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Introduction: The aim of this 6-month prospective study was to seek out the factors affecting surgical outcome, predictors of treatment response and their correlates in open discectomy for herniated lumbar disc. Methods and Materials: Eighty patients who fulfilled the required criteria were chosen. Socio-demographic, clinical data proforma, Visual Analogue Scale for pain (VAS), Japanese Orthopedic Association (JOA) Scale for subjective and objective pain related QoL, General Health Questionnaire-12 (GHQ-12) for screening mental health, Short Form-36 (SF-36) Health Survey for assessing Health-related Quality of Life (HRQOL) and Montgomery Asberg Depression Rating Scale (MADRS) for measurement of clinical depression were used at the preoperative stage and reassessed again at 1 month, 3 months and 6 months post-discectomy. Results: Postoperatively, VAS and JOA Scale scores continued to show improvement at each follow up (p

[Purpose] We have previously shown inversion therapy to be effective in a small prospective randomised controlled trial of patients with lumbar disc protrusions. Our purpose now was to measure symptoms and to compare the surgery rate following inversion for 85 participants with the surgery rate in 3 control groups. [Participants and Methods] Each of the 85 inverted participants acted as their own control for the "symptomatic" part of the study. In the "Need for surgery" part of the study, one control group was made up of similar patients with leg pain and sciatica who were referred to the same clinic in the same year. Two additional control groups were examined: the original control group from the pilot trial and the lumbar disc surgery waiting list patients. [Results] Inversion therapy relieved symptoms: there were improvements in the Visual Analogue Score, Roland Morris and Oswestry Disease indices and Health Utility Score compared with their pre-treatment status. Also, the 2 year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years). It was also lower than the surgery rate in the other 2 control groups. [Conclusion] Inversion therapy relieved symptoms and avoided surgery.

Objectives This study aims to evaluate whether ultrasound (US)- guided facet joint injection reduces pain and improves mobility in patients with failed back surgery syndrome (FBSS). Patients and methods This retrospective study included 27 patients (8 males, 19 females; mean age 43.6±11.5 years; range, 31 to 54 years) who underwent US-guided facet injections for FBSS between January 2017 and January 2019. Patients’ medial records were assessed. Pain rating scores were evaluated with the Numeric Rating Scale (NRS). Functional status was assessed with Oswestry Disability Index (ODI) version 2.0. Lumbar flexion degree was noted. After injection (lidocaine-betamethasone mixture), patients were reevaluated at first and sixth months. The study data were analyzed with Wilcoxon signed-rank test. Results Successful facet joint injections were achieved without any complications in all patients. The median duration of time after surgery was 7.8±1.3 months. Mean duration of pain was 6.7±5.7 months. There was a significant decrease in NRS values between baseline and sixth month comparison (7.0 at baseline and 6.0 at sixth month, p=0.006). Baseline-first month and first-sixth months comparisons were not significant (p=0.165 and p=0.106, respectively). For ODI, no significant change was observed between baseline-first month, first-sixth months, and baseline-sixth month comparisons (p=0.109, p=0.857, and p=0.095, respectively). For lumbar flexion, all comparisons resulted in significant increase (50.0° for baseline, 60.0° at first month, and 70.0° at sixth month; p

Aortoiliac vascular injury during lumbar disc surgery is potentially life-threatening, but occasionally presents with delayed-onset symptoms. This is a case report of a fistulized pseudoaneurysm presenting with claudication. A 73-year-old female presented with swelling of the left leg and short-distance claudication. Two months prior, she had undergone discectomy for the management of right foot drop caused by an L4-L5 herniated lumbar disc. The left ankle-brachial index was 0.71. Computed tomography angiography revealed a 31 mm×20 mm pseudoaneurysm of the left common iliac artery fistulized to the left common iliac vein. The patient was successfully treated with stent graft placement.

Failed Back Surgery Syndrome (FBSS) is persistent pain and disability following lumbar laminectomy which is associated with decreased quality of life and disability and has been reported in up to 40% of the patients undergoing lumbar laminectomy. Several approaches have been introduced to reduce the rate of the FBSS. Among these, applying anti-adhesive barrier gels have been studied with interest with controversial results. The aim of the current study was to determine the effects of anti-adhesive barrier gels on functional outcome and recurrence of patients undergoing lumbar disc surgery. We searched databases including EMBASE, PUBMED, Web of Science, Scopus, Cochrane Library, and scholar databases until November 2019. To assess the heterogeneity across included studies was used Cochran's Q and I-square (I2) statistics. Standardized mean difference (SMD) and 95% CI between were used to estimate pooled effect sizes. Out of 4507, 10 clinical trials found to be appropriate for current meta-analysis. The pooled results of included clinical trials indicated that adhesion barrier gel significantly decreased leg pain (LP) (SMD = −0.31; 95% CI, −0.60, −0.03; P = 0.032; I2: 59.2%) among patients with lumbar disc herniation surgery. Back pain (BP) (SMD = −0.03; 95% CI, −0.23, 0.16; P = 0.734; I2: 40.2%), and Oswestry disability index (ODI) (SMD = −0.11; 95% CI, −0.27, 0.05; P = 0.178; I2: 0.0%), were not significantly affected following adhesion barrier gel application. Application of adhesion barrier gel in single level lumbar disc surgery is associated with deceased leg pain. However, its application does not affect the low back pain, disability and gate. Further, larger randomized clinical trials are required., Adhesion barrier gel; Functional outcome; Lumbar disc surgery; Meta-analysis.

Study design Case series and review of literature. Objective To report three cases of vascular injury during posterior lumbar disc surgery, two of these occurred during open discectomy, and one during an endoscopic surgery. Aim is to highlight importance of early diagnosis and prompt steps taken to prevent morbidity and mortality. Summary of background data Vascular injury during lumbar discectomy is rare injury. Also no case has been reported so far occurring during an endoscopic discectomy. Methods Three patients were treated for lumbar intervertebral disc prolapse, two had undergone open posterior discectomy while the third patient underwent endoscopic discectomy and all of them were diagnosed to have suffered an abdominal vascular injury. Results In two cases pseudo-aneurysm was found while third case was diagnosed as an arterio-venous fistula. All the three cases were managed with endovascular stenting and followed for a minimum period of 2 years. No further complications were detected. Conclusion Vascular injury during a disc surgery is difficult to diagnose due to the rarity of occurrence and subtle signs which need to be recognized to start early management. Level of evidence 5.

Objectives: Effectiveness of 0.5% bupivacaine administered onto dura, under lumbar superficial fascia and subcutaneous tissue on postoperative pain control was analyzed in patients undergoing lumbar microdiscectomy. Methods: Sixty adult patients scheduled to undergo elective, single-level lumbar discectomy were randomly divided into four groups: the control group (Control), the subcutaneous tissue group (Group C), which received 20 ml of 0.5% bupivacaine in the subcutaenous tissue, the superficial fascia group (Group F), which received 12 ml bupivacaine in the subcutaneous tissue and 8 ml in the space below the lumbar superficial fascia, and the dura group (Group D), which received a total of 20 ml (100 mg) of bupivacaine, consisting of 10 ml in the subcutaneous tissue, 8 ml in the space below the lumbar superficial fascia, and 2 ml on the dura. Visual Analog Scale Values (VAS) on postoperative 0, 15, 30, 45 minutes, at 1, 2, 4, 6, 12 and 24th hour and time of the first analgesic need were evaluated for all patients and recorded. Results: While mean VAS value measured at min 0 (as soon as the patient awakened) was 2.3 ± 1.2 in Group D; it was 2.7 ± 0.9 in Group C; 2.7 ± 1.0 in Group F and 3.1 ± 0.6 in control group (p = 0.232). At the end of 1th hour, mean VAS value was recorded as 2.8 ± 1.0 in Group D; 3.6 ± 1.5 in Group C; 3.6 ± 1.1 in Group F and 4.4 ± 1.1 in control group (p = 0.005). In Group D, 0.5% bupivacaine administered as 2, 8, 10 ml onto dura, fascia and subcutaneously was detected to provide significantly lower VAS values and significantly longer first analgesic need time. Conclusions: 0.5% bupivacaine administered onto dura, under lumbar superficial fascia and in subcutaneous tissue was detected to be a simple, effective and safe method in lumbar microdiscectomy operations.

The reoperation for recurrent lumbar disc herniation (LDH) causes difficulties and low surgical outcome. The operation technique which was preferred in the first surgery has gained importance in reoperation for recurrent-LDH. The aim of our study is to evaluate the efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum (LF) for recurrent lumbar disc surgery. 149 patients were evaluated in two groups in our study, who were treated for single level recurrent-LDH in our clinic. The first group contains 86 patients who were treated by lumbar microdiscectomy without preserving LF during first surgery in other clinics, the second group contains 63 patients who were treated by lumbar microdiscectomy with preserving of LF during first surgery in our clinic. We investigated age, weight, gender, recurrence-time, level-side of recurrent-LDH, the surgical outcomes and hemorrhage, complications, operation-time. The mean-age was 45,9 ± 12,9, 44,1 ± 11,6 years and mean-weight was 73,4 ± 14,4, 77,3 ± 14,2 kg in two groups. 29 patients were treated for L3-4, 63 patients for L4-5, 57 patients were treated for L5-S1 recurrent LDH. The preoperative and follow-up back-leg pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores decreased significantly in all patients (p 0,05). The average operation-time was 70,9 ± 5,2 and 42,3 ± 4,6 min and the average surgical hemorrhage was 91,1 ± 11,3 and 50,3 ± 7,4 ml in 1. group and 2. group respectively. Preserving of LF in first surgery is gaining importance for recurrent lumbar disc surgery with protected anatomical structures. Our technique decreases complication, operation time, surgical hemorrhage and provides good surgical outcomes in recurrent lumbar disc surgery.

Background: This study aimed at investigating the effect of showing surgery educational documentary film on the anxiety of patients candidate for lumbar disc surgery. Materials and Methods: This study, as a randomized clinical trial, was conducted in 2018 on 60 patients undergoing lumbar disc surgery, Iran. The patients were divided into two groups of intervention and control (N = 30). An educational film was shown to the patients of the intervention group for 20 min and the control group was provided with the ward's routine trainings. All patients completed demographic characteristics questionnaire and the Spielberger State-Trait Anxiety Inventory (SSTAI) on the admission day, 1 day before the surgery, and 2 h before the surgery. SSTAI was recompleted by the patients. Data analysis was performed using independent t-test, Chi-square, Mann–Whitney test, and paired t-test. Results: Before the intervention, the mean score of the state (obvious) and trait (hidden) anxieties was not significantly different between the two groups, but after the intervention, the mean [standard deviation (SD)] score of the state anxiety in the intervention group was significantly lower than that of the control group [mean (SD) = 40.78 (10.34) vs. 47.45 (10.33), F10,33 = 58, p = 0.01]. In addition, after the intervention, the mean (SD) anxiety score of the patients in the intervention group was significantly lower than that of the control group [mean (SD) = 38.65 (11.01) vs. 44.71 (10.34), F10,34 = 58, p = 0.03). Conclusions: The results showed that educational film reduces the patients' level of anxiety before the surgery. As such, it is recommended that these trainings be included in preoperative nursing practices.

Purpose: The aim of this study was to determine the effect of progressive relaxation exercises on the comfort level and sleep quality of patients undergoing lumbar disc herniation surgery. Methods: The study was conducted between July 2015 and October 2016 in the neurosurgery clinic. The sample consisted of 96 patients (n = 56, experimental patients; n = 40 control patients) randomized into groups. The data was collected by using the personal information form, The Perianesthesia Comfort Questionnaire, The General Comfort Questionnaire and Visual Analog Sleep Scale. Findings: In the postoperative General Comfort Scale that there was a statistically significant difference between the mean of the control group and experimental group on the final test (P < .05). When the Visual Analog Sleep Scale mean of the experimental and control group patients were compared between the groups, there was a statistically significant difference on the postoperative 2nd day and 3rd day (P < .05). Conclusion: This study supports previous work that progressive relaxation exercises are feasible and effective to improve patient comfort levels after lumbar disc surgery. (c) 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Background: A dural tear (DT) is the most commonly encountered complication during lumbar spine surgery. The incidence of DT increases depending on the complexity of the surgical procedure and the presence of a DT is related to a poor outcome and patient satisfaction. Objectives: This study aimed to determine the incidence and clinical outcomes of DTs in those patients who undergo lumbar disc surgery. Methods: We retrospectively reviewed consecutive patients who underwent surgery for the management of a primary single-level lumbar disc herniation at a single institution between 2004 and 2014. Among the studied population, those with DTs were included in the study group. An age- and sex-matched group of randomly selected patients who underwent the same level and type of lumbar spine surgery, but did not develop DTs, were assigned as the control group. The outcomes were compared at 12 months postoperatively between the groups. Results: A total of 5,476 consecutive patients (2,608 female, 2,868 male; mean age, 54 ± 11.45 [range, 21-86] years) underwent surgery for primary single-level lumbar disc herniation. DT was noted in 192 (2.85%) cases. Of these, 102 patients with complete data were included in the DT group. The DT group had a significantly increased length of hospital stay (p = 0.001). Also, the duration of bed rest in the hospital was significantly higher in patients wherein DT was repaired using hemostatic material and fibrin glue, compared to the patients with primary closure with suturing of the tear. Conclusion: Incidental DTs, if recognized and treated appropriately, will not lead to poor clinical results and do not adversely impact postoperative outcomes.

Introduction: Low back pain is one of the most chronic debilitating conditions involving considerable loss of cash, work, and quality time. Lasers are utilized in different fields of drugs, providing unique advantages. They are useful and advantageous in treating lumbar disc disease. In this research, an attempt is made to examine the role and importance of different lasers in lumbar disc surgeries. Methods: We conducted studies about laser therapy in lumbar disc surgery. Our primary search began with reviewing English-language citations from PubMed and Scopus between 1990 and 2019 using the keywords: (laser therapy) OR (lumbar disc AND disc surgery). The initial search yielded 97 articles. However, about 49 articles were selected and used in the present study. Results: Based on the present study, it can be found that there are several methods of using lasers to treat lumbar disc surgery. These methods all have their strengths and weaknesses. Conclusion: The development of laser lumbar disc surgery can be very helpful due to the reduction of surgical risks and the length of the patients' hospital stay. However, the choice of method used for this type of surgery should be made according to the patient's condition and based on the opinion of the treating physician.

Methods This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. Results The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. Conclusion We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Objectives: A thoracolumbar interfascial plane (TLIP) block is a novel ultrasound (US)-guided technique that provides effective analgesia after lumbar spinal surgery.Two approaches for a TLIP block have been defined: a classical (cTLIP) technique and a modified (mTLIP) technique. A literature review revealed no published comparison of the 2 techniques.This study examined the practicality and analgesic efficacy of US-guided mTLIP and cTLIP blocks following lumbar disc surgery.Methods: Sixty patients aged 18-65 years with an American Society of Anesthesiologists classification of I or II who were scheduled for lumbar disc surgery under general anesthesia were included. US-guided mTLIP (n=30) and cTLIP (n=30) blocks were performed. The performance time of the block procedures, the success of a one-time block, postoperative pain scores, opioid consumption, adverse effects, and block-related complications were recorded and analyzed.Results: The performance time was significantly less in the mTLIP group (p0.05).Conclusion: The results showed that a US-guided mTLIP block had a shorter performance time and a higher one-time block success rate compared with the cTLIP block. The quality of analgesia provided by the mTLIP and cTLIP blocks was similar. Amaç: Torakolomber interfasiyal plan (TLIP) bloğu, lumbar spinal cerrahi sonrası etkili analjezi sağlayan, ultrason (US) eşliğinde yapılan yeni bir rejyonal anestezi tekniğidir. Bu bloğun iki farklı tekniği tanımlanmıştır: klasik (cTLIP) ve modifiye (mTLIP)teknik. Literatürde henüz bu iki tekniği karşılaştıran bir çalışma bulunmamaktadır. Çalışmamızda lomber disk cerrahisi sonrasıUS eşliğinde mTLIP ve cTLIP bloklarının işlem uygulama kolaylığını ve analjezik etkinliğini karşılaştırmayı amaçladık.Gereç ve Yöntem: Amerikan Anestezistler Derneği (American Society of Anesthesiologist/ASA) anestezi risk sınıflamasınagöre sınıf I-II, 18-65 yaş arası ve genel anestezi altında lomber disk cerrahisi planlanan 60 hasta çalışmaya dahil edildi. HastalaraUS eşliğinde mTLIP (n=30) ve cTLIP (n=30) blok uygulandı. Blok uygulama süresi, tek seferde blok başarısı, opioid tüketimi,postoperatif ağrı skorları, yan etkiler ve bloğa bağlı komplikasyonlar kaydedildi.Bulgular: Blok uygulama süresi mTLIP grubunda anlamlı derecede düşüktü (p0.05).Sonuç: Çalışmamızın sonuçlarına göre US eşliğinde yapılan mTLIP blok ve cTLIP blok lomber cerrahi geçiren hastalarda benzeretkinlikte analjezi sağlar. mTLIP blok daha kısa uygulama süresine ve daha yüksek tek girişimde blok başarısına sahiptir.

Objective: Although spondylodiscitis seen after lumbar discectomy is very rare, its incidence has been reported to be around 0.1-18.8\% by many different authors. The most common pathogen is Staphylococcus aureus. Methods: Medical records of 1,154 patients who were operated in our hospital between 2007 and 2015 due to a single or two-level lumbar disc hernia were retrospectively extracted. Of these patients, 554 were female and 600 were male. Discectomy operation was performed in 1,062 of these patients with single-level and 91 with two-level lumbar microdiscectomy. All of these patients were given a prophylactic single dose of cefazolin sodium in accordance with the recommendations of the surgical antimicrobial prophylaxis guidelines during anesthesia. Spondylodiscitis developed in 12 patients (1.03\%). Comorbidities in patients who developed spondylodiscitis, isolated pathogens, antibiotic susceptibility, antibiotics used, and hospital stay were noted. Results: Of the 12 patients, 7 were female and 5 were male. Mean age was 45.75 +/- 14.16 years. Eleven of these patients underwent single level, one had 2 levels of lumbar microdiscectomy. Five patients underwent discectomy at L4-5 and 8 patients at L5-S1 levels. Three of these patients had S. aureus (25\%), 4 had Staphylococcus epidermidis (33\%) and 3 had Escherichia coli (25\%) and 2 patients had no reproduction. The mean hospital stay was 29.45 +/- 3.98, and in patients without spondylodiscitois it was 1.99 +/- 0.81, the two groups were significantly different from each other (p=0.0001). Conclusion: Although most surgeons nave a tendency to maintain antibiotic prophylaxis postoperatively or during hospitalization period, our study found that a single dose prophylactic antibiotic administered during anesthesia induction did not increase rate of spondylodiscitis by medical literature.

Lumbar disc surgery is a common procedure in the USA. It is frequently performed with good or excellent results in most patients. This article reviews common causes of persistent radiculopathy after surgical intervention. We performed an extensive review of the literature as well as applying our own experience. Common causes of persistent leg pain following operative intervention include re-herniation, epidural fibrosis, biochemical/physiologic changes in the nerve root, and psychosocial issues. Patients with persistent leg pain after surgical treatment of lumbar disc herniation can pose a challenging clinical problem. Summary of these topics and available treatment options are reviewed.

To analyze and clarify conflicting aspects of fusion and total disc replacement (TDR) surgery in literature. Using keywords, 23 literature reviews, 41 studies accepted by “importance criteria” from the Internet, and 16 articles “published in 2018” were chosen. Altogether 80 studies. General assessment was mentioned as affirmative for TDR in 40 papers, five were negative, 24 without clear decision. Long term results TDR seven affirmative, four nondecisive. Comparison to fusion (general, ALIF, 3600, BAK cage) 18 found as better, nine equal, one nondecisive. Complications TDR 3–50%. Adjacent disc degeneration disease recognized in 14 papers, denied existence in four. Cost-benefit effective in three papers comparing to fusions, ALIF, 3600. Nonimbursement from the state mentioned as problem in three papers. Salvage surgery seven papers, rare but extremely problematic. Anterior approach 16 challenging surgery, one 10% minor, one 38.5% transient complications, one 1.8% retrograde ejaculations, one 6.6% vascular injuries, two access surgeon needed. Construct judgment two no importance, 22 wear and durability problems, two inadequate biomechanics and biomaterials, three construct and lateral approach. Impact of TDR upon spine surgery is decreasing, currently is less than 2%. It is concluded that problems with anterior surgery, imbursement policy, and potential problems with salvage surgery are major reasons for loosing popularity of TDR surgery.

BACKGROUND Studies have shown late post-operative physical disability and residual pain in patients following lumbar disc surgery despite growing evidence of its beneficial effects. Therefore, rehabilitation is required to minimise the late post-operative complications. OBJECTIVE To assess the feasibility of manipulative rehabilitation to improve late post-operative outcomes. METHODS Twenty-one patients aged 25-65 years undergoing lumbar microdiscectomy were randomly assigned to the rehabilitation group (n= 14) or active control group (n= 7) by simple randomisation. Eight rehabilitation sessions were initiated 2-3 weeks after surgery. Thirty-minute sessions were conducted twice weekly for four weeks. Post-operative physical disability and pain were assessed at baseline and at the two-year follow-up. RESULTS Post-operative physical disability improved more in patients who had undergone rehabilitation than in those who had received control care (63% vs. -23%, P< 0.05). Post-operative residual low back and leg pain were alleviated in the treatment group (26% and 57%, respectively), but intensified in the control group (-5% and -8%, respectively). CONCLUSIONS This study demonstrated the potential of manipulative rehabilitation and importance of post-operative management after lumbar disc surgery. Definitive trials with larger sample sizes are required to confirm the feasibility and potential therapeutic effectiveness of this approach.

PubMed ID: 28460344 Objective The aim of this study was to evaluate the Internet use of a group of lumbar disc surgery candidates in order to determine the rate of Internet search by the patients on their disorders and more importantly the reliability of the accessed websites. Patients and methods Fifty patients who were scheduled for lumbar disc surgery were divided into 2 groups, namely patients who accepted the surgery at the first offer and those who wanted to think over. Educational level information was obtained and patients were asked whether they had searched their disorder and offered surgery on the Internet. Then, a questionnaire was administered and the reliability of the websites was evaluated. Correction: The first 30 websites on the first 3 pages of Google® search engine, the most commonly used search engine in Turkey, were evaluated with the DISCERN® instrument. Results Of 50 patients, 33 (66%) had conducted a search for the surgery on the Internet. All university graduates, 88.2% of high school graduates, and 18.7% of primary-secondary school graduates had conducted an Internet search. The quality and reliability of the information was high (4.5 points) for 2 (7.1%) websites, moderate (2.3 points) for 6 websites (21.4%) and poor (1 point) for 20 websites (71.4%) as scored with the DISCERN® instrument. The mean DISCERN® score of was 1.1 for websites of health-related institutions or healthcare news, 2.75 for personal websites of physicians and 2.5 for personal websites of non-physicians. The mean DISCERN® score of all websites was 1.5. Conclusion Most of the patients undergoing lumbar disc surgery at our clinic had searched information about the surgical procedure on the Internet. We found that 92.9% of the websites evaluated with the DISCERN® instrument had inadequate information, suggesting low-level reliability. © 2017 Elsevier B.V.

Total lumbar facetectomy may be advantageous for exposure or to completely free a constricted nerve root.We retrospectively reviewed a single surgeon series without fusion for short and long term outcomes regarding radicular pain relief, subsequent relevant surgeries, and any identifiable instability.All operations in which a single, total lumbar facetectomy was performed were reviewed. A total of 222 patients were identified with a minimal follow-up of 3 months; 187 (84.2%) were available for long term follow-up ≥1 year by continued accessible health care records, correspondence, or mailed questionnaire.Short term success (3-month follow-up) for radicular pain relief in 222 patients found the following results: 176 patients (79.3%) had no pain or minimal pain, and 16 patients (7.2%) were improved, and thus resulting in 192 (86.5%) with no pain, or improved radicular pain. 30 patients (13.5%) were postoperative failures at 3 months. Long term follow-up ≥1 year was available for 187 patients (84.2%); (range 1-17 years; mean 7 years); found the following results: 23/30 (76.6%) short term surgical failures remained failures in long term follow-up with (7 patients) or without (16 patients) further surgery of any kind; 13/16 improved patients at long term follow-up remained improved (6), were pain free (6), or worse (1); 19/151 no or minimal pain patients at long term follow-up recurred or worsened by 1 year or longer, 12/19 pursued a second surgery with (9) or without (4) fusion and many improved. A total of 13 patients had a subsequent fusion operation (6.95%).Most patients do well in the short term for radicular pain relief. Most patients continue to do well in long term follow-up. Surgically induced clinical instability is uncommon in this highly selected series.

Background Data Decompression discectomy is a common procedure for treatment of sciatica caused by lumbar disc herniation. Conventional discectomy may damage many important motion segment structures. Microscopic lumbar disc surgery can offer better visualization, magnification and illumination that lead to less invasive disc surgery. Shorter hospital stay, rapid recovery, and decrease the surgical cost is a trend to broaden the types of procedures that can be safely performed as one day care procedure. Purpose: To assess the safety and efficacy of microscopic lumbar discectomy with partial ligamentum flavum preservation in treating L5-S1 lumbar disc herniation as outpatient procedure in one day care hospital. Study design: Prospective clinical case study. Patients and Methods: Between the period of 2012 and 2015 seventy cases were treated for prolapsed L5-S1 disc after failure of conservative treatment. All patients were operated by microscopic lumbar discectomy with partial preservation of the ligamentum flavum as outpatient one day surgery. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and patient satisfaction questionnaire were used to assess the safety and efficacy of our procedure. Preoperative and postoperative MRI was done to confirm ligamentum flavum preservation. Results: At the last follow up, VAS improved from 7.29±0.89 to 1.8±0.93 with P value P

We report a case of recurrent postoperative spinal hemorrhage after lumbar disc surgery in a Glanzmann thrombasthenia patient.

Objective: The most common complication after lumbar discectomy is reherniation. Although many studies have investigated factors that may increase the reherniation risk, few are agreed upon all. It has been suggested that limited nucleus removal is associated with higher reherniation risk, while more aggressive nucleus removal can result in increased disc degeneration. Here, we assessed the efficacy of a coblation-assisted microdiscectomy in adult patients undergoing single-level disc surgery. Methods: We prospectively compared the reherniation rate in 75 patients (Group 1) undergoing single-level lumbar disc surgery completed with the radiofrequency bipolar system Aquamantys® (Medtronic, Minneapolis, MN, USA) to that of a historical control group (n = 75) matched for variables related to herniation level and characteristics (Group 2). Patients were followed up to 4 years. Reherniations were assessed, pain and function were monitored throughout, and imaging was performed at annual follow-up. Results: The overall symptomatic reherniation rate was 4%. In particular, one case (1.3%) was observed in Group 1 and five (6.7%) in Group 2 (P < 0.05). Magnetic resonance imaging identified a total of 4 (2.7%) asymptomatic reherniations at 12 months, 6 (4%) at 24 and 36 months, and 7 (4.7%) at 48 months. Overall, Group 1 contained one (1.3%) asymptomatic reherniation case, while six (8%) were observed in Group 2 (P < 0.05). Conclusions: The low reherniation rate in patients treated by the coblation-assisted microdiscectomy suggests that this technique may reduce the reherniation risk. Clinical outcomes for pain and function at 4 years follow-up compared favorably with literature data. Randomized controlled trial could confirm these results. © 2019 Journal of Craniovertebral Junction and Spine.

Fedor Krause's inspiring biography shows the value of translational thinking: one of the fathers of modern neurosurgery, this gifted child was recognized for his musical talent; he was able to study medicine thanks to financial support in recognition for his study performances. He wrote his doctor thesis on pneumology, and contributed to general surgery, neuroanaesthesiology, and neurosurgery application of novel technologies in neurosurgery and ethics. More in detail, in the neurosurgical field, he performed the first lumbar discectomy, set up intraoperative nerve monitoring, and pioneered trigeminal and acusticus nerve surgery, epilepsy surgery, and cortical mapping. His passion and engagement for surgery allowed him to make small centers turn into great centers recognized as renowned academic environments.

Aims The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. Patients and Methods This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression. Results Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity. Conclusion The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470–477.

The objective of this case is to provide an update based on the current highest level of evidence on several aspects of one the most commonly performed neurosurgical procedures, lumbar disc surgery for sciatica. Using a straightforward case we discuss the following issues: timing of surgery for sciatica, surgical approach of symptomatic disk herniation surgery (tube, transforaminal or microdiscektomy), and technique of removal (nucleo- and sequesterectomy).

Vascular complications of lumbar disc surgery are rare. Few cases have been reported. Arteriovenous fistulas are the most common. They are due to anatomical relationships between the last lumbar vertebrae, the corresponding discs, and the iliac vessels; degenerative lesions of the intervertebral discs facilitate instrumental vessel perforation, and operative difficulty. Computed tomography is particularly accurate for making the diagnosis. Treatment strategies consist in surgery or endovascular management. Percutaneous endovascular treatment using a stent-graft is a reasonable option for treating arteriovenous fistula. We describe the case of a 50-year-old patient who developed an iliocaval arteriovenous fistula following lumbar disc hernia surgery. The lesion was excluded by a stent-graft. The postoperative period was uneventful.

OBJECTIVE Surgical drains are commonly used after the spine surgeries for minimizing hematoma formation, which can delay wound healing and may become a source of fibrosis, infection, and pain. The drain, however, may provide a direct route for infection if it is contaminated. Our objective was to survey the relationship between surgical drains and infection. METHODS The 70 patients who had undergone single-level lumbar discectomy from April 2011 to March 2012 were retrospectively analyzed. Each patient's medical chart and magnetic resonance image were thoroughly reviewed after all the patients had been divided into the drainage and the nondrainage groups. The amounts and durations of the surgical drains in the drainage group were analyzed. Additionally, the levels of C-reactive protein, rates of infection, scores of preoperative and postoperative visual analog scale (VAS), and lengths of hospital stay after operation were compared between the 2 groups. RESULTS In this study, 70 patients were retrospectively analyzed; out of which, 42 and 28 patients were included in the drainage and the nondrainage groups, respectively. Two of the postoperative infection cases in the nondrainage group required to undergo repeated operations. The frequency of the postoperative infection cases was higher in the nondrainage group than in the drainage group; however, there was no significant statistical difference between the 2 groups (p=0.157). CONCLUSION Surgical drains did not elevate postoperative infection. Furthermore, drain tip cultures allowed us to detect postoperative infection at an early stage, and it led to faster initiation of antibiotics treatment.

Introduction Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection. Patient concerns We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery. Diagnosis The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods. Intervention We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect. Outcomes Post-operative period was uneventful and the patient showed good recovery. Conclusion Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.

OBJECTIVEThe positive effect of primary lumbar disc surgery on braking reaction time (BRT) has already been shown. The authors investigated the effect of recurrent lumbar disc herniation surgery on BRT.METHODSTwenty-four patients (mean age 49.9 years) were investigated for BRT 1 day before surgery, postoperatively before hospital discharge, and 4 to 5 weeks after surgery. Thirty-one healthy subjects served as a control group.RESULTSSignificant improvement of BRT following surgery was found in all patients (p < 0.05). For patients with right-sided recurrent disc herniation, median BRT was 736 msec before surgery, 685 msec immediately postoperatively, and 662 msec at follow-up. For patients with left-sided recurrent disc herniation, median BRT was 674 msec preoperatively, 585 msec postoperatively, and 578 msec at follow-up. Control subjects had a median BRT of 487, which differed significantly from the patient BRTs at all 3 test times (p < 0.05).CONCLUSIONSA significant reduction in BRT in patients with recurrent disc herniation was found following lumbar disc revision surgery, indicating a positive impact of surgery. Due to the improvement in BRT observed immediately after surgery, we conclude that it is appropriate to recommend that patients keep driving after being discharged from the hospital.

Study Design: This is a prospective, randomized, controlled study designed and conducted over 10 years from 2002 to 2012. Purpose: The study aimed to monitor the effect of suction drains (SD) on the incidence of epidural fibrosis (EF) and to test, if the use of SD alone, SD with local steroids application, SD combined with fat grafts and local steroids application, or SD combined with fat grafts and without local steroids application, would improve outcome. Overview of Literature: EF contributes to significant unsatisfactory failed-back syndrome. Efforts have been tried to reduce postop erative EF, but none were ideal. Methods: Between September 2002 and 2012, 290 patients with symptomatic unilateral or bilateral, single-level lumbar disc herniation were included in the study. Two groups were included, with 165 patients in group I (intervention group) and 125 patients in group II (control group). Group I was subdivided into four subgroups: group Ia (SD alone), group Ib (SD+fat graft), group Ic (SD+local steroids), and group Id (SD+fat graft+local steroids). Results: The use of SD alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome and significantly reduced EF as measured by magnetic resonance imaging (MRI). Conclusions: This study has clearly demonstrated the fact that the use of suction drainage alone or combined with only fat grafts, fats grafts and local steroids application, or only local steroids application significantly improved patient outcome with respect to pain relief and functional outcome and significantly reduced EF as measured by an MRI. A simple grading system of EF on MRI was described.

The aim of this study was to describe the associations among pain, disability and psychosocial factors preoperatively as well as 3 and 24 months later for patients who undergo first time discectomy and to analyse the predictive value of psychosocial factors on the outcome 24 months after surgery.Fifty-nine patients, 41 % women, with a mean age of 40 years and without comorbidities were included, of whom 56 responded to the 24-month follow-up; at that point, they were divided into patients with complaints (C, n = 36) and patients without complaints (NC, n = 20). Correlations among the pain intensity, disability and psychosocial factors were analysed preoperatively, 3 and 24 months after discectomy, and regression analyses of psychosocial factors on the outcome at 24 months were performed.Psychosocial variables were weakly correlated with the pain intensity and disability preoperatively. High expectations on the return to work were predictive of both pain intensity (β = 8.0, p = 0.03) and disability (β = 9.1, p0.001) at 24 months. Associations between psychosocial variables and outcome variables were strengthened at the 3-month follow-up in the C group, and this association remained 24 months after surgery. Fear of movement was most strongly correlated with leg pain intensity (r (s) 0.64, p0.001) and the ability to decrease pain was the most correlated with disability (r (s) 0.78, p0.001).Having high expectations on the return to work after surgery was the strongest predictor for a favourable outcome. Therefore, low preoperative expectations on return to work convey an important prognostic signal.

PURPOSE: We aimed to determine whether there was a difference in post-operative symptomatic control and quality of life (QoL) between patients who were obese (BMI >30) and non-obese (BMI METHODS: We conducted a prospective questionnaire-based study of QoL and symptom control in 120 patients with postal follow-up at 3 and 12 months after lumbar disc surgery. This study was conducted in two United Kingdom regional neurosurgical units, with ethical approval from the North of Scotland Research Ethics Service (09/S0801/7).RESULTS: 120 patients were recruited; 37 (34.5%) were obese. Follow up was 71% at 3 months and 57% at 12 months. At recruitment, both obese and non-obese patient groups had similar functional status and pain scores. At 3 and 12 months, non-obese and obese patients reported similar and significant benefits from surgery (e.g. 12 month SF-36 80.5 vs. 68.8, respectively). In non-obese and obese patients, time to return to work was 47.5 days and 53.8 days, respectively, (p = .345). After 12 months all QoL scores were significantly improved from pre-operative levels in both groups.CONCLUSIONS: Obese patients derive significant benefit from lumbar discectomy that it is similar to the benefit experienced by non-obese patients. Obese individuals may achieve excellent results from discectomy and these patients should not be refused surgery on the basis of BMI alone.

INTRODUCTION The most common cause of poor outcome following lumbar disc surgery is recurrent herniation. Recurrence has been noted in 5% to 15% of patients with surgically treated primary lumbar disc herniation. There have been many studies designed to determine the risk factors for recurrent lumbar disc herniation. In this study, we retrospectively analysed the influence of disc degeneration, endplate changes, surgical technique, and patient's clinical characteristics on recurrent lumbar disc herniation. METHODS Patients who underwent primary single-level L4-L5 lumbar discectomy and who were reoperated on for recurrent L4-L5 disc herniation were retrospectively reviewed. All these operations were performed between August 2004 and September 2009 at the Neurosurgery Department of Ataturk Education and Research Hospital in Ankara, Turkey. RESULTS During the study period, 126 patients were reviewed, with 101 patients underwent primary single-level L4-L5 lumbar discectomy and 25 patients were reoperated on for recurrent L4-L5 disc herniation. Preoperative higher intervertebral disc height (P

Background: The relationship of exiting root and Kambin's triangle is discussed in this article. Transforaminal endoscopic surgery as the gold standard of less invasive lumbar disc surgeries is performed through Kambin's triangle. Existing root damage is one of the most important complication for this type of surgery. Anatomic variations in Kambin's triangle may be the main reason for nerve root damage during endoscopic lumbar disc surgery. Methods: Kambin's triangle was investigated with surgical views and cadaver studies. Thirty-four patients with far lateral disc herniation were treated with an extraforaminal approach under the microscope. On the other hand, 48 Kambin's triangles were dissected on 8 cadavers. Three main types of triangle were identified, and patients were grouped according to these 3 types of the triangle. Results: Only 6 of the 34 patients had type 3 triangles, which is the wide classical triangle described by Kambin; however, 17 patients had type 2, with a narrow space in the triangle, and 11 patients had type 1, with no space inside the triangle. Cadaver results were similar; only 10 of the 48 specimens had the type 3 classical triangle, whereas 23 specimens had type 2, and 15 specimens had type 1 triangles. Our results disclosed narrowed or no space in 82.4% of the patients and 79.2% of the cadavers. Conclusion: We observed that a wide and safe room of the triangle may not be exist in some patients. Therefore, more care must be taken during endoscopic lumbar disc surgery to avoid nerve damage., NA

Microdiscectomy (MD) is accepted nowadays as the operative method of choice for lumbar disc herniation, but it is not rare for neurosurgeons to opt for standard discectomy (SD), which does not entail the use of operating microscope. In our study, differences in disc herniation recurrence and clinical outcome of surgical treatment of lumbar disc herniation with and without the use of operating microscope were assessed. Our study included 167 patients undergoing lumbar disc surgery during a three-year period (SD, n=111 and MD, n=56). Clinical outcome assessments were recorded by patients via questionnaire forms filled out by patients at three time points. Operation duration, length of hospital stay and revision surgeries were also recorded. According to study results, after one-year follow up there was no statistically significant difference between the SD and MD groups in functional outcome. However, we recorded a statistically significant difference in leg pain reduction in favor of the MD group. According to the frequency of reoperations with the mean follow up period of 33.4 months, there was a statistically significant difference in favor of the MD group (SD 6.3% vs. MD 3.2%). There appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome. However, we choose MD over SD because it includes significantly lower recurrent disc herniation rate and higher reduction of leg pain.