Comparison of Clinical Efficacy between Microendoscopic Discectomy and Open Discectomy in the Treatment of Patients with Lumber Intervertebral Disc Herniation / 昆明医科大学学报

Objective To compare clinical efficacy between microendoscopic discectomy (MED) and open discectomy (OD) in the treatment of patients with lumber intervertebral disc herniation (LIDH).Methods 116 cases of LIDH who were given surgical treatment were selected as research subjects to retrospectively analyze their clinical data.Then,these cases were divided into MED group (n=54) and OD group (n=62) according to operation type.The curative efficacy,operation situation and incidence of complications were compared.Results All patients' operations were successful.After the one-year follow-up,the MED group had an excellent and good rate of 96.3％,which was statistically same with that of 93.5％ in the OD group (P ＞0.05) In comparison with the OD group,MED group had a statistically shorter operation time,less bleeding volume in the operation,shorter length of incision and shorter rest time on bed after operation (all P＜0.05).After operation,there's no case of severe complication,and the incidence of complications between the two groups was statistically same (P＞0.05) Conclusions MED and OD are both effective operations for LIDH,which have high excellent and good rate.But in comparison with OD,MED has advantages of less damage and faster recovery.

Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion

OBJECTIVE: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection. METHODS: Twenty patients of lumbar open discectomy (LOD) and 20 patients of posterior lumbar interbody fusion (PLIF) were enrolled in this study. Preoperative and postoperative prophylactic antibiotics were administered routinely for 7 days. Blood samples were obtained one day before surgery and postoperative day (POD) 1, POD3, and POD7. Using repeated measures ANOVA, changes in effect measures over time and between groups over time were assessed. All data analysis was conducted using SAS v.9.1. RESULTS: Changes in CRP, within treatment groups over time and between treatment groups over time were both statistically significant F(3,120)=5.05, p=0.003 and F(1,39)=7.46, p=0.01, respectively. Most dramatic changes were decreases in the LOD group on POD3 and POD7. Changes in ESR, within treatment groups over time and between treatment groups over time were also found to be statistically significant, F(3,120)=6.67, p=0.0003 and F(1,39)=3.99, p=0.01, respectively. Changes in WBC values also were be statistically significant within groups over time, F(3,120)=40.52, p<0.001, however, no significant difference was found in between groups WBC levels over time, F(1,39)=0.02, p=0.89. CONCLUSION: We found that, dramatic decrease of CRP was detected on POD3 and POD7 in LOD group of non-infection and dramatic increase of ESR on POD3 and POD7 in PLIF group of non-infection. We also assumed that CRP would be more effective and sensitive parameter especially in LOD than PLIF for early detection of infectious complications. Awareness of the typical pattern of CRP, ESR, and WBC may help to evaluate the early postoperative course.

Clinical Results about More than 5 Years Follow-up after Open Discectomy

STUDY DESIGN: Retrospective study. OBJECTIVES: We analyzed to verify clinical result and recurrence of long term follow-up after open lumbar discectomy. SUMMARY OF LITERATURE REVIEW: There are many reports concerning the clinical result of open discectomy. However, long-term result is not frequently reported. MATERIALS AND METHODS: From 1989 to 2000, 289 patients underwent open discectomies. 142 patients who was followed more than 5 years were enrolled in this study. Follow-up rate, clinical outcome were analyzed as gender, age at the operation and operated level. Re-operation rate was analyzed as gender, age at the operation, operated level divided into same level-same side, same level-contralateral side and other level and the time at reoperation. Clinical outcomes were evaluated by Kim and Kim criteria. RESULTS: More than 5 years follow-up rate was 49.1%. Average follow-up period were 99.2 months. Clinically successful result was obtained in 75.4%, and it was not related with gender, age at the operation and operated level. Reoperations were needed in 21 patients(14.8%). Reoperation rate was not related with gender, age at the operation. Same level-same side reherniation were frequent before 6 months after first surgery, but other side and different level were similar more than 2 years after first surgery. CONCLUSIONS: Our clinical result was acceptable(75.4%). Main cause of reoperations before 6 months after first surgery was recurrence at the same level and same side, but cause of reoperation more than 2 years after first surgery were herniation at the other side and different level increased with time.

An Analysis of the Prognostic Factors Affecing the Clinical Outcomes of Conventional Lumbar Open Discectomy : Clinical and Radiological Prognostic Factors

STUDY DESIGN: This is a retrospective study. PURPOSE: We wanted to examine the clinical and radiological prognostic factors affecting the postoperative clinical outcome of patients with lumbar disc herniation and who underwent open discectomy. OVERVIEW OF LITERATURE: Conventional open discectomy has been widely used as a treatment regimen for the management of lumbar disc herniation. Still, much controversy exists regarding the factors that affect the postoperative clinical outcomes. METHODS: The current study was conducted on 40 patients who were diagnosed with lumbar disc herniation by the senior surgeon of our department from March 2004 to June 2007. These patients were refractory to conservative treatment and they could be followed up for more than one year following their surgical treatments. Preoperatively, after postoperative year 1 and at the final follow-up, a comparison was made for the Oswestry disability index (ODI) scores and the visual analogue scale (VAS) scores that indicated low back pain and radiating pain. For identifying prognostic factors, an analysis was also performed for such factors as age, gender, the operated level, the duration of preoperative low back pain and radiating pain, a smoking history, the body mass index and whether the surgery was revision or the primary operation. A radiological analysis, based on the preoperative plain flexion-extension radiography, was performed for the presence of mild segmental instability of < 3 mm, spondylolysis and disc space narrowing. Pfirrmann's degenerative grade of the disc, the degree of herniation and whether a herniation was central or massive on the magnetic resonance imaging scans. RESULTS: At the final follow-up, the ODI was significantly higher in the cases of revision as compared with the cases of primary operation. The female gender also had a tendency for a poor ODI as compared with that of the men, but this had only borderline statistical significance. There was significant correlation between the preoperative ODI and the preoperative VAS indicating radiating pain. At a final follow up, the low back pain VAS score was significantly lower in the extruded cases as compared with that of the protruded or sequestrated cases. CONCLUSIONS: Following an analysis for detecting the prognostic factors of open discectomy, the final clinical outcome was found to be poor for the revision surgery cases. In regard to the type of herniation, the degree of low back pain was relatively lower at a final follow-up for the extruded cases as compared with that for the protruded or sequestrated cases. Open discectomy surgery should be performed after evaluating the patients' various prognostic factors that could affect the final clinical outcome.

Recurrence Rate and Survival Analysis of the Lumbar Disc Herniation After Open Discectomy / 대한정형외과학회잡지

PURPOSE: The aim of this study was to estimate the true recurrence rate of lumbar disc herniation after open discectomy, and to compare these results with those from other studies. MATERIALS AND METHODS: From January 1992 to June 2002, the medical records and radiological findings, including a telephone survey were studied retrospectively. This study examined 306 cases, who had been operated by an open discectomy on a single level and had no other spinal lesions such as spondylolisthesis, spondylolysis, or spinal stenosis. MRI was used to confirm the diagnosis of a lumbar disc herniation in all cases. The recurrence of lumbar disc herniation was diagnosed only in those cases who had the same pattern of symptoms and was confirmed by MRI. The cases who had undergone additional surgery at another hospital at the same spinal level were also included as recurrence. In order to make up for weak points such the losses to a long term follow-up, statistical survival analysis was carried out using a life table method. In the life table method, the assumption is that all patients undergo surgery simultaneously. The longest follow-up duration was 11 years. RESULTS: In 252 of the 306 cases (82%), follow-up study was possible. The average duration of the follow-up was 5.9 years (from 1 to 11 years). The average age of the patients was 27.1 years (17 to 75), and the male to female ratio was 11.6: 1. The most common lesion of lumbar disc herniation was L4-5 (74%) at the initial diagnosis. The simple recurrence rate was 8.3% (21 cases) using the conventional method, in which the cases lost to follow-up were excluded. Survival analysis showed that, the annual recurrence rate was highest at the first year postoperatively as 3.4%, but decreased with time. At the last follow-up of 11 years, the cumulative survival rate was 88.9% and the recurrence rate was estimated to be 11.1% at final stage. CONCLUSION: Using survival analysis, the true rate of a recurrence of lumbar disc herniation after an open discectomy calculated. Even though the annual recurrence rate decreased with time, the true recurrence rate using the conventional method may be higher than the results obtained suggest.

Lumbar HIVD Associated with Spondylolysis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study determining the surgical result of lumbar HIVD associated with spondylolysis. OBJECTIVES: To analyze the incidence of lumbar HIVD associated with spondylolysis and to compare the results of open discectomy for lumbar HIVD associated with spondylolysis to simple lumbar HIVD. SUMMARY OF LITERATURE REVIEW: Lumbar HIVD associated with spondylolysis need be treated by spinal fusion. MATERIALS AND METHODS: Nine patients(5 males and 4 females) who had lumbar HIVD with spondylolysis, no instability, fol-low-up period of 1yr were identified out of 273 patients with lumbar HIVD, treated by open discectomy from March 1989 to Feb. 1999. The type of HIVD and level of spondylolysis were evaluated, the clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: The incidence of lumbar HIVD associated with spondylolysis is 3.7%. The recovery of back pain was 2.1 to 2.1 by visu-al analogue scale, radiating pain was 7.6 to 0.8. The recovery rate of SLR was 100%, motor deficit; 100%, sensory deficit; 85%, change of DTR; 40%. The clinical evaluation was excellent(2), good(6), fair(1). CONCLUSIONS: According to the recovery rate of the clinical symptoms, the results of open discectomy for lumbar HIVD associ-ated with spondylolysis without spinal instability and simple HIVD was not different. Therefore, we conclude that lumbar HIVD associated with spondylolysis need not be treated by spinal fusion.

Early Problems of Open discectomy for Lumbar Intervertebral Disc Herniation / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study analyzing early problems of open discectomy for lumbar intervertebral disc herniation. OBJECTIVES: To analyse the incidence of intraoperative and postoperative problems developed within six weeks and their relationship with reoperation and prognosis. MATERIALS AND METHODS: Hundred and ninty-four patients with intervertebral disc herniation, treated by open discectomy from April 1987 to December 1997, were assessed for intraoperative and postoperative problems. The problems were classified into three degrees : major, moderate and minor problem. when the problem was related to readmission, reoperation and prolonged admission for more than six weeks, it was classified as major problem. When the problem was related to prolongation of duration of admission for two to six weeks, it was classified as moderate problem. When the problem was not related to any prolongation of duration of admission, it was classified as minor one. RESULTS: Seven intraoperative and twenty-three postoperative problems were developed in twenty-seven patients. There were seven major problems : three recurrence of symptom and four suspicious deep infections. Nine moderate problems : six remained radiating pain, two serous discharge from operative wound and one urinary tract infection. and remained fourteen were minor problems : two recurrent symptom, two persistent pain, three serous discharge and seven intraoperative complications. CONCLUSIONS: The early major problems of open discectomy were recurrence of intervertebral disc herniation and deep infections. Problems with remainded radiating pain usually don't need reoperation and those symptoms were relieved with time goes. The prognosis was not influenced by minor problems.

A Clinical Study of the Open Discectomy of the Herniated Lumbar Disc: Analysis of Relationship between Operative Indications and MRI Findings / 대한정형외과학회잡지

The purpose of this study is to evaluate the correlation between the operative indications and the MRI findings in the herniated lumbar disc. We reviewed the lumbar spine MRI and medical records in the 158 patients of the herniated lumbar disc which were removed by open discectomy. We assessed the herniated lumbar disc in the MRI by the Steinmetz s classification and the operative findings with postoperative results at least 6 months. 170 levels of the operated lumbar discs in these patients consisted of protruded discs in 41 levels, extruded subligamentous discs in 91 levels, extruded transligamentous discs in 27 levels, sequestered discs in 11 levels. We recognized especially in the operated protruded discs that were combined with the lateral recess stenosis in most cases. Postoperatively, 139 patients (88%) had excellent and good results. We concluded that the clinical operative indications were correlated with the cases which were more severe than extruded subligamentous discs or protruded discs combined with lateral recess stenosis in MRI findings.

Radiologic Changes after Lumbar Discectomy / 대한정형외과학회잡지

Open discectomy is one of usual treatment for herniated intervertebral disc. We may expect the reduction of height of intervertebral disc due to decreased volume by partial resection of herniated disc. But the effect of decreased height of intervertebral disc space to posterior joint and spinal canal has not been identified, and the correlation between the amount of reduced height and the changes of range of motion has been undetermined. Thus, we analyzed radiologic changes of disc height and segmental motion by the flexion-extension view in 20 patients who had undergone discetomy for prolapsed intervertebral disc from June 1989 to January 1991 who could be followed up for 3 years or more. As a result, lumbar discetomy associates with 1) significant decrement of disc height (average 14%), 2) decreased disc motion of involved segment without hypermobility (average 34%), 3) hypermobility of adjacent segment, 4) and posterior facet overriding consistent with recurred low back pain.