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Objective To evaluate the efficacy of percutaneous endoscopic BEIS technique in the treatment of recurrent lumbar disc herniation and to analyze its possible prognostic factors.Methods A total of 39 patients who are diagnosed as lumbar disc herniation and treated with percutaneous endoscopic BEIS technique were selected from March 2013 to March 2015.The clinical efficacy was evaluated according to VAS,ODI,JOA and modified MacNab criteria in the follow-up,and the possible prognostic factors were analyzed.Results The average follow-up time was 14 months(12 ～ 18 months).According to the MacNab standard,the excellent and good rate was 82.1％.The average score of back and leg pain VSA was reduced from(7.33 ± 1.01)before operation to(2.69 ± 1.50)after operation,t =16.111,the difference was statistically significant (P ＜ 0.05);ODI and JOA were used to evaluate lumbar function,the score of ODI was reduced from (59.08 ± 7.16) to (13.54 ± 3.36),t =35.946,and that of JOA was increased from(14.92 ±3.37) to(26.05 ± 1.76),t =-18.526,the difference was statistically significant (P ＜ 0.05).Patients with symptoms lasting no more than 3 months and with no lateral recess stenosis were able to obtain good therapeutic effect.Conclusion This study indicates that percutaneous endoscopic BEIS technique is effective in the treatment of recurrent lumbar disc herniation,and duration of symptoms and lateral recess stenosis are important prognostic factors.
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PURPOSE: To analyze the result of a repeat discectomy for ipsilateral recurrent lumbar disc herniation and to investigate the potential factors that influenced the outcomes for this surgery. MATERIALS AND METHODS: Fifty-nine patients, who underwent reoperation after lumbar discectomy with a minimum follow-up period of 2 years, were reviewed. The surgical outcome was assessed using the visual analogue scale (VAS) and Macnab classification, and the recovery rate was calculated in accordance with VAS. A statistical analysis was carried out by SPSS to evaluate the possible factors that may have influenced the outcomes of the reoperation. RESULTS: The rate of reoperation after lumbar disc surgery due to the recurrent disc herniation was 6.0% (59/983 cases). The average recovery rate of VAS from the 1st operation was approximately 77%, and from the 2nd operation was 71%. According to the Macnab criteria, the results were “excellent” or “good” in 96% of cases. Statistical analysis revealed that there was no difference of the average recovery rate (p<0.05). There is no additional instability after repeat discectomy. Factors, such as smoking, precipitating traumatic events, and diabetes mellitus did not have much influence on the average recovery rate after repeat discectomy for ipsilateral recurrent lumbar disc herniation. CONCLUSION: The outcomes of repeat discectomy were satisfactory. Moreover, factors, smoking, trauma history and diabetic mellitus, only had a minor impact on the outcomes of a repeat discectomy.
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Humans , Classification , Diabetes Mellitus , Diskectomy , Follow-Up Studies , Reoperation , Smoke , SmokingABSTRACT
Objective To investigate the curative effect of Quadrant channel transforaminal lumbar interbody fusion(TLIF) in the treatment of recurrent lumbar disc herniation(RLDH).Methods Seventy-six cases patients with RLDH were divided into traditional TLIF group(36 cases) and Quadrant group(40 cases) by the different operation modes.The operation,VAS scores and ODI scores were compared between the two groups.Results Operation time((98.2±18.1) min vs.(118.5±27.2) min,t=3.79,P<0.05),incision length((2.7±0.6) cm vs.(5.5±1.0) cm,t=14.97,P<0.05),intraoperative blood loss((90.7±20.1) ml vs.(170.3±33.5) ml,t=12.71,P<0.05) and intraoperative drainage((43.8±12.4) ml vs.(117.1±28.9) ml,t=14.62,P<0.05) in Quadrant group were less than that in traditional TLIF group.The ambulation time((2.8±0.6) d vs.(6.8±1.1) d,t=19.95.P<0.05) and hospitalization time((7.1±2.0) d vs.(14.2±2.7) d,t=13.11,P<0.05) of Quadrant group were shorter than those of TLIF group.VAS scores in both groups were significantly decreased.VAS in Quadrant group was significantly lower than that in traditional TLIF group from 3 d to 6 months after operation((4.4±1.0,3.9±1.2,3.4±0.8,1.9±0.6,1.3±0.4) points vs.(5.0±1.4,4.5±1.1,4.1±0.9,3.6±0.7,2.5±0.6) points,P<0.05).ODI scores in both groups were significantly decreased.ODI in Quadrant group was significantly lower than that in traditional TLIF group from 1 d to 6 months after operation((36.7±7.1,33.4±6.2,30.7±4.1,27.8±5.3,24.5±5.4,18.4±4.7) points vs.(39.8±6.0,36.8±5.8,33.5±6.6,31.3±5.1,28.9±6.6,22.3±5.2) points,P<0.05).Conclusion The treatment of RLDH by Quadrant channel TLIF has obvious curative effect,short operation time,less trauma,faster recovery and shorter hospital stay.
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STUDY DESIGN: Retrospective study. PURPOSE: To study the surgical outcome of transforaminal lumbar interbody fusion (TLIF) combined with trans-pedicular screws fixation for management of selected cases of recurrent lumbar disc herniation. OVERVIEW OF LITERATURE: Recurrent lumbar disc herniation is a major cause of surgical failure, occurring in 5%-11% of cases. The optimal technique for treatment is controversial. Some authors believe that repeated simple discectomy is the treatment of choice, but approach-related complications can be considerable. Other surgeons prefer more removal of posterior elements (as lamina and facet joints) with posterior fusion. METHODS: The study included 15 patients who presented with symptomatic recurrent lumbar disc herniation who underwent reoperation through posterior trans-pedicular screws and TLIF in our department from April 2008 to May 2010, with a 24-month follow-up. Japanese Orthopedic Association Scale (JOA) was used for low back pain. The results of surgery were also evaluated with the MacNab classification. RESULTS: The mean JOA score showed significant improvement, increasing from 9.5 before surgery to 24.0 at the end of follow-up (p<0.001). Clinical outcome was excellent in 7 patients (46% of cases), good in 6 patients (40%) and fair in only 2 patients (14%). There was a significant difference (p<0.05) between patients presenting with recurrent disc at the ipsilateral side and those at the contralateral side. CONCLUSIONS: In spite of the small number of patients and the short follow-up period, the good clinical and radiological outcome achieved in this study encourage the belief that TLIF is an effective option for the treatment of selected cases of recurrent lumbar disc herniation.
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Humans , Asian People , Classification , Diskectomy , Follow-Up Studies , Low Back Pain , Orthopedics , Reoperation , Retrospective StudiesABSTRACT
The recurrence of lumbar disc herniation after single-level discectomy is a well-known complication. Pain and neurological symptoms during the first week after surgery can be caused by missed pathology or early recurrent disc herniation. However, recurrent disc herniation that causes segmental instability after repeat operation is rare. Here, we report a case of a 42-year-old woman having a rare complication of rapid recurrent lumbar disc herniation after 2 microscopic discectomies within a short period. We suggest that rapid disc fragmentation and rapid growth of annular defect caused rapid repeated recurrence of lumbar disc herniation and segmental instability. Further investigation will be needed to identify the cause of this rapid disc degeneration.
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Adult , Female , Humans , Diskectomy , Intervertebral Disc Degeneration , RecurrenceABSTRACT
[Objective]To investigate the surgical treatment of recurrent lumbar disc herniation. [Methods]A total of 17 patients with recurrent lumbar disc herniation were grouped into stable,unstable and severe unstable groups according to the dynamic X-ray film. Patients in stable group and unstable group were treated with open-window discectomy, and those of severe unstable group were treated with full laminectomy, decompression, pedicle screw fixation and fusion. JOA and VAS system were used to follow up before and after operation. Statistic analysis was performed between the stable and unstable groups in pain score and recovery rate.[Results]All the patients were followed up for 3 month to 3 years. The average JOA score was 4.94 before operation, and 12.18 at follow-up,with an average recovery rate of 71.74%. There was no statistic difference between stable group and unstable group in recovery rate.[Conclusion]For patients with spinal instability and chief complaint of leg symptom, reoperative treatment for recurrent lumbar disc herniation can be done with open-window discectomy which may offer good outcome.
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[Objective]To analyze and evaluate the relevant factors of recurrent lumbar disc herniation for providing strategy of prevention of this syndrome.[Method]Sixteen cases of recurrent lumbar disc herniation were analyzed according to medical history,physical examination and image examination before re-operation and the primary operation,and all the patients received exploration during operation.[Result]The relevant factors of recurrent lumbar disc herniation were as follows:the extent of disc degeneration,the stability of lumbar spine,the time of getting out of bed after primary operation and the weight of the patients.[Conclusion]Besides iatrogenic factors,there are several factors related to recurrent lumbar disc herniation,including the characteristics of disc and lumbar spine,as well as the compliance of patients.To remove these factors is the main preventive strategy of recurrent lumbar disc herniation.
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[Objective]To investigate surgical therapeutic methods of recurrent lumbar disc herniation(RLDH).[Method]From December 1996 to December 2003,a retrospective analysis on surgical treatment of 74 cases of RLDH was made and those cases acquired 1～5 years follow-up.There were 41 males,33 females aging from 21~53 years(mean,37.2 years),case history was 6~192 months from primary surgery to disc reprolapse(mean,37 months).Among primary surgery,9 cases were total laminectomy,23 cases were hemilaminectomy,31 cases were windowing,11 cases were microdiscectomy with diskoscope.Re-surgery:5 cases treated with lumbar disc excision,45 cases treated with posterior lumbar interbody fusion(PLIF)technich,23 cases treated with transforminal lumbar interbody fusion(TLIF)technich.[Result]No death case occurred during peri-operation.Various complications were found in 18 cases which recovered by symptomatic treatment.Cases with lumbar disc excision left bed in 3 weeks with the help of lumbar back brace and cases with fusion surgery left bed in 3～5 d after surgery.Oswestry score improved from(52.32?9.17)pre-operatively to(20.33?5.72)in average 18 months follow-up.Totally 73.5% cases had satisfactory surgical results.[Conclusion]Cases with RLDH can adopt propotional surgical methods,thoroughly decompression and gain satisfactory therapeutic effect on bases of imageology,clinical manifestation and surgery history.
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[Objective]To investigate the surgical feasibility and efficiency with microendoscopy discectomy technique for the recurrent lumbar disc herniation.[Method]Ninteen cases underwent disc excision with different operative approaches,11 cases had undergone previous surgery with MED,7 cases with conventional approach,2 cases removing whole vertebrate plate approach,3 cases removing half vertebrate plate approach,2 cases with minor vertebrate plate window approach.There were 13 cases of ipsilateral protrusion and 2 cases of contralateral protrusion,3 cases of adjacent segment protrusion.All of these cases were revisioned by MED except for 1 case.[Result]Eighteen cases were finished by MED technique successfully except for 1 case which was changed to open operating.All cases were followed up from 6 months to 2.5 years,averaged 1.5 years.Postoperative JOA score was improved from preoperative average (9.61?3.40)? to average (26.17?2.60) ?,the rate of improvement final was 86.32%.In terms of Macnab scoring system,the satisfactory rate was 88.89%.[Conclusion]MED technique is an effective method for recurrent lumbar herniation,but the operator needs lots of experience in minimal invasive spine surgery.
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STUDY DESIGN: A retrospective study of patients with contralateral recurrent lumbar disc herniation at the same level. OBJECTIVES: To analyze the risk factors of recurrence, clinical result and reoperative efficiency of contralateral recurrent lumbar disc herniation at the same level after primary discectomy compared with those after discectomy in primary lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: There have been many studies on recurrent disc herniation, but little investigation of risk factors and clinical result of contralateral recurrent lumbar disc herniation at the same level. MATERIALS AND METHODS: Ten cases who can investigate for 2 years among the patients who underwent reoperation for contralateral recurrent lumbar disc herniation at the same level after primary discectomy were selected as study group (group I) and thirty cases who underwent discectomy during the same study period were selected as control group (group II). Age, gender, etiology and symptom of disc herniation, clinical improvement rate and amount of remove disc were recorded. Overall patient satisfaction, pain severity, functional outcome and work status were evaluated. Risk factors of recurrence were analyzed. RESULTS: Etiology was no different between both groups but showed the abrupt onset symptom in study group. Recurrence was more common in the case herniated posterolaterally and had severe degeneration change in lumbar disc before primary discectomy. The amount of bulging disc removed were average 1.5 cc in study group and 2.5 cc in control group. Recurrence was more in the cases removed smaller amount of bulging disc and remained the symptom of pain after primary discectomy. Clinical result show the same between both group after 2 years (p>0.05). CONCLUSIONS: Contralateral recurrent disc herniation at the same level mainly has abrupt symptom and more in the cases degenerated discs. Recurrence was more common in the cases removed smaller amount of bulging disc and remained the symptom after primary discectomy.
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Humans , Diskectomy , Patient Satisfaction , Recurrence , Reoperation , Retrospective Studies , Risk FactorsABSTRACT
Recurrent lumbar disc herniation after standard lumbar discectomy was the mostcommon complication among the failed back surgery syndrome. Clinical manifestations and radiologic findings were analyzed in 56 paients who were proved to have recurrent lumbar disc herniation. Comparative analysis with Lumbar Disc Surgery Predictive Score(LDSPS) between 160 patients of failed back surgery syndrome and 56 patients of recurrent disc herniation was performed. LDSPS of the recurrent disc herniation was 81.3. The interval of the reoperation after onset of symptom was considered to be one ofthe major factors in the prognosis of the recurrent disc herniation. The patient must be educated how to prevent lumbar disc herniation. When recurrency was suspected one must diagnose precisely with the help of MRI andreoperate as soon as possible.