Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: A prospective study

Nicassio, Nicola; Bobicchio, Paolo; Umari, Marzia; Tacconi, Leonello

doi:10.1016/j.jocn.2010.04.031

Cited by 24 publications

(34 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…2,3,9,[17][18][19]21,25,26,28,33,36,[41][42][43]45,49,[52][53][54][56][57][58]61 MED techniques employ a longitudinal paramedian incision through which a tubular retractor is placed and visualization is achieved through an endoscope. 2,6,10,13,19,24,25,29,36,46,51,53,57,60,62,64 Percutaneous discectomy entails placing a sheath directly into the disc space via a transforaminal approach, extraforaminal approach, or interlaminar approach and then using a suction/debrider or chemical injection to remove the disc.…”

Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

126

View full text Add to dashboard Cite

OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

show abstract

Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

126

View full text Add to dashboard Cite

show abstract

“…Lumbar microdiscectomy (LM) is one of the most common spinal procedures, and is usually performed under general anesthesia (GA) (18). However, spinal anesthesia (SA) provides a safe and highly satisfactory alternative to general anesthesia in patients undergoing limited lumbar surgery (17).…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, the risk associated with spinal anesthesia (SA) is rare and generally minor (25). In addition, SA may reduce the length of hospital stays and overall costs (18).…”

Section: Introductionmentioning

confidence: 99%

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Dağıstan¹,

Ökmen²,

Dağıstan³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

AIm:To compare the safety and efficacy of spinal anesthesia (SA) in patients undergoing lumbar microdiscectomy (LM). mAterIAl and methOds:We evaluated 180 patients who underwent LM between 1 January 2012 and 5 July 2013. Demographic, clinical, laboratory, and pre-, intra-, and postoperative information was determined from the patients' medical records. results:Total anesthetic times were longer in the general anesthesia (GA) group. There was less bleeding at the surgical site in the SA group. Intraoperative blood pressure was significantly also lower in the SA group. Meanwhile, tachycardia was significantly higher in the GA group. The analgesic requirement in post-anesthesia care unit (PACU) was higher in the general anesthesia group. At PACU admission, analgesic requirement, heart rate, and the mean arterial pressure were higher in the GA group. Postoperative nausea and vomiting was more frequent among patients recovering in general anesthesia group. SA patients had an increased incidence of urinary retention compared with GA patients. Pulmonary complications requiring specific treatment were insignificantly higher among GA patients. COnClusIOn:In patients who undergo lumbar disc surgery, SA is a good alternative for experienced surgeons because of a more comfortable healing process.

show abstract

“…[6] Several studies comparing spinal anaesthesia and general anaesthesia in lumbar disc surgery have reported spinal anaesthesia as the preferred method for lumbar spine surgery. [1,[5][6][7][8] In relation, some centres have been routinely performing regional anaesthesia for lumbar laminectomy and discectomy. [3] As a consequence of this current study, spinal anaesthesia was more frequently used anaesthetic approach.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Though recent controlled trials showed distinct results, there remains no consensus on the appropriate anaesthesia method for lumbar disc surgery. [4][5] Disadvantage of regional anaesthesia is the inability to resuscitate and administer CPR in any eventuality.…”

Section: Introductionmentioning

confidence: 99%

Comparative Retrospective Study on Anaesthesia Approaches for Lumbar Spine Surgery

S¹,

B²,

Roshankumar³

2016

jemds

View full text Add to dashboard Cite

OBJECTIVELumbar spinal surgeries have been performed with either spinal or general anaesthesia. In this study, we aimed to evaluate the superiority of either spinal or general anaesthesia on lumbar spine surgery. METHODSAfter approval of institutional ethical committee, we retrospectively analysed 270 patients (ASA I and II) undergoing surgery of lumbar spine from 2009 to 2015 by one surgeon. Of these 150 patients underwent general anaesthesia with controlled ventilation, 120 patients were offered spinal anaesthesia with conscious sedation. Patient records were reviewed to obtain demographic features, type of anaesthesia, baseline heart rate, mean arterial pressure, intraoperative maximum heart rate, mean arterial pressure, duration of surgery, amount of intravenous fluids, intraoperative blood loss, incidence of perioperative complications such as bleeding, nausea, vomiting, hypotension, bradycardia, and postoperative analgesic consumption. RESULTSPatient characteristics including baseline/intraoperative mean arterial pressure and heart rate values did not differ between groups. However, the spinal anaesthesia group experienced significantly shorter durations in the operating room and had a lower incidence of nausea, vomiting. Analgesic consumptions in general anaesthesia group was significantly higher than in spinal anaesthesia group. CONCLUSIONThe present study revealed that spinal anaesthesia is a safe and effective alternative to general anaesthesia for patients undergoing single level or two level lumbar laminectomy, discectomy, or even instrumentation below L2 level and has the advantage of decreased nausea, antiemetic, analgesic requirements, and fewer complications. It also ensures better postoperative recovery when compared to general anaesthesia.

show abstract

Lumbar microdiscectomy under epidural anaesthesia with the patient in the sitting position: A prospective study

Cited by 24 publications

References 11 publications

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Lumbar microdiscectomy under spinal and general anesthesia: a comparative study

Comparative Retrospective Study on Anaesthesia Approaches for Lumbar Spine Surgery

Contact Info

Product

Resources

About