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Microdiscectomy is one of the surgical methods for the treatment of herniated intervertebral disc in patients with low back pain. The aim of the research was to evaluate the presence of psychological and cognitive-behavioral factors, including anxiety, fears and fear-avoidance beliefs of physical activity and work and their correlation with the pain and functional disability in patients after lumbar microdiscectomy and subsequent physical therapy. Th e research was performed on 198 patients (95 men and 103 women), mean age 50.20±10.26 years. Th e following questionnaires were used in the study: Spielberger Anxiety Inventory-State and Trait; Fear-Avoidance Beliefs Questionnaire (Physical activity and Work); for intensity of pain, visual analog scale and Oswestry Low Back Pain Disability Questionnaire. Th ese assessments were carried out after microdiscectomy, as follows: just before rehabilitation treatment, and 1, 3 and 6 months after microdiscectomy. Th e pain and functional disability had significant correlations with the following factors: anxiety-state (p

Study Design: Retrospective cohort study. Objective: To determine association between preoperative Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores with postoperative pain, narcotics consumption, and patient-reported outcome measures (PROMs) following single-level lumbar microdiscectomy. Methods: Consecutive patients who underwent single-level lumbar microdiscectomy were identified from May 2017–May 2020. Patients were grouped by their preoperative PROMIS-PF scores: mild disability (score≥40), moderate disability (score 30-39.9), and severe disability (score<30). Preoperative PROMIS-PF subgroups were tested for association with inpatient postoperative pain, total inpatient narcotics consumption, time to narcotic use cessation as well as improvements in postoperative PROMIS-PF, ODI, VAS-Leg Pain, VAS-Back Pain, SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS) at 2-, 6-, 12-weeks, 6-month, 1-year, 2-year follow-up. Results: A total of 127 patients were included. Patients with greater disability reported higher inpatient maximum Visual Analog Scale (VAS) pain scores (P =.023) and total inpatient narcotics consumption (P =.008) but no difference in time to narcotic cessation after surgery (P =.373). However, patients with greater preoperative disability also demonstrated greater improvement from baseline in PROMIS-PF, ODI, SF-12 PCS, and SF-12 MCS at 2-week follow-up (P <.05). These higher improvements from baseline for patients with greater preoperative disability were sustained for PROMIS-PF, ODI, and VAS-Leg Pain at 2-year follow-up (P <.05) Conclusions: Patients with greater preoperative disability, as measured by PROMIS-PF, had increased inpatient postoperative pain and narcotics consumption, but also higher improvement from baseline in long-term PROMs. This data can be utilized for patient counseling and setting expectations. [ABSTRACT FROM AUTHOR]

Study designRetrospective case series.ObjectivesTo evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy.MethodsWe retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone).ResultsBetween 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, P < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed.ConclusionsWe found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.

Background: Lumbar Disc Herniation (LDH) is the most frequent entity affecting the spine resulting in low back pain and sciatica. Many minimally invasive procedures have been proposed for the treatment of LDH. Percutaneous Endoscopic Discectomy (PELD) is gaining popularity in recent years for the treatment of LDH and its supremacy over the well-established gold standard Microsurgical Lumbar Discectomy (MLD) is yet to be proven. Aim and Objectives: To compare pain relief using Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI), duration of surgery and incision length between MLD and PELD; To evaluate systemic cytokine response (CPK-CK, hs-CRP, IL-6) between MLD and PELD. Material and Methods: This was a prospective comparative analysis between MLD and PELD in patients undergoing surgery for single-level lumbar disc prolapse from January 2022 to October 2022 at a single institute. Results: The study included 64 patients, divided equally into two groups: 32 patients underwent conventional MLD, and 32 patients underwent PELD. Groups had similar demographic profiles and preoperative clinical features. Postoperatively, both groups showed significant improvements in pain (VAS) scores and functional disability (ODI), with no significant difference between the two groups. However, there were differences in certain biochemical markers: CPK and IL-6 levels were lower in the PELD group compared to the MLD group, and hs-CRP levels were also lower in the PELD group, though statistically significant only on the 3rd postoperative day. The surgery duration and incision length were shorter in the PELD group. Complication rates were low, with two complications in the MLD group and one in the PELD group. Conclusion: Both MLD and PELD demonstrated positive outcomes in terms of pain and functional disability reduction, but PELD showed advantages in terms of shorter surgery duration, smaller incision length, and lower levels of certain inflammatory markers. No significant difference was noted in clinical outcomes between MLD and PELD. Postoperative systemic cytokine response is significantly lower in the PELD group than in the MLD group.

Background: Lumbar Disc Herniation (LDH) is the most frequent entity affecting the spine resulting in low back pain and sciatica. Many minimally invasive procedures have been proposed for the treatment of LDH. Percutaneous Endoscopic Discectomy (PELD) is gaining popularity in recent years for the treatment of LDH and its supremacy over the well-established gold standard Microsurgical Lumbar Discectomy (MLD) is yet to be proven. Aim and Objectives: To compare pain relief using Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI), duration of surgery and incision length between MLD and PELD; To evaluate systemic cytokine response (CPK-CK, hs-CRP, IL-6) between MLD and PELD. Material and Methods: This was a prospective comparative analysis between MLD and PELD in patients undergoing surgery for single-level lumbar disc prolapse from January 2022 to October 2022 at a single institute. Results: The study included 64 patients, divided equally into two groups: 32 patients underwent conventional MLD, and 32 patients underwent PELD. Groups had similar demographic profiles and preoperative clinical features. Postoperatively, both groups showed significant improvements in pain (VAS) scores and functional disability (ODI), with no significant difference between the two groups. However, there were differences in certain biochemical markers: CPK and IL-6 levels were lower in the PELD group compared to the MLD group, and hs-CRP rd levels were also lower in the PELD group, though statistically significant only on the 3rd postoperative day. The surgery duration and incision length were shorter in the PELD group. Complication rates were low, with two complications in the MLD group and one in the PELD group. Conclusion: Both MLD and PELD demonstrated positive outcomes in terms of pain and functional disability reduction, but PELD showed advantages in terms of shorter surgery duration, smaller incision length, and lower levels of certain inflammatory markers. No significant difference was noted in clinical outcomes between MLD and PELD. Postoperative systemic cytokine response is significantly lower in the PELD group than in the MLD group. [ABSTRACT FROM AUTHOR]

Objective: The most used method in the surgical treatment of lumbar disc herniation (LDH) is lumbar microdiscectomy (LMD). In this study, we aimed to show the relationship between Tuffier's line (TL), which is widely used in determining the L4-5 distance in lumbar spinal interventions, and LMD levels. Materials and Methods: In this study, a total of 204 patients who had LMD or had low back pain were reviewed retrospectively. According to the projection of TL at the spine level; it was divided into 5 categories as L4 corpus, L4 lower endplate, L4-5 disc space, L5 upper endplate, L5 corpus. The cases were analyzed according to age, gender, disc level and changes in TL. Results: 92.1% of the cases were operated at the L4-5 or L5-S1 level. TL was mostly at L5 upper endplate level in women, L4-5 disc space and above in men, and there was a significant relationship between TL and gender in both groups (p<0.05). Conclusion: In our study, we found that although TL were caudally in patients operated at L5-S1 level, they displaced cranially in patients operated at L4-5 level. However, it was observed that LDH development in the lower lumbar region and increased at the upper levels with ageing. [ABSTRACT FROM AUTHOR]

Objectives The objective is to determine whether the preoperative duration of symptoms can affect the clinical and functional outcomes after microdiscectomy. Method This study is a single blind randomized controlled trial with level 1 evidence. From 3 January 2016 to 15 February 2017, 122 adult patients with symptomatic lumbar disc herniation were divided randomly by computer system into three groups were treated by microdiscectomy at 6 weeks, 3 months and 6 months from onset of symptoms respectively. Ninety‐seven patients, age (19–47) years, 42 males and 55 females, were analyzed at the end of this study with 3 years of follow up. Primary outcome measures are Oswestry Disability Index (ODI), Roland‐Morris Questionnaire (RMQ) and Visual Analogue Scale (VAS) for back pain and leg pain. Secondary outcome measures are post‐operative complications, length of hospital stay and time of return to daily activities. Results There was significant difference in VAS for back pain among study groups (P = 0.002) at 2 weeks). There were significant differences in VAS for leg pain among study groups (P

Objective: Sciatic scoliosis (SS) induced by lumbar disc herniation (LDH) is a great mimicked of adolescent idiopathic scoliosis (AIS). This study aimed to evaluate the clinical-radiographic presentation of SS in adolescents caused by LDH, while reporting on the average 3 years results of lumbar microdiscectomy in terms of radiographic and functional outcomes. Materials and Methods: Eighteen adolescent patients who presenting for evaluating SS with radiculopathy were enrolled. They had an average age/follow-up duration of 17.1 years/36.8 months. Lumbar microdiscectomy was applied to them. Radiographic measurements, including the analysis of curve pattern, major curve magnitude and coronal balance were undertaken. Results: A short lumbosacral curve combined with an opposite sided long thoracic and/or thoracolumbar curve was detected. 16/18 patients were detected to have LDH at the convex side of the lumbosacral curve. 14/18 were detected to have a trunk shift directed to the opposite side of the LDH. Average major curve magnitudes pre-op and at the last follow-up (FU) visit were 25.1°/4.2° respectively (p=0.001). Patients had an average pre-operative coronal imbalance of 4.1 cm reduced to 1.3 cm at the last FU (p=0.003). Average visual analogue scale leg-back and Oswestry Disability Index scores improved from 7.1-4.2 and 36.1% pre-operatively to 1.3-0.7 and 6.2% at the last FU (p<0.001). SF-36 scores were detected to be improved with high statistical significance at the last FU. Conclusion: SS was associated with short lumbosacral curves accompanied by long thoracic and/or thoracolumbar curves, while the LDH was often located at the convex side. In adolescent cases, microdiscectomy could yield an immediate recovery of the radicular pain in addition to excellent functional outcomes, while successfully restoring the coronal balance in the long term follow-up. [ABSTRACT FROM AUTHOR]

Background Context: Lumbar microdiscectomy is an effective treatment for short-term pain relief and improvements in disability in patients with lumbar radiculopathy, however, many patients experience residual pain and long-term disability. The 'people like me' approach seeks to enhance personalized prognosis and treatment effectiveness, utilizing historical data from similar patients to forecast individual outcomes., Purpose: The primary objective was to develop and test the 'people-like-me' approach for leg pain intensity and disability at 12-month follow-up after lumbar microdiscectomy and postoperative physical therapy. The secondary objective was to verify the clinical utility of the prediction tool via case vignettes., Study Design/setting: A 12-month prospective cohort study., Patient Sample: Patients (N=618, mean age: 44.7) with lumbar radiculopathy who undergo a lumbar microdiscectomy and postoperative physical therapy., Outcome Measures: Leg pain intensity (Visual Analogue Scale) and disability (Roland-Morris Disability Questionnaire) were measured at 12-months following surgery., Methods: Predictors were selected from data collected in routine practice before and 3-months after lumbar microdiscectomy. Predictive mean matching was used to select matches. Predictions were developed using preoperative data alone or combined with 3-month postoperative data. The prediction performance was evaluated for bias (difference between predicted and actual outcomes), coverage (proportion of actual outcomes within prediction intervals), and precision (accuracy of predictions) using leave-one-out cross-validation., Results: Overall, the 'people-like-me' approach using preoperative data showed accurate coverage and minimal average bias. However, precision based on preoperative data alone was limited. Incorporating 3-month postoperative data alongside preoperative predictors significantly enhanced prognostic precision for both leg pain and disability. Including postoperative data, leg pain prediction accuracy improved by 43% and disability by 23% compared to the sample mean. Adjusted R 2 values improved from 0.04 to 0.21 for leg pain, and from 0.07 to 0.34 for disability, enhancing model precision. The effectiveness of this method was highlighted in two case vignettes, illustrating its application in similar patient scenarios., Conclusion: The 'people-like-me' approach generated an accurate prognosis of 12-months outcomes following lumbar discectomy and physical therapy. Scheduling a 3-month postoperative follow-up to evaluate the course, and refine therapy plans and expectations for patients undergoing lumbar microdiscectomy would be recommended to assist clinicians and patients in more personalized healthcare planning and expectation setting., Competing Interests: Declaration of Competing Interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: Although the length of hospital stay after lumbar microdiscectomy operations, one of the most common surgical interventions in current neurosurgery practice, is quite short, nauseavomiting and urinary retention, particularly postoperative pain, may prolong this period. Also, systemic side effects may occur in cases due to pharmacological agents applied for postoperative pain control. This study was conducted to seek answers to whether bupivacaine administered intraoperatively into the paravertebral muscle mass decrease the need for postoperative narcotic analgesics and/or nonsteroidal anti-inflammatory drugs (NSAIDs). Materials and Methods: Lumbar disc hernia patients with a similar history of age, gender, body weight, disc hernia level, preoperative pain score, and preoperative analgesic use were included in the study between 01.06.2020 and 31.06.2021 (n=48). The control group of the study consisted of cases who did not receive paravertebral intramuscular bupivacaine during single-level lumbar microdiscectomy operations under general anesthesia and named as group 1 (n=24). The study group of the study consisted of cases who were administered preoperative paravertebral intramuscular bupivacaine and named group 2 (n=24). After the operation, the assessment of pain with the frequency of need for morphine sulfate or pethidine hydrochloride was performed with the Visual Analogue Scale (VAS). After the obtained data were assessed with a one-way analysis of variance, the relationship between parameters was tested using the Pearson correlation coefficient (r). Alpha significance value was accepted as <0.01. Results: It was found in comparisons between groups that the post-op VAS score (F=47.3; P=0.00), the post-op mobilization time (F=22.8; P=0.00), the post-op NSAIDs need (F=12.7; P=0.00), and the length of stay (F= 12.6; P=0.00) were statistically significant (P<0.01) in the groups using bupivacaine. However, in the cases in group 2, although the mean dose of post-op narcotic drug use decreased from 11.46±16.45 mg to 6.33±2.14 mg, it was reported that this result (F=0.5; P=0.47) was not statistically significant (P>0.01). It was determined that there was a moderate and positive relationship between the use of NSAIDs and the post-op VAS value and between the use of NSAIDs and post-op mobilization. It was determined that the post-op VAS score had a strong correlation above the moderate level with post-op mobilization time (r=0.609) and hospitalization time (r=0.603). Conclusion: In the cases for which pre-op paravertebral intramuscular bupivacaine was applied, although the decrease in the need for narcotic analgesics after the operation is not statistically significant, it was seen that it reduces the need for NSAIDS-featured dexketoprofen trometamol statistically and significantly. These results make us think that preoperative intramuscular bupivacaine administration may be effective in controlling postoperative pain and reducing the need for additional analgesics. [ABSTRACT FROM AUTHOR]

Previous studies have reported the return to play (RTP) rates for athletes after lumbar discectomy but not specifically for younger athletes. The purpose of the present study was to evaluate the RTP rate for young athletes after lumbar microdiscectomy. The medical records from a single spine surgeon were reviewed to identify patients who had undergone lumbar microdiscectomy. The patients were included if they were aged ≤21 years at surgery and were athletes. A total of 38 patients (25 males and 13 females) were identified, with a mean age at surgery of 19 years. The level of the herniated nucleus pulposus, variant anatomy, degenerative changes, gender, preoperative blocks, ring apophyseal fractures, and duration of symptoms from onset until surgery were recorded. The patients were interviewed to determine when and if they had returned to play. Most patients had had degenerative changes at surgery, with a mean Pfirrmann score of 2.2. The average time from symptom onset to surgery was 11 months. All patients were reached for follow-up at an average of 51 months postoperatively. Of the 38 patients, 71% had returned to play at an average of 4.5 months postoperatively. No statistically significant differences were found in the Pfirrmann grade and RTP rates between the high school and collegiate athletes, between the genders, nor between patients with 2-level and 1-level discectomy. The Pfirrmann grade was not significantly different between the patients who had and had not returned to play. The prognosis for returning to competitive sports after lumbar microdiscectomy in young athletes is good. The RTP rate and Pfirrmann grade were not related to gender, sport level, or discectomy level. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to characterize the effect of preoperative variables on outcomes after minimally invasive lumbar microdiscectomy. Materials and Methods This study was done from January 2019 to May 2020. This included medical records of all patients who were diagnosed with lumbar disc herniation and treated surgically by microdiscectomy. The medical records of such patients from January 2016 to January 2018 were included in this study. Postoperative outcomes were analyzed by Oswestry Disability Index (ODI), visual analog scale (VAS) leg, and VAS back scores, that were noted at preoperative, immediate postoperative, 6 months postoperative, and 1 year after operation. Difference in each outcomes score was calculated postoperatively with respect to the preoperative readings. Minimal clinically important difference was further calculated for each outcome score. Results On analyzing the ODI, VAS leg, and VAS back scores across various age groups, genders, body mass indexes, addictions, comorbidities, preoperative epidural steroid injection and physiotherapy, and levels of disc herniation, and it was found that there was no statistically significant difference across these categories. However, the ODI scores (∼ ODI) at all time points showed greater difference in the younger age group, that is, 18 to 30 years, males, nonsmokers, those with symptom duration of less than 6 weeks, and with disc herniation at L3 to L4. Conclusion The findings of this study will help to properly counsel patients with regard to the factors mentioned above so as to set realistic expectations, to help improve the outcomes, and for appropriate surgical decision making, that is, at which point should a surgical intervention be made. [ABSTRACT FROM AUTHOR]

Background: Low preoperative platelet count, or thrombocytopenia, has previously been associated with increased complications in elective spine surgeries. No other study has investigated the effects of abnormal coagulation profiles on postoperative outcomes specific to lumbar microdiscectomy (MLD) using a propensity matched cohort. Methods: Patient data was retrospectively retrieved from the National Surgical Quality Improvement Program database using Current Procedural Terminology (CPT) code 63030 to isolate patients who solely underwent MLD. Data was collected from 2010 to 2019 and included preoperative, perioperative, and 30-day postoperative variables. Patients were grouped into four platelet categories for ANOVA analysis and pairwise comparisons: Severe Thrombocytopenia (≤100), Thrombocytopenia (101-150), Moderate (151-199), and Normal (200-450). Variables that were significant in the univariate analysis were used in the multivariate analysis to determine the likelihood of experiencing adverse postoperative events – unplanned return to the operating room and surgical site infection. A propensity matched analysis was performed to control for confounding variables. Results: A total of 64,747 patients were identified within the 10-year period. The results of the multivariate analysis and the propensity matched analysis showed no significant differences in low preoperative platelet count as an independent predictor of experiencing a return to the operating room or surgical site infection. Furthermore, patients who had diabetes, history of smoking, or had emergency cases were associated with a high likelihood of experiencing these negative adverse events. Conclusion: Thrombocytopenia does not appear to independently predict return to the operating room or postoperative infection following MLD. Proper preoperative management strategies should be implemented to monitor comorbidity burden which would otherwise influence adverse outcomes in patients with thrombocytopenia undergoing MLD.

Simple Summary: The recurrence rate after lumbar spine disc surgeries is estimated to be 5–15%. Lumbar spine flexion of more than 10° is mentioned in the literature as the most harmful load to the operated disc level that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify flexions during daily living following such surgeries, for six weeks postoperatively, using wearable sensors technology. These data determine the patients' kinematic pattern, reflecting a high-risk factor for pathology recurrence. The operated patients were measured to have 30% normal lumbar motion after the first postoperative week, while they were restored to almost 75% at the end of the sixth, respectively. Further in vitro studies should be carried out using these data to identify if such kinematic patterns could lead to pathology recurrence. Background: The recurrence rate of lumbar spine microdiscectomies (rLSMs) is estimated to be 5–15%. Lumbar spine flexion (LSF) of more than 10° is mentioned as the most harmful load to the intervertebral disc that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify LSFs, following LSM, at the period of six weeks postoperatively. Methods: LSFs were recorded during the daily activities of 69 subjects for 24 h twice per week, using Inertial Measurement Units (IMU). Results: The mean number of more than 10 degrees of LSFs per hour were: 41.3/h during the 1st postoperative week (P.W.) (29.9% healthy subjects-H.S.), 2nd P.W. 60.1/h (43.5% H.S.), 3rd P.W. 74.2/h (53.7% H.S.), 4th P.W. 82.9/h (60% H.S.), 5th P.W. 97.3/h (70.4% H.S.) and 6th P.W. 105.5/h (76.4% H.S.). Conclusions: LSFs constitute important risk factors for rLDH. Our study records the lumbar spine kinematic pattern of such patients for the first time during their daily activities. Patients' data report less sagittal plane movements than healthy subjects. In vitro studies should be carried out, replicating our results to identify if such a kinematic pattern could cause rLDH. Furthermore, IMU biofeedback capabilities could protect patients from such harmful movements. [ABSTRACT FROM AUTHOR]

Objectives: The objective is to determine whether the preoperative duration of symptoms can affect the clinical and functional outcomes after microdiscectomy. Method: This study is a single blind randomized controlled trial with level 1 evidence. From 3 January 2016 to 15 February 2017, 122 adult patients with symptomatic lumbar disc herniation were divided randomly by computer system into three groups were treated by microdiscectomy at 6 weeks, 3 months and 6 months from onset of symptoms respectively. Ninety‐seven patients, age (19–47) years, 42 males and 55 females, were analyzed at the end of this study with 3 years of follow up. Primary outcome measures are Oswestry Disability Index (ODI), Roland‐Morris Questionnaire (RMQ) and Visual Analogue Scale (VAS) for back pain and leg pain. Secondary outcome measures are post‐operative complications, length of hospital stay and time of return to daily activities. Results: There was significant difference in VAS for back pain among study groups (P = 0.002) at 2 weeks). There were significant differences in VAS for leg pain among study groups (P < 0.001) at 2 weeks and at 3 months (P = 0.003). There was significant difference in ODI among study groups at 2 weeks, 3, 6 months, 1, 2 and 3 years (P = 0.037 at 2 weeks and P < 0.001 at other periods of assessments) and we found that the mean of ODI in group 6 weeks was better than group 3 months and this was better than group 6 months in all periods of assessment. Group 6 weeks was better than group 3 months and this was better than group 6 months in postoperative improvements regarding RMQ with significant difference at 2 weeks postoperatively (P < 0.001) and at 3 months postoperatively (P < 0.001). Conclusion: Duration of preoperative symptoms, in patients with lumbar disc herniation, can affect the clinical and functional outcomes after lumbar microdiscectomy as the shorter duration of symptoms resulted in better postoperative clinical and functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the effect of pedometer‐supported walking and telemonitoring after lumbar disc hernia surgery on pain and disability levels and quality of life. Methods: This was a randomized controlled trial with two randomly selected groups conducted between March 2018 and January 2019. Sixty‐seven participants (33 in the intervention group and 34 in the control group) who had undergone lumbar microdiscectomy were allocated to receive and not to receive walking exercise. Pain and disability levels and quality of life of groups were tested with the McGill Pain Questionnaire, the Oswestry Disability Index and the 36‐Item Short Form Survey. Measurements were taken 3 weeks after surgery and following completion of the first, second and third months. Results: Compared with the control group, pain level at the first and second months and disability level at the second and third months in the intervention group were significantly lower (p < 0.05), and in the third month, subdimension scores of quality of life (the physical role difficulty, energy and vitality, mental health, social functionality and pain) were higher (p < 0.05). Conclusions: Walking after herniated disc surgery decreased pain and disability levels and increased the quality of life; nurses can encourage adherence to walking as an effective intervention. SUMMARY STATEMENT: What is already known about this topic? After lumbar disc hernia surgery, patients experience low to moderate levels of pain and disability.Pain and disability levels can be decreased with appropriate post‐operative care and rehabilitation.Walking is a cheap and safe type of physical activity that is effective both in increasing physical activity after surgery and in decreasing pain and disability. What this paper adds? Walking was effective for reducing post lumbar disc hernia surgery pain and disability levels, positively contributing to better quality of life for these patients.This study showed that post discharge monitoring by nurses was necessary and important. The implications of this paper: Nurses should inform patients to gradually increase physical activity during discharge training.Walking is a simple and cheap activity with low risk of injury, which could be recommended as a type of exercise after lumbar disc herniation surgery.Nurses can use pedometers and the telemonitoring methods to motivate patients to walk. [ABSTRACT FROM AUTHOR]

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Objective: One of the causes which accelerates spinal degeneration process is lumbar disc hernia (LDH). In this study, we observed the changes in spinopelvic parameters one month after single-level lumbar microdiscectomy (LM). Materials and Methods: Standardized bilateral standing scoliosis radiography images of 19 patients, which were performed before and 1 month after LM operation, were evaluated retrospectively. Sagittal vertical axis and coronal vertical axis distances, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope and pelvic tilt angles were measured with Surgimap software. Results: There was a positive correlation between pre-and post-LM values of all spinopelvic parameters included in the study. In comparative tests however, the difference was found to be not statistically significant. As a result, despite LM operation slightly improved spinopelvic parameters in the first month, there was not a significant change overall. Conclusion: LDH is known to worsen the degenerative process in spine. LM as a treatment option is seen to alleviate this degenerative process by slowing down the deterioration in spinopelvic parameters. [ABSTRACT FROM AUTHOR]

Background: The recurrence rate of lumbar spine microdiscectomies (rLSMs) is estimated to be 5–15%. Lumbar spine flexion (LSF) of more than 10° is mentioned as the most harmful load to the intervertebral disc that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify LSFs, following LSM, at the period of six weeks postoperatively. Methods: LSFs were recorded during the daily activities of 69 subjects for 24 h twice per week, using Inertial Measurement Units (IMU). Results: The mean number of more than 10 degrees of LSFs per hour were: 41.3/h during the 1st postoperative week (P.W.) (29.9% healthy subjects-H.S.), 2nd P.W. 60.1/h (43.5% H.S.), 3rd P.W. 74.2/h (53.7% H.S.), 4th P.W. 82.9/h (60% H.S.), 5th P.W. 97.3/h (70.4% H.S.) and 6th P.W. 105.5/h (76.4% H.S.). Conclusions: LSFs constitute important risk factors for rLDH. Our study records the lumbar spine kinematic pattern of such patients for the first time during their daily activities. Patients’ data report less sagittal plane movements than healthy subjects. In vitro studies should be carried out, replicating our results to identify if such a kinematic pattern could cause rLDH. Furthermore, IMU biofeedback capabilities could protect patients from such harmful movements.

Background: To evaluate the associations between magnetic resonance imaging (MRI) findings and pain, disability and quality of life before surgery and up to 5 years after lumbar microdiscectomy. Materials and methods: Sixty-one patients who underwent one-level lumbar microdiscectomy by the same surgeon participated in this analytic, observational, prospective study. Lumbar spine MRI was performed preoperatively and 5 years postoperatively. Pain, disability and quality of life were measured with VAS, ODI, Roland Morris and SF-36 pre- and up to 5 years postoperatively. Subsequently associations between radiological findings and clinical outcomes were recorded. Results: Before surgery patients with disc extrusion or sequestration, with increased thecal sac compression (d > 2/3), with Modic changes (MC) 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and both adjacent discs presented the worst preoperative clinical outcomes. MC preoperatively were not related with postoperative results, in contrast with the type of disc herniation and thecal sac compression. Preoperative Pfirrmann grade IV and V on the operated and both adjacent discs and postoperative MC 2 and 3 on the operated level were related to poor clinical outcomes 36–60 months post-discectomy. Conclusions: Extrusion or sequestration of the operated disc, increased compression of thecal sac, MC 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and adjacent discs were associated with the worst clinical outcomes. Nerve root impingement, facet joint arthritis, perineural fibrosis and disc granulation tissue had no effect on clinical scores. [ABSTRACT FROM AUTHOR]

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 spondylodiscitöis it was 1.99±0.81, the two groups were significantly different from each other (p=0.0001). Conclusion: Although most surgeons have 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. [ABSTRACT FROM AUTHOR]

Aim: Lumbar microdiscectomy (LMD) is considered as a gold standard surgical technique for the treatment of patients with lumbar disc hernia (LDH) although various types of treatment are being developed. This study aimed to investigate the safety and efficacy of LMD in our clinic. Material and Methods: The study exclusively included 271 patients undergoing LMD due to LDH. Preoperative and postoperative (10th day, 1st month, and long-term) Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared. Clinical outcomes were analyzed retrospectively based on modified Macnab criteria. Complications were noted. SPSS Statistics 22.0 software package was used to analyse the data for pre- and postoperative VAS and ODI scores. A p value of <0.05 was considered statistically significant. Results: The mean length of stay in the operating room and hospital was 165.04±36.99 min and 1642.02±574.90 min, respectively. There was a significant decrease in postoperative VAS and ODI (%) scores compared to preoperative scores. Preoperative VAS and postoperative long-term VAS scores were 8.99±0.62 and 1.38±0.95, respectively whereas preoperative ODI (%) and postoperative long-term ODI (%) scores were 85.33±6.74 and 12.96±9.58, respectively (p<0.001). The success rate for excellent or good outcomes according to the modified Macnab criteria was 87.45%. During surgery, cerebrospinal fluid (CSF) leak and dura defect developed in four patients (1.48%) and there was only dura defect in two patients (0.73%). After the surgery, recurrent LDH, spinal infection, and spinal epidural hematoma developed in seven (2.58%), three (1.11%), and one patient (0.37%), respectively. Conclusion: LMD is an effective and safe method in the treatment of LDH as it has low complication rates and high success rates. [ABSTRACT FROM AUTHOR]

Purpose: Postoperative bracing treatment is widely used after surgery for lumbar degenerative diseases. However, the guidelines are lacking in this regard, and its use is mainly driven by individual surgeon preferences. The objective of the current review was to evaluate the available evidence on the use of postoperative bracing after surgery for degenerative disease of the lumbar spine. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed while conducting a systematic search of the PubMed/Medline, Scopus, and Cochrane databases from January 1990 to January 2019. High-quality studies were included that evaluated disability, pain, quality of life, the rate of fusion, complications, and rate of reoperations in patients who had surgery for lumbar degenerative disease, with and without postoperative bracing. The overall strength of evidence across the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results: Of the 391 citations screened, four randomized controlled trials met the inclusion criteria and were included in the review. Based on low- to moderate-quality evidence, postoperative bracing in patients with lumbar degenerative disease does not result in improved disability, pain, and quality of life compared to no bracing patients. Low-quality evidence suggests that there was no significant difference between the two groups in terms of the rate of fusion, complications, and the need for reoperation. Conclusions: To date, there is not a medical evidence to support the use of bracing after surgery for lumbar degenerative disease. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Objective: Incidence of spondylodiscitis after lumbar discectomy has been reported to be as low as 0.1-18.8% by many different authors. Most common pathogen is Staphylococcus aureus. Methods: We collected retrospectively the medical records of 1154 patients who were single-level or two-level disc herniations operated for lumbar microdiscectomy between 2007 and 2015 in our hospital. Of these patients, 554 were female and 600 were male. 1062 of these patients underwent single-level, 91-level two-level lumbar microdiscectomy. These patients received a single dose of prophylactic cephazoline during anesthesia in order to prophylaxis guidelines. Spondylodiscitis developed in 12 patients (1.03%). Comorbidities in spondylodiscitis-treated patients, 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, 1 two-level lumbar microdiscectomy operations. Five patients received L4-5, and 8 patients underwent discectomy from L5-S1 patients. Staphylococcus aureus was present in 3 patients (%25), Staphylococcus epidermidis in 4 patients (33%), Escherichia coli in 3 patients (25%) and 2 patients were not. Mean duration of hospital stay was 29.45 ± 3.98 days, and in patients without spondylodiscitis 1.99±0.81 days, there were significant difference between these groups (p = 0.0001) Conclusion: Although most surgeons have 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 compared to medical literature. [ABSTRACT FROM AUTHOR]

• Lumbar microdiscectomy technique with preserving of ligamentum flavum protects normal anatomic structures. • The preserving of ligamentum flavum technique is gaining importance in recurrent lumbar disc surgery. • Preserving of ligamentum flavum in first surgery decreases complication, operation time and surgical hemorrhage. 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. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to review the evidence-based approach for surgical complications following disc herniation.Methods: A search of the primary English literature was conducted for research examining the outcomes and complications of surgical discectomy. Special regard was given to high-quality prospective randomized studies.Results: The most commonly reported complications of surgical treatment of disc herniation are included in this review. Medical complications, and surgical complications including infection, durotomy, neurological injury, symptomatic re-herniation, and revision surgery are defined and systematically reviewed in detail for incidence, evaluation, and management.Conclusion: This article provides the clinician and surgeon with a review of the evidence-based evaluation and management of surgical complications following disc herniation, offering best practice guidelines for informed discussions with patients in shared decision-making. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effect of lumbar microdiscectomy (LM) in pain, disability and quality of life in a 5-year period and to identify potential demographic and clinical risk factors.Methods: One hundred patients who underwent LM by the same surgeon participated in this prospective study. Clinical assessment was made with validated questionnaires preoperatively and up to 5 years postoperatively. Subsequently, associations between clinical outcomes and demographic data were recorded.Results: In every assessment questionnaire, there was a significant improvement in the first postoperative month, which lasted up to 1 year post-discectomy. After that, improvement was statistically significant (p < 0.05) but without clinical importance. Women reported more pain preoperatively and 1 month after surgery. Urban residents also presented more pain preoperatively. Older patients had more pain, disability and worse quality of life 1-5 years postoperatively. Similarly, patients with lower education presented the worst scores in every questionnaire at the same time. Smokers reported less pain 1.5-4 postoperative years. Higher alcohol consumption and obesity were associated with lower levels of preoperative pain. However, obese patients had worse SF-36 and ODI scores after the 6th postoperative month. Patients with heavy jobs presented the worst preoperative ODI scores.Conclusion: Significant clinical improvement was recorded from the first postoperative month to the first postoperative year; stabilization was noticed later on. Feminine gender, urban residency, older age, low level of education, obesity and heavy physical occupation were negative prognostic factors. Oddly smoking and alcohol were correlated with less pain. [ABSTRACT FROM AUTHOR]

Background: Lumbar microdiscectomy is a common procedure with satisfactory results; however, postoperative events like progressive adjacent level degeneration and perineural fibrosis can contribute to long-term pain. The purpose of the study was to evaluate MRI changes 5 years after lumbar microdiscectomy and assess their association with clinical parameters.Materials and methods: A prospective study enrolling 61 patients who underwent microdiscectomy. Changes between preoperative and postoperative MRI findings were recorded, and these findings were tested for associations with demographic, clinical and perioperative parameters. The measured imaging parameters were degeneration of the operated and adjacent discs and endplates, morphology of the disc herniation, facet joints arthritis and the presence of postoperative perineural fibrosis.Results: Statistically significant differences were found between preoperative and postoperative morphology of the operated disc, facet joints arthritis and degeneration of the operated and caudal adjacent disc. There were no differences between preoperative and postoperative disc degeneration of the superior adjacent disc and in degeneration of the operated and adjacent endplates. Postoperatively perineural fibrosis was common; however, thecal sac compression and nerve root impingement were reduced. Age at the time of surgery was the only parameter associated with postoperative changes.Conclusion: Five years after microdiscectomy, several postoperative MRI changes including operated disc's morphology, facet joints arthritis and degeneration of the operated and caudal adjacent disc were shown. Taking into consideration that participants were on average middle-aged, these changes could be attributed not only to the impact of the surgery but also to the natural history of lumbar spine degeneration. [ABSTRACT FROM AUTHOR]

Objective: Lumbar microdiscectomy (LMD) is still the gold-standard treatment for lumbar disc herniations with progressive neurological deficits that are refractory to conservative treatment. With improvement of endoscopic systems in recent years, endoscopic discectomy techniques have been developed as an alternative to LMD. The unilateral biportal endoscopic discectomy (UBE) technique is one of these endoscopic techniques, and its popularity has increased in recent years because it does not require high-cost specialized endoscopes, many microsurgical instruments are compatible with this system, and it is similar to LMD in terms of anatomical orientation. This study compared results between LMD and UBE techniques in patients with lumbar disc herniations performed by the same spine surgeons at a single center., Methods: The data of patients with lumbar disc herniation who were operated on with LMD and UBE techniques were retrospectively reviewed. The data obtained were statistically evaluated. The operative video of one of the patients who underwent UBE was edited for demonstration., Results: Between January 2021 and June 2022, 93 patients were operated on for lumbar disc herniation. LMD was performed in 39 patients, and UBE was performed in 54 patients. There were no significant differences in the complications, recurrence, postoperative back and leg pain, patient satisfaction rates, and quality of life index results of the patients in the two groups. The operation time was shorter in the LMD group. In the UBE group, estimated blood loss was lower and postoperative hospitalization was shorter., Conclusions: Although LMD is still the gold-standard treatment for lumbar disc herniation, the results of UBE are comparable to those of LMD, and it may be a good alternative for spine surgeons who prefer minimally invasive surgery.

Objective: Incidence of spondylodiscitis after lumbar discectomy has been reported to be as low as 0.1-18.8% by many different authors. Most common pathogen is Staphylococcus aureus. Methods: We collected retrospectively the medical records of 1154 patients who were single-level or two-level disc herniations operated for lumbar microdiscectomy between 2007 and 2015 in our hospital. Of these patients, 554 were female and 600 were male. 1062 of these patients underwent single-level, 91-level two-level lumbar microdiscectomy. These patients received a single dose of prophylactic cephazoline during anesthesia in order to prophylaxis guidelines. Spondylodiscitis developed in 12 patients (1.03%). Comorbidities in spondylodiscitis-treated patients, 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, 1 two-level lumbar microdiscectomy operations. Five patients received L4-5, and 8 patients underwent discectomy from L5-S1 patients. Staphylococcus aureus was present in 3 patients (%25), Staphylococcus epidermidis in 4 patients (33%), Escherichia coli in 3 patients (25%) and 2 patients were not. Mean duration of hospital stay was 29.45 ± 3.98 days, and in patients without spondylodiscitis 1.99±0.81 days, there were significant difference between these groups (p = 0.0001)Conclusion: Although most surgeons have 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 compared to medical literature. [ABSTRACT FROM AUTHOR]

Background and Purpose: There are no significant differences in outcomes between patients receiving inpatient and day-case lumbar microdiscectomy, but the latter is still underused in the NHS. Here we aimed to identify factors contributing to successful same-day discharge in day-case patients.Methods: This was a retrospective observational study of patients undergoing elective lumbar microdiscectomy between August 2012 and December 2014. Age, gender, day of surgery, distance to hospital, ASA grade, regular opiate use, smoking status, order on the operating list, and side and level of surgery were examined by logistic regression to assess their influence on same-day discharge.Results: 28/95 (29.5%) patients were discharged on the day of surgery. Age (p = 0.041), ASA grade (p = 0.016), distance to hospital (p = 0.011), and position on the list (p = 0.004) were associated with day-case discharge by univariate analysis. ASA grade (p = 0.032; OR 0.176), distance to hospital (p = 0.003; OR 0.965), and position on the operating list (morning case; p = 0.011; OR 8.901) remained significant in multivariate analysis. Thirteen (13.7%) patients were identified who could have been managed as day cases had they been listed for morning operations.Conclusions: Day-case lumbar microdiscectomy is viable when patients are carefully selected. Younger, fit patients living close to the hospital and operated on in the morning are more likely to be discharged on the same day. Knowledge of these factors while planning elective lists can help optimise bed space and improve spinal services. [ABSTRACT FROM AUTHOR]

Аfter lumbar microdiscectomy, different psychological factors can influence the postoperative back pain, including depression and pessimism. The aim of the study was to determine the correlation between pain intensity and functional disability in patients after lumbar microdiscectomy. The research was conducted on 198 patients at Clinical Centre of Vojvodina, Medical Rehabilitation Clinic Novi Sad, Serbia, with a permit from the Ethics Committee of Clinical Centre of Vojvodina. Four administered and validated questionnaires were utilised to obtain information about pain and its intensity and character, presence and degree of functional disability and depression, as well as personal expectations (pessimistic/optimistic) about the treatment results after microdiscectomy. These assessments were carried out after lumbar microdiscectomy in four time slots: just before rehabilitation treatment, and 1, 3 and 6 months after microdiscectomy. Patients with a high degree of current and general anxiety and with clinically pronounced depression had pain of greater intensity. Significantly lower pain intensity, if any pain was present at all, was in patients who were not anxious or depressed and who were optimistically oriented. The mentioned differences in pain intensities, in all periods of the examination, were statistically highly significant (p < 0.01). Pain and functional disability of the patients after lumbar microdiscectomy are notably related to gender, depression and pessimism. The sensation of the pain was higher in women, while men had a greater degree of functional disability. Intensity of pain and functional disability were significantly greater in patients with a higher degree of depression and pessimism and by registering mentioned factors it is possible to predict the postoperative results. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Study Design: Systematic Review and Meta-Analysis OBJECTIVE.: To identify whether intramuscular local anesthetic infiltration prior to wound closure was effective in reducing postoperative pain and facilitating early discharge following lumbar spine surgery.Summary Of Background Data: Local anesthetic infiltration prior to wound closure may form part of the multimodal strategy for postoperative analgesia, facilitating early mobilization and discharge. Although there are a number of small studies investigating its utility, a quantitative meta-analysis of the data has never been performed.Methods: This review was conducted according the PRISMA statement and was registered with the PROSPERO database. Only randomized controlled trials were eligible for inclusion. Key outcomes of interest included time to first analgesic demand, total postoperative opiate usage in the first 24 hours, visual analogue score (VAS) at 1, 12 and 24 hours and postoperative length of stay.Results: Eleven publications fulfilled the inclusion criteria. A total of 438 patients were include; 212 in the control group and 226 in the intervention group. Local anesthetic infiltration resulted in a prolonged time to first analgesic demand (mean difference (MD) 65.88 minutes, 95% confidence interval (95% CI) 23.70 to 108.06, P.0.002) as well as a significantly reduced postoperative opiate demand (M.D. -9.71 mg, 95% CI -15.07, -4.34, p = 0.0004). There was a small but statistically significant reduction in postoperative visual analogue score (VAS) at 1 hour (M.D. -0.87 95%CI -1.55, -0.20, p = 0.01), but no significant reduction at 12 or 24 hours (p = 0.93 and 0.85 respectively).Conclusion: This systematic review and meta-analysis provides evidence that postoperative intramuscular local anaesthetic infiltration reduces postoperative analgesic requirements and the time to first analgesic demands for patients undergoing lumbar spine surgery. Key research priorities include optimization of the choice and strength of local anaesthetic agent and health-economic analyses to strengthen the case for routine use of postoperative local anesthetics in lumbar spine surgery.Level Of Evidence: 1. [ABSTRACT FROM AUTHOR]

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Background and Aim: We propose a vast study to examine the effect of high-frequency bipolar coagulation used in the operating room to prevent the development of epidural fibrosis after lumbar microdiscectomy., Materials and Methods: A total of 1004 participants were divided into two groups: no high-frequency bipolar coagulation (NC group) and high-frequency bipolar coagulation (C group). Postoperative epidural fibrosis, infection rates, reoperation status, and dural injury complications during the operation were recorded., Results: Considering the epidural fibrosis rates of the two groups, epidural fibrosis was seen in 10.6% of the patients in the NC group. In contrast, it was seen in only 6.2% of the patients in the C group., Conclusion: The complication of epidural fibrosis that develops after lumbar microsurgery operations both impairs patient comfort and brings with it the complications of reoperation. After performing hemostasis with bipolar, coagulating the annulus may effectively reduce epidural fibrosis and prevent reoperation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Yavuz et al.)

Background: Lumbar microdiscectomy is the most frequent surgical intervention used in the treatment of sciatica from herniated lumbar discs. Many discectomy trials have been plagued with an excessive number of crossovers that have rendered results inconclusive., Methods: We review the design and results of influential lumbar microdiscectomy trials. We also discuss the various strategies that have been used to decrease the number of crossovers or to mitigate the effects of crossovers on analyses., Results: Randomized trials on lumbar discectomy were affected by crossover rates of 8% to 42%. Various strategies that have been used to decrease that number or to mitigate the effects on results include: patient selection, blinding (placebo-controlled trials), an immediate access to surgery for the surgical group (but limited access to surgery for the conservative group), shortening the follow-up period necessary to reach the primary outcome measure, postponing crossovers to surgery after determination of the primary outcome, and modifying the primary outcome measure to include treatment failures. Crossovers should be anticipated and compensated for by increasing the number of participants., Conclusion: Non-adherence to randomly allocated management options can deprive trials of the statistical power needed to inform clinical care. Crossovers and ways to mitigate related problems should be anticipated at the time of trial design., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Formulating a pertinent research question is of the utmost importance in clinical research. An ill-conceived question may lead to an erroneous trial design, which may adversely affect the care of patients and provide uninformative or even misleading results., Methods: We review the research question of a randomized trial on the timing of lumbar discectomy. We compare the resulting design with other trials, real or hypothetical, that would have been more appropriate., Results: The RCT we examine randomly allocated patients to early or delayed surgery to answer a theoretical question of the effect of time on the efficacy of surgery. The trial was interpreted to have shown that early surgery was associated with better clinical and functional outcomes as compared to delayed surgery. This conclusion is clinically misleading. Valid comparisons between groups should be performed on intent-to-treat analyses and at the same time points after randomization (and not at a fixed follow-up period after surgery). The clinically pertinent comparison is not between the theoretical efficacy of surgery performed at various times, but between surgery and conservative management in patients presenting at various times. Better-designed trials on the clinical benefits of lumbar discectomy, including the treatment of chronic sciatica, have been published., Conclusion: Theoretical research questions inspired from observational data can lead to erroneous trial design. Prospective randomized trials impact practice immediately: they are unique occasions to address clinical problems and optimize care under uncertainty in real time. However, they require the research question to be formulated with great care., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)