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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.

OBJECTIVEThe purpose of this study was to investigate whether the intraoperative application of an epidural steroid (ES) on the decompressed nerve root improves short- and midterm subjective and objective clinical outcomes after lumbar microdiscectomy.METHODSThis study was a retrospective analysis of a 2-center database including consecutive cases in which patients underwent lumbar microdiscectomy. All patients who received ES application (40 mg triamcinolone, ES group) were matched by age and sex to patients who had not received ES application (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores of the Timed Up and Go (TUG) test. Back and leg pain (visual analog scale), functional impairment (Oswestry Disability Index [ODI], Roland-Morris Disability Index [RMDI], and health-related quality of life (hrQoL; 12-Item Short Form Health Survey [SF-12] physical component summary [PSC] score and EuroQol [EQ-5D index]) were measured at baseline, on postoperative day 3, and at postoperative week 6.RESULTSFifty-three patients who received ES application were matched with 101 controls. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment, and hrQoL were similar. On postoperative day 3, the ES group had less disability on the RMDI (mean 7.4 vs 10.3, p = 0.003) and higher hrQoL as determined by the SF-12 PCS (36.5 vs 32.7, p = 0.004). At week 6, the ES group had less disability on the RMDI (3.6 vs 5.7, p = 0.050) and on the ODI by trend (17.0 vs 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 vs 39.9, p = 0.018); and lower OFI (TUG test T-score 100.5 vs 110.2, p = 0.005). The week 6 responder status based on the minimum clinically important difference (MCID) was similar in the ES and control groups for each metric. The rates and severity of complications were similar, with a 3.8% and 4.0% reoperation rate in the ES group and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the ES group (5.0 vs 5.8 days, p = 0.066).CONCLUSIONSIntraoperative ES application on the decompressed nerve root is an effective adjunct treatment that may lower subjective and objective functional impairment and increase hrQoL in the short and intermediate term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs for each metric, indicating that the effect size of the benefit is limited.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective cohort trial; evidence: Class II.

Background Despite growing evidence regarding the role of osteopathic manipulative treatment (OMT) for the management of low back pain, there is little evidence to support the use of OMT as a post-operative rehabilitation to improve the functional outcomes of lumbar disc surgery. Objective To assess the feasibility for a future definitive randomised control trial that would indicate whether OMT improves post-operative outcomes after lumbar microdiscectomy compared to a standard exercise programme. Design Randomised controlled pilot study. Setting Department of Spinal Surgery and Department of Spinal Rehabilitation at a major metropolitan spine surgery hospital, Seoul, South Korea. Methods Patients who underwent lumbar microdiscectomy due to low back pain with referred leg pain resulting from a herniated disc were enrolled in the study. Thirty-three patients aged 25–65 years were randomly assigned using a random number table to the OMT ( n = 16) group or exercise group ( n = 17). Patients received the allocated intervention twice a week for 4 weeks. Each session was 30 min. Primary outcomes were post-surgical functional disability and intensity of low back and leg pain. Outcome measures were assessed at baseline (2–3 weeks after surgery) and post-intervention (7–8 weeks after surgery). Double blinding was not feasible in the study setting. Results Thirty-three participants were analysed. Both rehabilitation interventions improved all primary and secondary outcomes. Post-surgical physical disability improved more with OMT rehabilitation than the exercise programme (54% vs. 26%, P Conclusion The current pilot study shows the feasibility of a future definitive randomised control trial investigating whether rehabilitation with OMT is a viable approach for post-operative management of a lumbar microdiscectomy.

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.

The objective of this study is to investigate the effects of acupuncture, core-stability exercises, and treadmill 12-minute walking exercises in treating patients with postsurgical lumbar disc herniation. A 34-year-old woman with a history lumbar disc prolapse who had undergone lumbar disc surgery on two different occasions was treated using acupuncture, core-stability exercises, and treadmill walking exercises three times per week for 12 weeks. The outcome measures used in this study were pain intensity, spinal range of movement, and general health. After 12 weeks of treatment, the patient had made improvement in terms of pain, which was reduced from 9/10 to 1/10. In a similar vein, the patient's general health showed improvement of >100% after 12 weeks of treatment. Pre-treatment scores of spinal flexion and left-side flexion, which measured 20 cm and 12 cm, respectively, increased to 25 cm and 16 cm after 12 weeks of treatment. This study showed that acupuncture, core-stability exercises, and treadmill walking exercises were useful in relieving pain, increasing spinal range of movement, and improving the health of a patient with postsurgical lumbar disc herniation.

Lumbar disc herniation surgery is usually performed through a posterior approach. Vascular injuries can be counted among the complications. 39 years old male patient had lower extremity pain which has started after lumbar disc herniation surgery and continued for a month. Iliac arterial pseudoaneurysm has been detected in computerized tomography. It was successfully treated with vascular surgery [Cukurova Med J 2016; 41(0.100): 5-7]

QUESTION: Is referral for early rehabilitation after lumbar disc surgery effective and cost-effective compared to no referral?DESIGN: Multicentre, randomised, controlled trial, and economic evaluation with concealed allocation and intention-to-treat-analysis.PARTICIPANTS: Adults who underwent discectomy for a herniated lumbar disc, confirmed by magnetic resonance imaging, and signs of nerve root compression corresponding to the herniation level.INTERVENTION: Early rehabilitation (exercise therapy) for 6 to 8 weeks, versus no referral, immediately after discharge.OUTCOME MEASURES: In line with the recommended core outcome set, the co-primary outcomes were: functional status (Oswestry Disability Index); leg and back pain (numerical rating scale 0 to 10); global perceived recovery (7-point Likert scale); and general physical and mental health (SF12), assessed 3, 6, 9, 12 and 26 weeks after surgery. The outcomes for the economic evaluation were quality of life and costs, measured at 6, 12 and 26 weeks after surgery.RESULTS: There were no clinically relevant or statistically significant overall mean differences between rehabilitation and control for any outcome adjusted for baseline characteristics: global perceived recovery (OR 1.0, 95% CI 0.6 to 1.7), functional status (MD 1.5, 95% CI -3.6 to 6.7), leg pain (MD 0.1, 95% CI -0.7 to 0.8), back pain (MD 0.3, 95% CI -0.3 to 0.9), physical health (MD -3.5, 95% CI -11.3 to 4.3), and mental health (MD -4.1, 95% CI -9.4 to 1.3). After 26 weeks, there were no significant differences in quality-adjusted life years (MD 0.01, 95% CI -0.02 to 0.04 points) and societal costs (MD -€527, 95% CI -2846 to 1506). The maximum probability for the intervention to be cost-effective was 0.75 at a willingness-to-pay of €32 000/quality-adjusted life year.CONCLUSION: Early rehabilitation after lumbar disc surgery was neither more effective nor more cost-effective than no referral.TRIAL REGISTRATION: Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017) Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy XX: XX-XX].

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.

Background: Our review question was “Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?” Methods: We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included. Study outcomes included postoperative back pain, leg pain, length of hospital stay, and return to work. Data was extracted through a proforma. Means and mean differences were calculated for continuous data, whereas odds ratios were calculated for dichotomous data. Data were analyzed with the help of Rev Man 5. Results: Twenty RCTs were included in the review. Quantitative analysis could be performed on 19 RCTs. Intraoperative steroids improve control of back pain at 24–48 hours. Although there was some benefit of steroid administration in controlling postoperative leg pain, it disappeared at 1 year and in the overall pooled analysis. The length of hospital stay was much shorter in the steroid group. The frequency of adverse events and complications also favored steroid administration. Conclusion: Intraoperative epidural steroid administration offers some benefit in pain control with a significant reduction in the length of hospital stay. However, there is insufficient evidence to support the routine use of oral and intravenous steroids in the perioperative period.

Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.

Although aortocaval fistula is mostly encountered as a complication of abdominal aortic aneurysms, it may also arise as a complication of lumbar disc surgery. Great arteriovenous shunts especially may lead to high-output heart failure in due time. In this paper, we aim to present a case of high-output heart failure secondary to aortocaval fistule caused by lumbar disc surgery.

For the development of a new-generation training system for spinal surgery, an iterative development cycle based on four steps was used. By using (i) empathy, (ii) cognitive model, (iii) prototyping and testing, and (iv) validation, an interdisciplinary development team was able to successfully build and validate a training system for lumbar disc surgery. The training system consists of a realistic training model based on synthetic materials and an accompanying training concept. It allows the training of different scenarios, starting from basic surgical tasks to complex surgeries with different complications. This article describes the development process and the results of the validation of the training system.

This study examines the relationship between low back pain, disability and fatigue and overt physical activity with respect to fear-avoidance and endurance-related subgroups.49 patients completed questionnaires (Pain, Disability, Fatigue, Depression, Pain-responses pattern) 6 months after lumbar disc surgery and underwent an 8-hour accelerometer assessment measuring overall physical activity (PAL), constant strain postures (CSP), standing time (ST) and lying time (LT). Four subgroups, representing patterns of distress-endurance (DER), eustress-endurance (EER), fear-avoidance (FAR) and adaptive responses (AR) due to the avoidance-endurance model of pain-regulation were investigated.Multivariate analyses of covariance revealed significantly higher pain, disability and fatigue in FAR compared to AR patients and, as expected lower PAL and CSP in FAR than in endurance patients. Both endurance groups revealed higher pain accompanied by higher accelerometer-based physical activity (PAL, CSP) than AR and FAR patients. Most of the subgroup differences displayed moderate to high effect sizes.The results indicate different pathways to chronic pain and disability with physical underuse in FAR patients and overuse/overload in endurance patients suggesting the need for individually targeted cognitive-behavioral treatments in the maladaptive groups. Implications for Rehabilitation Improving the return to a normal physical activity level is an important goal for the rehabilitation of patients after lumbar disc surgery. Different pathways to chronic pain and disability with physical underuse in fear-avoidance patients and overuse in endurance patients should be considered. Different pain-related pain response pattern, based on the avoidance-endurance model, indicate the need for individual targeting of rehabilitation programs.

Most pain and disability variance in patients with low back pain still remains unexplained. The aim of this study was to enhance the degree of explained variance by including measures of pain and tactile sensitivity as well as pain-related endurance and fear-avoidance responses. Thirty-six post lumbar disc surgery patients completed psychometric questionnaires (Avoidance-Endurance Questionnaire, Fear-Avoidance Beliefs Questionnaire, Beck Depression Inventory) and underwent quantitative sensory testing (QST) with measures of pain (pressure (PPT) and mechanical pain threshold) and tactile sensitivity (MDT). Bivariate correlations and hierarchical multiple regression analysis were computed. In addition to the contribution of fear-avoidance responses, pressure pain sensitivity and endurance behavior significantly contributed to explanations of pain variance, whereas disability was primarily predicted by fear-avoidance. While all psychological variables and MDT were positively related to pain or disability, PPT was negatively related to pain. The regression model accounted for 69 % of the variance in back pain intensity and 68 % of the variance in disability. Tactile hypaesthesia was related to increased clinical pain. Pain-related endurance responses and pressure pain hyperalgesia were significant additional predictors for pain, but not for disability. These findings are compatible with generalized disinhibition via descending pathways and a general inhibition of tactile acuity by ongoing pain.

The purpose of this study was to compare the causes and characteristics of reoperations after different primary operations for lumbar disc herniation (LDH).Out of a series of 5,280 patients who underwent operations for LDH between 2001 and 2012, 207 patients (135 male and 72 female, mean age 47.7 years) underwent primary and revision operations, which were included in this study. The following clinical parameters were retrospectively assessed: the primary surgical methods, the intervals between primary and revision operations, and surgical findings in the revisions.In total, 232 lumbar discs underwent reoperations. One hundred and nineteen reoperations were performed after microendoscopic discectomy (MED group), 68 after percutaneous endoscopic lumbar discectomy (PELD group) and 45 after open disc surgery (open group). The locations of revision operations had priority over those of primary surgery, with a moderate correlation (kappa coefficient = 0.533). A total of 46.6 % of reoperations were performed within 0.5 years after primary surgery, and 35.3 % were performed between one and five years. Real recurrent herniation (homolateral herniations at the same level) was significantly more common than other reoperative surgical findings (70.6 % in PELD group, 47.1 % in MED group, 37.8 % in open group). The overall mean interval until revision surgery was 18.9 months (8.1 months in the PELD group vs. 19.7 months in the MED group vs. 33.1 months in the open group, p0.01).For LDH, real recurrent herniation was the most common cause of reoperations, and more reoperations for real recurrent herniations and shorter intervals were found after minimally invasive endoscopic discectomy than after open disc surgery.

Background and purpose Various techniques are available for lumbar disc surgery. But failure and severe adverse events still occur during such procedures. Recent work concluded that the use of microscope was not mandatory for such procedures. Methods The first 70 spinal procedures for lower limb radicular syndrome by a surgeon at the beginning of this activity where studied. Particular interest was paid on adverse events, especially complications and failures. Result Average duration of surgery (50 min) and rate of reoperation (six reoperations needed out of 65 patients, five of them by the same surgeon) where, as expected, a bit higher than published in experienced hands. But no battered-root syndrome, injury to neighboring structures or other severe complication was observed. Noteworthy is that no patient was neurologically worsened by surgery. Conclusions If the use of microscope may not be needed for lumbar disc open surgery in experienced hands, we strongly advice surgeons at the beginning of their practice to use it. At least, to avoid unforgiving mistakes such as picking out the root instead of the herniation.

WOS: 000406170300015, PubMed ID: 27593803, AIM: Lumbar discectomy is a common surgical intervention in neurosurgical practice. latrogenic vascular injury during this surgery is a rare, but serious complication. In this study, our aim was to review the average safe depth of discectomy for both sexes. MATERIAL and METHODS: This study involved a total of 56 patients between 21 and 79 years old (28 male and 28 female) who had no surgical pathology as documented by lumbar magnetic resonance imaging study. Measurements at L3-4, L4-5, and L5-S1 were performed for both sexes as follows: 1St measurement, from the furthest lateral part of the dura to the end of the disc (right-left); 2nd measurement, the anteroposterior length of the cross-section passing through the midline of the disc; 3rd measurement; from the furthest lateral part of the dura to the furthest lateral part of the disc (right-left); 4th measurement, the length from right to left of the cross-section passing through the midline of the disc. RESULTS: Measurement 1 at L3-4, L4-5, and L5-S1, this value was estimated to be 35.9 and 36.7 mm, 35.9 and 36.9, and 34 and 34.9 mm in the right and left sides respectively, for female subjects. The corresponding values for males were 41.4 and 42.1, 40.6 and 40.9, and 37.4 and 37.7 mm at L3-4, L4-5, and L5-S1, respectively. Measurement 3 in L3-4, L4-5, and L5 -S1 disc spaces on the right and left sides in female subjects were 14.8 and 16.3 mm, 15.7 and 17.2 mm, and 14.9 and 17.1 mm, respectively, with corresponding figures of 18.6 and 19.5, 19.7 and 20.6, and 18.2 and 18.6 mm among male participants. Measurement 2 and 4 in females for L3-4, L4-5, and L5 -S1 were 38.4 and 52.3 mm, 38.9 and 53.4 mm, and 37 and 51.8 mm, respectively. The corresponding figures for males were 43.2 and 57.6 mm, 43.2 and 58.9 mm, and 40.1 and 56.7 mm, respectively. CONCLUSION: Determination of the safe discectomy depth in both males and females, as well as the use of marking disc punches to indicate the safe margins may help clinicians to avoid this unwanted complication.

Introduction: Pain is one of the most important reasons for the patients concern after surgery. The perfect sedative should have properties like rapid onset, least pain and adverse effects. Aim: To assess the effect of sevoflurane plus propofol on postoperative pain, haemodynamic stability and complication after lumbar disc surgery. Materials and Methods: This was a randomized double- blind clinical trial. A total of 75 patients scheduled for elective lumbar disc surgery with simple random sampling design received sevoflurane (n=25, induced with Thiopentone and maintained with sevoflurane), propofol (n=25, induced and maintained with propofol) and sevoflurane plus propofol (n=25, induced with propofol and maintained with sevoflurane). Visual Analog Scale (VAS) was used to determine the intensity of postoperative pain. Complications after surgery and haemodynamic changes during surgery were recorded. Results: The mean pain intensity and morphine consumption in the sevoflurane plus propofol group was lower compared to the propofol and sevoflurane groups at different intervals (p 0.05

International audience; BACKGROUND: In the context of the establishment of a new surveillance system, the aim was to assess the proportion of cases of lumbar disc surgery (LDS) attributable to work according to occupation category and industry sector. METHODS: The sociodemographic and socioeconomic data of 3150 inpatients living in a French region discharged in 2007-2008 from spine centers of the region following LDS were compared with those of the regional population. Occupational history was gathered using a mailed questionnaire. The attributable fraction of risk for exposed individuals (AFE) and population attributable fraction of risk (PAF) were calculated in relation to occupations and industries.RESULTS: Three occupational subcategories presented an AFE >50% for men (police and armed forces, unskilled agricultural and skilled craft blue-collar workers). There were eight subcategories for women, including material handlers and related equipment workers, and skilled industrial and unskilled agricultural blue-collar workers. The PAF for men was highest for construction and for women it was highest for wholesale and retail trades.CONCLUSION: The AFE and PAF are valuable for public policy. Although PAF could be used to help public health policy makers to implement preventive measures, the AFE could assist expert tribunals who take decisions about compensation for occupational diseases.

It is quite rare for foreign bodies retained after surgery to display tumour-like clinical and radiological findings. A 60 year-old female patient presented to the clinic with low-back and left hip pain. She had undergone lumbar disc surgery 31 years ago. She had pain in her low-back and left hip for 3 months. The patient’s CT and MRI showed a well-defined mass lesion at left posterior S2-S3, measuring 3.5 to 4 cm, with circumferential scattered contrast enhancement, which extended to the canal and caused bone erosion. Only when the mass was completely resected with its circumference, it was found out that it was the gauze retained after the surgical procedure. Our case is the oldest one in the neurosurgery and spinal surgery literature, which showed clinical findings 31 years after the lumbar disc surgery.

Major vascular injuries during lumbar disc surgery are rare but well-recognized complications. However, vascular injuries of the branches of the aorta and ureteral injuries are very rare. Although its incidence is not known definitely, it is estimated to be 1/1000. Ureteral injuries comprise less than 1% of all genitourinary traumas. In this article, we report clinical progress of a patient who had simultaneous internal iliac artery and ureteral injury during lumbar discectomy. The patient was managed with primary ureteroureterostomy. To our knowledge, this is the first case reported with simultaneous ureter and iliac artery trauma during lumbar disc surgery. © 2016 by Turkish Association of Urology.

The benefits of physiotherapy have been extensively demonstrated in human medicine. Although physiotherapy has been performed in veterinary medicine for already several decades, it is only very recently that scientific research on this subject is increasing. The purpose of this paper is to give an overview of the different veterinary physiotherapeutic assessment and treatment techniques and possibilities, and correlate them to the data in the veterinary literature.

A spinal cord ischemic injury defined by acute transient paraplegia, following lumbar disk surgery was not reported in the literature. A lumbar MRI was performed to a 60 years old obese and short female patient due to low back and leg pain. An acute disk extrusion was found at the L4-5 absolute spinal stenosis background. The patient had lumbar disc surgery at the prone position. The patient woke up with paralysis in both extremities under T10 level postoperatively. The MRI showed air bubbles in the spinal canal, originating from the giant venous dural lacs. After 6-8 hours with medical treatment, the patient completely regained the sensory first, then the motor function. Since the fast recovery in the early period and the air seen on MRI, the other reasons such as fibro cartilaginous embolism at the spinal cord level were excluded, and the etiology was thought to be the venous air embolism. This is the first case in the literature with paraplegia due to acute spinal ischemia, which is thought to happen due to venous air embolism during the lumbar decompression surgery. © 2016, Ege University Press. All Rights Reserved.