for dural lesions. An odds ratio estimate demonstrated an age-related risk increase with 2.7% per year. The risk for dural lesions also increased with number of levels decompressed. The 1-year outcome was identical in the two groups with and without a dural lesion.Conclusion A dural lesion was seen in 7.4% of decompressive operations for spinal stenosis. High age, previous surgery and smoking were risk factors for sustaining a lesion, which, however, did not affect the 1-year outcome negatively.

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Section: Discussionmentioning

confidence: 99%

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

2011

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“…In the large prospective SPORT study, an incidence of 4% is related [14]. Contrasting results concerning the effect of dural lesion on the long-term follow-up exist where several authors [3,6,10] did not report inferior outcome after this complication while in a recent pair matched study [8] the long-term outcome in lumbar disc herniation surgery was inferior in the group afflicted with an incidental durotomy.…”

Section: Introductionmentioning

confidence: 96%

Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome

2009

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In lumbar disc herniation surgery, dural lesions seem to be the most common complication today. Studies on incidence of and outcome after a dural lesion are mainly based on retrospective studies. In a prospective study within the framework of the Swedish Spine Register, 4,173 patients operated on for lumbar disc herniation were evaluated using pre-and 1-year postoperative protocols and complication registration. Mean patient age was 41 (18-81) years and 53% of the patients were male. 93% of the operations were performed on the two lowermost lumbar levels. The incidence of dural lesions in the material was 2.7%. In patients with previous disc surgery, the incidence was doubled, 5%, a significant increase (P = 0.02). Patients with dural lesions preoperatively had more back pain and inferior scores in general health and role emotional domains of the SF-36. These factors, however, were because they had been operated on previously, not related to the dural lesion as such. The relative improvement after surgery was similar whether a dural lesion had occurred or not. It is concluded that a dural lesion is a technical complication which must be solved at the time of surgery but which does not bear any negative implications on the long-term outcome for the patient.

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“…Some authors believe that repeat discectomy is the treatment of choice, with similar clinical results compared to the primary procedure [3,12], but approach-related complications can be considerable. Scar tissue makes a repeated discectomy more difficult, increasing the risk of dural tear or nerve injury [11,14].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion

Chen

Zhao

Ai-gang

et al. 2008

International Orthopaedics (SICO

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Between 2001 and 2005, 43 patients (average age 54.2, range 36-68 years) with recurrent lumbar disc herniation underwent reoperation with the transforaminal lumbar interbody fusion (TLIF) technique at our unit. All cases were followed up for 24-72 months (mean 45 months) and graded using the Japanese Orthopaedic Association (JOA) score system pre-and post-operation and during the follow-up period. The leg pain of all patients was relieved significantly within one month postoperatively. The mean JOA score was improved from 9.3 before surgery to 25.0 at the final follow-up visit (P<0.0001). The average recovery rate was 86.0% (range 52-100%). General clinical outcome was excellent in 23 (53.5%) patients, good in 14 (32.6%) and fair in 6 (13.9%). The fusion rate was 100% two years postoperatively. Three patients (7%) had transient neurological deficits, which resolved completely within 3 months. There were no major complications. We, therefore, believe the TLIF technique to be an effective procedure with satisfactory clinical results for the treatment of recurrent lumbar disc herniation.Résumé Entre 2001 et 2005, 43 patients (âge moyen 54,2 ans entre 36 à 68 ans) ont bénéficié d'une réintervention chirurgicale avec arthrodèse inter corporéale par technique transforaminale pour récidive de hernie discale lombaire. Tous ces patients ont été suivis en moyenne pendant 45 mois et évalués selon le score de la JOA en pré et post opératoire. Les douleurs des membres de tous ces patients ont été nettement améliorées dans le premier mois post opératoire. Le score de la JOA a été également améliorée de 9,3 avant l'intervention à 25 lors de la dernière revue de ces malades (P<0,0001). Le taux moyen de récupération a été de 86% (52 à 100%). L'évolution clinique générale a été excellente chez 23 patients (53,5%), bonne chez 14 patients (32,6%) et médiocre chez 6 patients (13,9%). Le taux de fusion a été de 100% en post opératoire. 3 patients (7%) ont eu des troubles neurologiques transitoires qui ont complète-ment régressé dans les trois mois. Il n'y a pas eu de complications majeures. L'étude technique TLIF est une technique efficace qui nous donne satisfaction dans le traitement des récidives de hernies discales lombaires.

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Intra- and Postoperative Complications in Lumbar Disc Surgery

Cited by 282 publications

References 0 publications

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

Dural lesions in decompression for lumbar spinal stenosis: incidence, risk factors and effect on outcome

Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome

Surgical treatment of recurrent lumbar disc herniation by transforaminal lumbar interbody fusion

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