Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation

Yan, Denglu; Zhang, Zaiheng; Zhang, Zhi

doi:10.1186/s12891-020-03302-5

Cited by 14 publications

(16 citation statements)

References 35 publications

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“…Our investigation was strictly focused on correlation between LDH and motor disturbances; numbness and sensitive disturbances, in fact, are frequently reported at the beginning of clinical presentation and strictly related to onset of pain, thus being difficult to prevent. 24 Moreover, sensitive impairment shows a weaker correlation with ODI score when compared with pain score and motor deficit, thus suggesting a lesser influence on social dysfunction. 25 Another possible limitation may be the fact that MRI images have been classified by only 1 reader; thus, the study considered neither intra-rater nor interrater variability.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection?

et al. 2021

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Background: Lumbar disc herniation (LDH) is the most common cause of radiculopathy; patients with severe pain refractory to conservative management or neurological deficits are candidates to surgical procedures. Michigan State University (MSU) classification is a radiological codification considering both the size of the LDH and its medial to lateral location on the axial plane. The purpose of this retrospective study is to identify which kind of LDH, according to the MSU scheme, is more likely to cause a motor deficit.Methods: We performed a retrospective analysis on data obtained from 114 patients treated with 117 lumbar microdiscectomies after failure of non-operative care. All patients underwent neurological and functional evaluation before and after surgery according to the following: Oswestry Disability Index, visual analog scale, and Japanese Orthopaedic Association back pain evaluation questionnaire. Magnetic resonance imaging proved that disc herniation was classified according to the MSU scheme and was correlated with motor disturbances expressed according to Medical Research Council grade.Results: Statistical analysis showed a significant correlation between the lateral location of disc herniation (preforaminal and extraforaminal LDH, respectively MSU B and MSU C) and the grade of muscle weakness, given that the LDH in these locations poorly responded to medical therapy and was at higher risk for motor deficit onset; no significant correlation with the size was observed.Conclusions: Beyond standardization of radiologic description, MSU classification proved to be useful in definition of prognosis and possibly in selection of surgical candidates. However, these data should be confirmed by prospective studies on a larger sample of patients, also including those under way for conservative treatment.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection?

et al. 2021

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“…In ammatory responses are known as a major component of secondary injury of initial ischemic insult and play an important role in modulating the pathogenesis of leg numbness [26,25]. The leg numbness symptoms were last longer in central disc herniation patients than in paracentral and foraminal disc herniation patients after surgery, which means the in ammatory response from herniated herniate disc fragments compression nerve may be an important factor in affection on it.…”

Section: Discussionmentioning

confidence: 99%

“…Although patients with leg pain and leg numbness pre-operation complain of leg numbness during or just after walking or standing not diminished after surgery, the leg numbness dismissed were 6 months post-operation in lateral herniation patients and 12 months post-operation in central herniation patients. Then, percutaneous one portal transforaminal endoscopic lumbar discectomy is the preferred minimally invasive approach in two-level disc herniation case due to less trauma, less blood lost, and short operation time, and faster recover [25].…”

Section: Discussionmentioning

confidence: 99%

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One Percutaneous Portal Endoscopic Discectomy in the Treatment of Two-Level Lumbar Disc Herniations Patients with Leg Pain and Numbness

Yan

Zhang

2020

Preprint

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Background: Although minimally invasive has been adopted in the treatment of lumbar disc herniation, there were no studies in literature of two-level lumbar disc herniations patients with leg pain and numbness treatment by one portal percutaneous endoscopic procedures. The purpose of this study was to evaluate the efficacy of one percutaneous portal transforaminal endoscopic lumbar discectomy techniques in the treatment of two-level lumbar disc herniations patients with leg pain and numbness. Methods: A total of 98 patients of two-level lumbar disc herniations who had one portal endoscopic surgery were categorized into two groups depending on the level number of endoscopic procedures. There were 51 patients had leg pain and leg numbness (A group), and 47 patients with leg pain (B group). One portal percutaneous endoscopic discectomy procedures were performed and the clinical outcomes were recorded. Results: The entry point of two levels disc herniations is planned by parallel to the plane of the proximal disc level and target to the site of distal disc herniation. The procedures in two levels disc herniations was performed beginning at proximal level in L3/4 with L4/5 herniation and distal level in L4/5 with L5/S1. There were no nerve root injury and dural tear of cerebrospinal fluid leakage complications. The postoperative disk and foramen height were no significant difference compare to preoperative in all patients (P > 0.05), and no significant difference between two groups (P > 0.05). The pain index and Oswestry Disability Index score were better than preoperational in all patients, and no significant difference between two groups (P > 0.05). The central disc herniation patients had more leg numbness than lateral disc herniation patients (P < 0.01). For patients with leg pain and leg numbness, the leg numbness release in lateral disc herniation patients were better than central herniation patients, and leg numbness dismissed were 6 months post-operation in lateral herniation patients and 12 months post-operation in central herniation patientsConclusions: Although two-level disc herniation present a significant challenge for spinal surgeon when adopted single portal techniques of endoscopic discectomy, one percutaneous portal transforaminal endoscopic lumbar discectomy was safe and minimally invasive techniques with faster recovery. For patients with leg pain and leg numbness, the central disc herniation patients had more leg numbness than lateral disc herniation patients, and the leg numbness release in lateral disc herniation patients were better than central herniation patients.

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“…Toyoda et al performed a cluster analysis on patients, and found that despite an improvement after spinal endoscopic surgery, cluster 4 patients retained severe leg numbness, postoperatively [ 8 ]. Yan et al showed that patients with central disc herniation displayed a longer duration of leg numbness after spinal endoscopic surgery than patients with paracentral disc herniation [ 9 ]. Ogura et al showed that 60% of patients retained leg numbness after spinal endoscopic surgery [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors in the Prediction of Leg Numbness after Spinal Endoscopic Surgery: Evaluation and Development of a Nomogram

Wang

Pan

et al. 2022

BioMed Research International

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Purpose. This study aims at constructing a clinical predictive model that predicted the risk factors for leg numbness after spinal endoscopic surgery. Methods. We collected the clinical data of patients, including general information, imaging parameters, and clinical score, from our hospital’s electronic database. Based on the postoperative leg numbness visual analog scale (LN-VAS), the clinical data were divided into the leg numbness group (≥25) and the improvement group (<25). All parameters were included in the least absolute shrinkage and selection operator (LASSO) regression analysis, while the parameters with the area under the curve (AUC) greater than 0.7 were selected to construct nomograms. Furthermore, the accuracy and validity of the model were evaluated using the C-index, decision curve analysis (DCA), calibration curve, and receiver operating characteristic curve (ROC). Results. A total of 73 patients’ clinical data were included in the training set, where 51 patients were assigned to the improvement group and 22 to the leg numbness group. The nomogram was constructed using four selected parameters, including symptom duration, lumbar spinal stenosis (LSS), pelvic incidence (PI), and preoperative low back pain visual analog scale (LBP-VAS). The nomogram predictions were found to range between 0.01 and 0.99. The values of the C-index, AUC, and internally validated C-index were 0.96, 0.96, and 0.94, respectively. Our result showed that the clinical net benefit of the nomogram ranged between 0.01 and 0.99. Conclusion. Our clinical prediction model demonstrated high predictive ability and clinical validity. Moreover, we found that symptom duration, LSS, PI, and preoperative LBP-VAS were the predictive risk factors for leg numbness after spinal endoscopic surgery.

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Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation

Cited by 14 publications

References 35 publications

Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection?

Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection?

One Percutaneous Portal Endoscopic Discectomy in the Treatment of Two-Level Lumbar Disc Herniations Patients with Leg Pain and Numbness

Risk Factors in the Prediction of Leg Numbness after Spinal Endoscopic Surgery: Evaluation and Development of a Nomogram

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