Lumbar microdiscectomy in the elderly patient.

This study retrospectively analysed 60 patients who had undergone microsurgical lumbar discectomy at an age of > or = 60 years. The results were compared with those obtained in 44 discectomy patients who were operated on during the same study period, but not selected for age. Sixty-five operations were performed on the elderly group and 49 on the age comparison group. Patients were scored for pain relief in a short-term follow-up (2 months) using office visit records. Long-term follow-ups [mean 6.5 years (elderly) vs 8.8 (comparison) years], obtained by a mailed questionnaire, quantified leg and back pain and scored success in return to normal activities (RTA) and satisfaction with the results of surgery. In the short-term, overall pain relief was highly successful and not significantly different in both group [94% (elderly), 98% (comparison)]. Long-term follow-up yielded the following successful outcomes (elderly, comparison groups): leg pain relief (91%, 86%), back pain relief (76%, 76%), RTA (68%, 87%), and satisfaction (81%, 91%). As with other pre- and postoperative parameters, these differences were not statistically significant. As the proportion of older individuals continues to rise in developed countries, physicians are increasingly faced with geriatric patients whose symptoms are caused by herniated lumbar discs. The present study indicates that microsurgical discectomy for relief of this condition can be performed safely and effectively on these older patients.

Day surgery for cervical microdiscectomy: is it safe and effective?

The objective of this pilot study was to evaluate the safety and efficacy of cervical discectomy with fusion performed on an outpatient basis. The experimental group (50 consecutive patients) was studied prospectively and the outcomes were compared with 53 consecutive, retrospectively analyzed, admitted controls who underwent the same procedure. Outcomes for both groups were assessed by patient-response questionnaires and clinical examination. At follow-up times of 1.3 (outpatient) and 1.6 (inpatient) years, outcomes (outpatient/inpatient) expressed as percent successful were as follows: Relief of arm pain (80/70%); relief of neck pain (78/68%); relief of arm muscle weakness and atrophy (94/96%); return to normal activities (64/70%); return to work (65/68%); and satisfaction with the results of surgery (86/83%). No statistically significant differences between outpatients and inpatients were found for any of the outcome parameters studied. There was no mortality and the operative complication rate was 2% for each study group. The results indicate that conversion of cervical discectomy with fusion from an admitted to an ambulatory practice did not compromise the safety or efficacy of the surgical procedure. Potential economic savings to overall health costs of the United States that might result from such conversion could exceed $100 million annually.

Lumbar disc excisions in patients under the age of 21 years.

STUDY DESIGN: This study retrospectively analyzed 15 patients in the rarely seen young (under 21 years) age group who had undergone discectomy without fusion for prolapsed (herniated) lumbar disc. OBJECTIVES: The results were analyzed for degree of success in several outcome parameters to relate the efficacy of this patient group/procedure pair to that of other studies. SUMMARY OF BACKGROUND DATA: Sixteen operations were performed on this patient group, including six by a conventional procedure and ten by a microsurgical technique. Although most previous studies tend to support the use of discectomy, some physicians have reportedly been reluctant to implement these procedures in young patients. METHODS: Patients were followed in a short-term (median 3.3 months) assessment using records of post-operative office visits. Long-term (median, 10.5 years) follow-up was done by a mailed, self-report questionnaire that quantified pain in leg and back and scored for degree of success in ability to return to normal activities and satisfaction with the results of surgery. RESULTS: The short-term results were excellent for all but one patient. Long-term follow-up yielded the following successful outcomes: relief of back pain, 77%; and relief of leg pain, return to normal activities, and satisfaction with surgery, each 85%. CONCLUSION: Despite some tendency to delay discectomy in children and young adults, physicians are urged to be aware of this rare condition and the excellent long-term outcomes and limited complications resulting from timely implementation of discectomy after a failed course of conservative therapy. Moreover, fusion should be avoided except in cases of vertebral instability.

Lumbar diskectomy for recurrent disk herniation.

Eighty-two patients who underwent reoperation using a lumbar microdiskectomy approach for recurrent back and leg pain were evaluated retrospectively. Patients were entered consecutively except for exclusion of those who had a spinal fusion in addition to the diskectomy or those where a diskectomy was performed as an adjunct to decompression for spinal stenosis. As a percentage of all diskectomies performed by us over the 13 years of the study, the overall rate of reoperation (including all patients who underwent more than one diskectomy procedure regardless of vertebral level and side) was 7.4%, with those having a reoperation on the same level and either the same or contralateral side as the initial procedure representing 4.5%. Long-term outcomes obtained from 68 questionnaire responses (83% compliance) included 56% who had successful leg pain relief, 54% who had successful back pain relief, 44% who successfully returned to work, 51% who successfully returned to normal activity, and 73% who were satisfied with the results of surgery. Poor outcomes correlated most significantly with reoperation on the same vertebral level, same side, and short (< or = 1 year) time interval between consecutive diskectomies. A major conclusion was that workers' compensation patients presenting within 1 year with recurrent complaints after diskectomy and whose radiologic findings indicate a same-level, same-side recurrence represent extremely poor outcome risks for repeat diskectomy.

Decompressive lumbar laminectomy for spinal stenosis.

A total of 258 consecutive decompressive lumbar laminectomies performed on 244 individuals presenting with spinal stenosis were analyzed retrospectively. Spinal fusion was avoided in all but two patients. Outcome in terms of pain relief and return to normal activity was evaluated in two stages, one derived from patient charts and having a relatively short-term follow-up time (mean 8.4 months) and a second derived from patient responses to a questionnaire (which also scored for satisfaction with the results of surgery), which had a longer follow-up time (mean 4.7 years). More than 20 clinical and operative parameters were analyzed. Overall, a high degree of success (93% pain relief, 95% return to normal activity) was achieved in the short term, which was supported by the longer-term follow-up data (64% pain relief, 56% activity return, 75% satisfaction). The following factors were not significantly correlated with outcome: patient age; sex; worker's compensation or no-fault insurance status; employed versus not employed; a history of back surgery prior to the laminectomy studied; existence of degenerative spondylolisthesis or scoliosis; complete versus incomplete myelographic block; or the level of the lumbar spine undergoing surgery. The major conclusions arising from these data are: 1) for all age groups through at least the eighth decade of life, decompressive lumbar laminectomy is a relatively safe operation having a high medium-to-long-term success rate; 2) lumbar instability following laminectomy is rare, even in individuals presenting prior to surgery with degenerative instability conditions; and 3) lumbar fusion in addition to the decompressive laminectomy procedure is rarely required for degenerative spinal stenosis.

Lumbar percutaneous facet rhizotomy.

The author reports on 223 patients who underwent lumbar percutaneous facet rhizotomy for chronic low-back or chronic back and leg pain. The overall success rate was 69%. The procedure is very safe and can offer relief for many patients in whom organic pathology, most commonly a herniated lumbar disc, has been eliminated. The procedure, screening and results are discussed.

Microsurgical versus standard lumbar discectomy.

Two hundred seventy consecutive patients operated upon by standard discectomy were compared to 270 patients treated with microlumbar discectomy. All patients had back and leg pain, as well as positive clinical findings and positive myelograms suggestive of disc herniation. The results demonstrated a 98% success rate in the microsurgical group as compared to a 95% success rate in the standard laminectomy group. Of microdiscectomy patients, 95% had an excellent result, as compared to 89% of the standard laminectomy group. Patients with pending compensation cases did only slightly poorer than those with no secondary gain regardless of what procedure was used. The postoperative hospital stay of the microsurgical patients averaged 3.7 days as compared to 7.1 for the standard technique. The time before return to work was significantly shorter in patients undergoing microdiscectomy. Microdiscectomy proved to be superior in both clinical results and cost effectiveness.