Minimum 25-Year Outcome and Functional Assessment of Lumbar Discectomy

Mariconda, Massimo; Galasso, Olimpio; Secondulfo, V.; Rotonda, Giuseppe Della; Milano, Carlo

doi:10.1097/01.brs.0000240726.26096.be

Cited by 38 publications

(22 citation statements)

References 38 publications

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“…Though all the postoperative ODI means never reached the level of the CG population, for the majority of patients moderate disability was estimated. Our mid-term results suggest of substantial improvement in 1-2 years of observation attributed to studies [17,37,45], however, coincide with those short-term ones [6,7,41].…”

Section: Discussionsupporting

confidence: 81%

Clinical outcomes of patients with lumbar disc herniation, selected for one-level open-discectomy and microdiscectomy

2010

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The aim of our study was twofold: firstly, to compare the preoperative and postoperative results at midterm follow-up periods along with the data of the control group. Secondly, to evaluate the effectiveness among opendiscectomy and microdiscectomy surgical groups. In the present study, we investigated a cohort of 100 patients with the lumbar disc herniation causing low back pain compared to 100 subjects of the control group with the non-specific low back pain by applying physical activity, pain scale, Short Form 36 General Health Questionnaire and additional postoperative records of patient's satisfaction and complications level, consumption of analgesics, and return to work status. The quantitative analysis of all questionnaires showed substantial differences in the preoperative and postoperative groups. The best results were achieved at the second year follow-up period. However, there were no statistically significant differences in both the examined surgical subgroups (p [ 0.05). In addition, we estimated from moderate to great statistical significance (p \ 0.01-0.05) among preoperative and overall postoperative results: PHC and MHC in the SF-36, Oswestry and VAS. The total increased satisfaction, reherniation rate and return to work frequency comprised 40, 9 and 64%, respectively. The analgesics were still indicated for 21% of the patients. The results of the present study suggest of sufficient decompression in both surgical groups, as the health-related quality of life parameters (Oswestry, VAS and SF-36) were defined as clinically improved. Regardless of persisted minor pain in both areas, it remained greater in the low back than in the leg, which should be held for beneficial to decompressive surgery.

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Section: Discussionsupporting

confidence: 81%

Clinical outcomes of patients with lumbar disc herniation, selected for one-level open-discectomy and microdiscectomy

2010

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“…Long-term clinical results of the whole cohort have been reported elsewhere [20,22]. The age, gender, levels of herniation, and functional results as assessed by validated tools of participants were not significantly different from that of remnants of the cohort.…”

Section: Study Populationmentioning

confidence: 85%

“…Actually the relatively small sample size might be a greater problem for the effects not found than for those found and in the current study significant clinical radiographic relationships were detected despite the small study group. Moreover, our study group can be considered representative of the entire cohort, because patients had demographic and functional characteristics alike to patients not enrolled and similar to those recorded in other long-term studies [19,20,28,36]. Another issue is represented by the choice of the control group that is less than optimal in this study.…”

Section: Discussionmentioning

confidence: 98%

“…Discectomy is only a single event in the lifespan of patients with LDH and, as in the general population, LBP and/or leg pain is a frequent complaint in patients who had undergone this operation many years earlier [19,20,36]. These patients, often concerned for their previous operation, frequently undergo standard radiography, which is the most usual investigation for back problems in primary care [17], even because of its reassurance value [13].…”

Section: Discussionmentioning

confidence: 99%

“…Patients who had undergone lumbar discectomy many years earlier usually have a satisfactory functional outcome [20,28,36] but they often complain of residual low back pain (LBP) [19,20,36]. Plain radiography is frequently required in elderly people with LBP [17] because of its low cost and easy availability, although there is not evidence that the routine use of this imaging test is associated with an improvement in the outcome of these patients [7,17].…”

Section: Introductionmentioning

confidence: 99%

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Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests

et al. 2009

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The aim of this retrospective controlled study was to evaluate radiographic degeneration in the lumbar spine of patients who had undergone lumbar discectomy minimum 21 years earlier and its clinical meaning. Indeed, no previous investigation on degenerative changes occurring after lumbar discectomy with a comparable long follow-up has been published. The study participants consisted of 50 patients who had undergone discectomy for lumbar disc herniation. The mean length of follow-up was 25.3 ± 3.0 years. Patients were assessed by Short Form-36 Health Survey (SF-36), Oswestry Disability Index, and a study-specific questionnaire. Radiographic views of the lumbar spine were obtained from all patients and compared to those of 50 asymptomatic controls. A five-step published classification was used to assess the increasing severity of radiographic changes. CT or MRI scans were also available for 27 patients who had undergone discectomy. Moderate to severe radiographic changes were present in 45 patients (90%) and 34 controls (68%), respectively (P = 0.013). The most prevalent MRI/CT changes were loss of disc height (89%), facet joint arthritis (89%), and endplate changes (57%). Thirty-two of 33 subjects (97%) reporting pain during the last 12 months had significant degeneration on their radiographs, and the frequency of changes was higher with respect to subjects without pain (P = 0.040).In conclusion, standard lumbar discectomy frequently leads to long-term degenerative changes on imaging tests. The presence of moderate to severe degeneration is associated with self-reported pain.

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Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy

Zhang

2013

Clinical Anatomy

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Posterior lateral endoscopic nucleotomy is widely accepted as a minimally invasive surgery for lumbar disc herniation, but few studies have compared the transforaminal approach using two different techniques, YESS and TESSYS. One hundred and fifty lumbar IVFs of cadaveric spines were studied. Eighteen-gauge needles were inserted percutaneously toward IVFs into the discs by either YESS or TESSYS. The distances from the needle to the nerve root and from the needle to the spinal dura were measured and compared across different spinal segments. The incidence of nerve roots compression by the operating endoscope was measured. The mean distances from needle to the nerve root and spinal dura in YESS were 3.5 ± 1.4 mm and 6.6 ± 1.9 mm. The respective mean distances in TESSYS were 4.6 ± 1.5 mm and 5.9 ± 1.4 mm. The distance from needle to the nerve root was longer in TESSYS, while the distance from the needle to spinal dura was longer in YESS. The distance from needle to nerve was shorter in proximal segments. The incidence of operating endoscope compression of the nerve root was high in both of techniques. The difference in theory and design between YESS and TESSYS, "intradisc" versus "intracanal", was confirmed by comparison of anatomic distances from the needle to the nerve. Puncture of the annulus in the distal lumbar is safer than proximal puncture. The high incidence of endoscope compression of the nerve root may be related with the transient postoperative dysaesthesia.

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Minimum 25-Year Outcome and Functional Assessment of Lumbar Discectomy

Abstract: Patients who had undergone lumbar discectomy a minimum of 25 years earlier have a satisfactory self-reported health-related quality of life and less pain than nonsurgically treated subjects.

Cited by 38 publications

References 38 publications

Clinical outcomes of patients with lumbar disc herniation, selected for one-level open-discectomy and microdiscectomy

Clinical outcomes of patients with lumbar disc herniation, selected for one-level open-discectomy and microdiscectomy

Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests

Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy

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