Search

PURPOSE: Verifying lumbar disc pain can present a clinical challenge. Low-pressure provocative discography (PD) has served as the gold standard, although it is invasive and often a challenge to interpret. We reported that magnetic resonance spectroscopy (MRS) biomarkers accurately predict PD results in lumbar discs and improved outcomes for patients with surgery at positive MRS levels versus nonsurgery. To further substantiate MRS for diagnosing painful discs, we report a prospective comparison of 2 MRS-derived measures: NOCISCORE (pain) and SI-SCORE (degeneration severity). METHODS: Lumbar MRS and software-based postprocessing (NOCISCAN-LS, Aclarion Inc.) was performed in 44 discs in 14 patients (prospective cohort [PC]). PC data were compared to prior data used to establish the NOCISCORE (training cohort [TC]). The NOCISCORE was converted to an ordinal value (high/intermediate/low; NOCI+/mild/-) and compared against painful (P) versus nonpainful (NP) control diagnosis (PD) for 19 discs where PD was performed in the PC (12 NP; 7 P). Sensitivity, specificity, and positive and negative predictive values were calculated. The SI-SCORE was compared against MRI Pfirrmann Grades for 465 discs in 126 patients (PC plus TC). RESULTS: For the PC, MRS (NOCI+/-) compared to PD (P/NP) with an accuracy of 87% and sensitivity and specificity of 100%. The positive and negative predictive values of MRS were 100%. NOCISCOREs were significantly higher for PD+ versus PD- discs for PC and TC (P < 0.05), and the NOCISCORE distributions for PD+/- group were not statistically different between the PC and TC (P > 0.05). SI-SCORES differed between Pfirrmann Grades 1 and 2 (less degenerated) versus Grades 3 and 4 (more degenerated; P < 0.05), with a progressively decreasing trend with Pfirrmann Grades 1-5. CONCLUSION: These current data provide prospective confirmation of the predictive value of disc MRS for distinguishing painful discs and for assessing the disc structural integrity. CLINICAL RELEVANCE: NOCISCAN is an adoptable, noninvasive, and objectively quantitative test to improve management of low back pain patients.

Background and Aims: We compared classical (medial) and modified (lateral) thoracolumbar interfascial plane block (TLIP) with only general anaesthesia (GA) using multimodal analgesia in patients undergoing lumbar disc surgeries. Methods: In this study, 100 patients aged 18--70 years were randomised to Group cTLIP (conventional TLIP block with 20 mL of 0.25% ropivacaine with GA), Group mTLIP (modified TLIP block with 20 mL of 0.25% ropivacaine with GA), and Group C (only GA using multimodal analgesia). The primary outcome was to assess the total peri-operative opioid consumption in the first 24 h. The secondary outcomes were to assess pain score upon arriving in the post-anaesthesia care unit, time to first analgesic need after surgery, post-operative opioid consumption in 24 h, and incidence of nausea and vomiting. Results: The total peri-operative opioid consumption in Group cTLIP (507.58 (258.55) µg) and Group mTLIP (491.67 (165.39) µg) was significantly lower than that in Group C (1225.4 (237.03) µg); (P < 0.001). However, it was comparable between groups cTLIP and mTLIP (P = 0.767). Pain score was comparable in groups cTLIP and mTLIP. It was significantly lower than Group C (P = 0.001). Rescue analgesia was needed in all (100%) patients of Group C but in only 15.2% of patients of the cTLIP and mTLIP groups. No patient in groups cTLIP and mTLIP complained of nausea and vomiting in the first 24 h, whereas it was significantly higher (61.8%) in Group C (P = 0.001). Conclusion: The analgesic effect of the modified TLIP block was not superior to the conventional TLIP block. Both techniques provided the same intra-operative and post-operative analgesia for lumbar disc surgeries. [ABSTRACT FROM AUTHOR]

Background: In rare instances, massive over inflation of the cuff may lead to acute complications such as tracheal bleeding or rupture.This may be associated with post-operative complications like sore throat hoarseness of voice. The purpose of this study was to evaluate the ETT cuff pressure changes between supine to prone and supine to knee chest position in lumber disc surgery. Materials & Methods: Sixty patients, aged between 18 to 60 years of either sex, belonging to American Society of Anaesthesiology (ASA) physical status I to II undergoing elective lumbar disc surgery under general anaesthesia either in prone position or in knee-chest position were considered for this study. The patients were randomly allocated into two groups of 30 patients each. Group “p” was undergone operation in prone position and group “k” undergone operation in knee-chest position. The patients were connected to standard monitoring system such as non-invasive blood pressure (NIBP), electrocardiogram (ECG), pulse oxymeter, and capnometer. All patients were pre-medicated with inj. glycopyrrolate 0.2 mg and inj. fentanyl 2µg/kg iv 5-6 minutes before induction of anaesthesia and were pre-oxygenated with 100% oxygen for atleast 3 minutes. All the patients were induced with inj. propofol 2.5 mg/kg i.v. followed by inj. rocuronium at a dose of 1.2 mg/kg for facilitating tracheal intubation with reinforced ETT. The ETT size selected for men and women were 8.0-8.5 mm ID and 7.0- 7.5 mm ID (Mallinckrodt) respectively. Results: Group k patients showed higher cuff pressure change from 25 to 39.97cm of H2O compared to group p from 25 to 30.47 cm of H2O after change of position only. There was statistically significant different found between groups Sore throat was found significantly higher in group k compared to group p (20% vs 16.67%). Conclusion: The cuff pressure of the endotracheal tube should be monitored and managed properly after the position change from supine to prone and prone to knee chest position. [ABSTRACT FROM AUTHOR]

Aim: Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy. Design: This qualitative study was conducted in 2022 using content analysis. Methods: Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi‐structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation. Results: The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine‐based practice in the healthcare system, futile attempt for team‐based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery. [ABSTRACT FROM AUTHOR]

Background and Aims: We compared classical (medial) and modified (lateral) thoracolumbar interfascial plane block (TLIP) with only general anaesthesia (GA) using multimodal analgesia in patients undergoing lumbar disc surgeries. Methods: In this study, 100 patients aged 18–70 years were randomised to Group cTLIP (conventional TLIP block with 20 mL of 0.25% ropivacaine with GA), Group mTLIP (modified TLIP block with 20 mL of 0.25% ropivacaine with GA), and Group C (only GA using multimodal analgesia). The primary outcome was to assess the total peri-operative opioid consumption in the first 24 h. The secondary outcomes were to assess pain score upon arriving in the post-anaesthesia care unit, time to first analgesic need after surgery, post-operative opioid consumption in 24 h, and incidence of nausea and vomiting. Results: The total peri-operative opioid consumption in Group cTLIP (507.58 (258.55) μg) and Group mTLIP (491.67 (165.39) μg) was significantly lower than that in Group C (1225.4 (237.03) μg); (P < 0.001). However, it was comparable between groups cTLIP and mTLIP (P = 0.767). Pain score was comparable in groups cTLIP and mTLIP. It was significantly lower than Group C (P = 0.001). Rescue analgesia was needed in all (100%) patients of Group C but in only 15.2% of patients of the cTLIP and mTLIP groups. No patient in groups cTLIP and mTLIP complained of nausea and vomiting in the first 24 h, whereas it was significantly higher (61.8%) in Group C (P = 0.001). Conclusion: The analgesic effect of the modified TLIP block was not superior to the conventional TLIP block. Both techniques provided the same intra-operative and post-operative analgesia for lumbar disc surgeries.

The prevalence of intervertebral disc degeneration in the lumbar region resulting in low back pain is high. One of the treatment options is neurosurgery. Previous studies and systematic reviews demonstrate the need to identify factors that affect the health-related quality of life of patients undergoing surgery. This study aimed to analyze the sociodemographic and clinical factors that affect the quality of life of patients undergoing lumbar disc surgery. A group of 128 patients was assessed for eligibility and qualified by radiological examinations for lumbar disc surgery by a neurosurgeon in the outpatient clinic. Finally, 110 patients were studied and evaluated 24 h and 3 months after surgery. Health-related quality of life (36-Item Short Form Survey, SF-36), disability level (Oswestry Disability Index, ODI), and pain intensity (Visual Analogue Scale, VAS) were assessed. The mean pain intensity before surgery was 7.8 ± 2.3 pts and decreased significantly 24 h after surgery, with a mean score of 3.8 ± 2.4 pts (p = 0.0000). After three months, the increase in pain intensity was at 4.8 ± 2.4 pts, but the score was still significantly better than before surgery (p = 0.0024). The mean ODI score before surgery was 29.3 ± 8.4 pts (slight disability), and three months after surgery, there was an insignificant increase to a mean value of 31.5 ± 10.4 pts (p = 0.0834). There was a statistically significant increase in quality-of-life scores at three months after surgery in the following domains: physical functioning (8.7%; p = 0.0176), bodily pain (26.2%; p = 0.0000), vitality (5.8%; p = 0.0132) and mental health (6.2%; p = 0.0163), and a decrease in role limitations due to physical problems (3.8; p = 0.0013) and general health perception (6.7%; p = 0.0112). In conclusion, the surgical procedure plays an important role in improving the quality of life of patients operated on for intervertebral disc degeneration. It was effective in reducing the pain level, especially 24 h after surgery; however, surgery did not affect the disability level. [ABSTRACT FROM AUTHOR]

Abstract Aim Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy. Design This qualitative study was conducted in 2022 using content analysis. Methods Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi‐structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation. Results The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine‐based practice in the healthcare system, futile attempt for team‐based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery.

Background and Aim: Low Back pain is one of the most common diseases that face adults with various physical, psychological, economic, and social problems. Due to the fact that patients experience various degrees of disability during this period, the present study was conducted to determine the quality of life and functional outcome in patients with lumbar disc herniation. Methods: This study was a descriptive-interventional study that was performed in 2022. One hundred twenty patients undergoing lumbar disc surgery were included in the study by census method. Patients were investigated before and, 3, 6, and 12 months after the operation using a 12-question short-form questionnaire to measure the quality of life, the Oswestry Functional Disability Questionnaire to measure the severity of the disability, the European Quality of Life Questionnaire to measure the health-related quality of life, and the DASS Questionnaire to measure depression, anxiety, and stress. The data were analyzed using SPSS software (version 22) and the significance level was less than 0.05. Results: The quality of life in the physical dimension improved after 12 months (P<0.05). Oswestry disability index improved from severe to moderate disability and preoperative disability improved compared to 12 months after surgery (P<0.05). The EQ-5D index improved after 12 months and significantly differed from before surgery (P<0.05). There was a significant difference between stress before and 12 months after surgery (P<0.05). The results indicated that there was a significant relationship between Oswestry functional disability index and body mass index (P = 0.002) and age (P = 0.01), and depression with gender (P = 0.003). Conclusion: The results showed that the quality of life, functional ability, and stress in patients undergoing lumbar disc surgery improved after 12 months. [ABSTRACT FROM AUTHOR]

Purpose: MRS was shown to reliably quantify relative levels of degenerative pain biomarkers, differentiating painful versus non-painful discs in patients with chronic discogenic low back pain (DLBP), and this correlates with surgical success rates. We now report results based on more patients and longer follow-up. Methods: Disc MRS was performed in DLBP patients who subsequently received lumbar surgery. Custom post-processing (NOCISCAN-LS®; Aclarion Inc.) calculated disc-specific NOCISCORES® that reflect relative differences in degenerative pain biomarkers for diagnosing chemically painful discs. Outcomes in 78 patients were evaluated using Oswestry Disability Index (ODI) scores. Surgical success (≥ 15-point ODI improvement) was compared between surgeries that were "Concordant" (Group C) versus "Discordant" (Group D) with NOCISCORE-based diagnosis for painful discs. Results: Success rates were higher for Group C versus Group D: 6 months (88% vs. 62%; p = 0.01), 12 months (91% vs. 56%; p < 0.001), and 24 months (85% vs. 63%; p = 0.07). Success rates for Group C surgeries were also higher than Group D surgeries in a variety of sub-group comparisons. Group C had a greater reduction in ODI from pre-operative to follow-up than Group D [absolute change (% change), (p)]: 6 months: − 35 (− 61%) versus − 23 (− 39%), (p < 0.05); 12 months: − 39 (− 69%) versus − 22 (− 39%), (p < 0.01); and 24 months: − 38 (− 66%) versus − 26 (− 48%), (p < 0.05). Conclusion: More successful, sustained outcomes were obtained when surgically treating chemically painful discs identified by NOCISCAN-LS post-processed disc MRS exams. Results suggest that NOCISCAN-LS provides a valuable new diagnostic tool to help clinicians better select treatment levels. [ABSTRACT FROM AUTHOR]

Amaç: Lomber disk hernisi (LDH) tanısı koyulan ve mikrodiskektomi cerrahisi geçiren bireylerde kinezyofobi, günlük yaşam aktiviteleri ve uyku kalitesinin değişimini araştırmaktır. Materyal&Method: LDH cerrahisi endikasyonu olup, cerrahi olan 30 hasta çalışmaya dahil edildi. Hastalar ameliyattan önce, ameliyat sonrası birinci, üçüncü ve altıncı aylarda değerlendirildi. Hastaların değerlendirilmesinde kısa form Mcgill ağrı anketi, görsel ağrı skalası (VAS), Oswestry disabilite indeksi (ODİ), Tampa kinezyofobi ölçeği (TKÖ), SF-36 yaşam kalitesi ölçeği ve Pittsburg Uyku Kalitesi İndeksi (PUKİ) kullanıldı. Ayrıca hastaların lomber fleksiyon-ekstansiyon ve lateral fleksiyon normal eklem hareket açıları (NEH) kaydedildi. Hastalara ameliyat sonrası önerilerde bulunuldu. Ev egzersiz programı verildi. Bulgular: Değerlendirmeler sonucunda SF-36’nın bütün alt parametrelerinde, TKÖ, PUKİ ve NEH’lerinin zaman içindeki değişimi anlamlı bulundu (p

The prevalence of intervertebral disc degeneration in the lumbar region resulting in low back pain is high. One of the treatment options is neurosurgery. Previous studies and systematic reviews demonstrate the need to identify factors that affect the health-related quality of life of patients undergoing surgery. This study aimed to analyze the sociodemographic and clinical factors that affect the quality of life of patients undergoing lumbar disc surgery. A group of 128 patients was assessed for eligibility and qualified by radiological examinations for lumbar disc surgery by a neurosurgeon in the outpatient clinic. Finally, 110 patients were studied and evaluated 24 h and 3 months after surgery. Health-related quality of life (36-Item Short Form Survey, SF-36), disability level (Oswestry Disability Index, ODI), and pain intensity (Visual Analogue Scale, VAS) were assessed. The mean pain intensity before surgery was 7.8 ± 2.3 pts and decreased significantly 24 h after surgery, with a mean score of 3.8 ± 2.4 pts (p = 0.0000). After three months, the increase in pain intensity was at 4.8 ± 2.4 pts, but the score was still significantly better than before surgery (p = 0.0024). The mean ODI score before surgery was 29.3 ± 8.4 pts (slight disability), and three months after surgery, there was an insignificant increase to a mean value of 31.5 ± 10.4 pts (p = 0.0834). There was a statistically significant increase in quality-of-life scores at three months after surgery in the following domains: physical functioning (8.7%; p = 0.0176), bodily pain (26.2%; p = 0.0000), vitality (5.8%; p = 0.0132) and mental health (6.2%; p = 0.0163), and a decrease in role limitations due to physical problems (3.8; p = 0.0013) and general health perception (6.7%; p = 0.0112). In conclusion, the surgical procedure plays an important role in improving the quality of life of patients operated on for intervertebral disc degeneration. It was effective in reducing the pain level, especially 24 h after surgery; however, surgery did not affect the disability level.

Postoperative early neuropraxia after lumbar disc herniation surgery is common. The emergence of new paresthesia findings with increased sensory and motor deficits in the postoperative period suggests iatrogenic neuropraxia. This study aimed to discuss the causes and prognosis of iatrogenic neuropraxia detected in the early postoperative period in patients who have been operated on for lumbar disc herniation. Cases with postoperative iatrogenic neuropraxia were determined retrospectively. Deficits were evaluated at intervals of 0–2 hours, 2–12 hours, 12–24 hours, and 24–48 hours. The cases were evaluated in 2 groups as those who underwent aggressive discectomy and simple discectomy. In addition, the treatment results were compared between the 2 groups as the cases that were treated and not treated with methylprednisolone. The iatrogenic neuropraxia rate was significantly higher in patients who underwent aggressive discectomy. Although it was observed that paresthesia findings improved more rapidly in cases treated with methylprednisolone, no difference was found between the 2 groups in terms of its effects on the motor deficit. Iatrogenic neuropraxia is a finding whose cause cannot be determined by quantitative criteria. It is common in patients who underwent aggressive discectomy. Methylprednisolone treatment is effective in recovering the paresthesia finding faster and may show that the radicular injury is in the neuropraxia stage in the early period. [ABSTRACT FROM AUTHOR]

Background: Persistent low back pain is an important disability after lumbar disc surgery. Erector spinae plane block (ESPB) is highly effective in providing post-surgical pain control, but its effectiveness in long-term persistent low back pain has not been investigated. The aim of this randomized controlled trial was to investigate the effect of ESPB on the reduction of persistent low back pain after surgery.Methods: 162 patients who were operated for lumbar disc herniation under spinal anaesthesia were divided into two groups according to the following criteria; ESPB block group (Group A); applied before surgery and 1 month after surgery and non-ESPB block group (Group B). The preoperative and postoperative 6th month Visual Analogue Scale (VAS), Oswestry Low Back Pain Disability Questionnaire (ODI) and Japan Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores of the patients were evaluated, and it was examined whether there was a difference.Results: In two groups with similar patient characteristics and no significant difference in preoperative pain scores, a significant improvement was observed in pain scores in Group A compared to Group B at the end of the 6th month.Conclusions: ESPB, which has a low risk of complications and is simple to perform, has been found useful in the treatment of persistent low back pain after disc surgery. [ABSTRACT FROM AUTHOR]

Background: Inadequate pain management after lumbar disc surgery may result in increasing morbidity and duration of hospital stay. This study aimed to evaluate the efficacy of analgesic effect of diclofenac sodium in reducing the total dose of morphine after lumbar disc surgery. Methods: This study was conducted in Shohada Teaching Hospital. Eighty-four patients with mean age of 51.74 ± 5.76 years were included in this double blinded clinical trial study. Patients were premeditated with diclofenac sodium supposition or placebo before surgery. After surgery, patients randomly assigned to 1 of 2 treatment groups: group A: diclofenac sodium supposition and group B: placebo. Visual analog scale and morphine consumption were recorded at 6 hours intervals up to 24 hours. Results: The base line mean pain relief and nausea and urinary retention were not statistically significant between groups (P>0.05). Weakness and fatigue, dry mouth and total morphine dose were statistically different (P

Postoperative surgical site infection still constitutes a major concern in spinal surgery and related with poor outcome. We aimed to investigate the effect of povidone-iodine (PVP-I) on skin colonization in lumbar disc herniation (LDH) surgery. Adult patients scheduled for LDH surgery were included in the study. Three skin swab cultures were taken when lying on the operating table (culture 1), after PVP-I application (culture 2), and at the end of the operation (culture 3). The effect of PVP-I and other independent predictors on skin culture was analyzed. A total of 62 [28 (45%) female, mean age 47±13 years] patients were included. Only male sex and taking shower before the surgery have been found to be independent factors for affecting culture 1 growth while adjusted to age, body ma ss index, smoking, preoperative hospital stay, and surgery site shaving [OR (95% CI): 7.8 (1.4-41.9), p=0.016; OR (95% CI): 0.34 (0.003-0.35), p=0.005]. After PVP-I, the growth frequency of culture 2 decreased significantly compared to culture 1 [8 (13%) vs. 43 (70%), p<0.001]. However, culture 3 positivity rate was similar to culture 2 (p=0.219). In preoperative sterilization of lumbar disc surgery, PVP-I significantly reduces skin colonization both immediately after application and at the end of the operation. [ABSTRACT FROM AUTHOR]

Pneumocephalus (PNC) is termed as an abnormal air presence in the cranium. PNC is a well-known complication of epidural and spinal anesthesia but it develops rarely after spinal surgery for lumbar disc herniation. A 67-year-old female patient was presented to the emergency department (ED) with diffuse non-localized headache and change in mental status. Non-contrast brain-computed tomography scans revealed massive PNC in the frontotemporal fossa and intraorbital region. The patient was transferred to the neurosurgery intensive care unit for clinical observation. Among patients admitted to the ED in the early period after spinal surgery; PNC should be considered in the differential diagnosis if there is persistent headache and confusion. [ABSTRACT FROM AUTHOR]

Objective: To develop a prognostic model for failure and worsening 1 year after surgery for lumbar disc herniation. Methods: This multicenter cohort study included 11,081 patients operated with lumbar microdiscectomy, registered at the Norwegian Registry for Spine Surgery. Follow-up was 1 year. Uni- and multivariate logistic regression analyses were used to assess potential prognostic factors for previously defined cut-offs for failure and worsening on the Oswestry Disability Index scores 12 months after surgery. Since the cut-offs for failure and worsening are different for patients with low, moderate, and high baseline ODI scores, the multivariate analyses were run separately for these subgroups. Data were split into a training (70%) and a validation set (30%). The model was developed in the training set and tested in the validation set. A prediction (%) of an outcome was calculated for each patient in a risk matrix. Results: The prognostic model produced six risk matrices based on three baseline ODI ranges (low, medium, and high) and two outcomes (failure and worsening), each containing 7 to 11 prognostic factors. Model discrimination and calibration were acceptable. The estimated preoperative probabilities ranged from 3 to 94% for failure and from 1 to 72% for worsening in our validation cohort. Conclusion: We developed a prognostic model for failure and worsening 12 months after surgery for lumbar disc herniation. The model showed acceptable calibration and discrimination, and could be useful in assisting physicians and patients in clinical decision-making process prior to surgery. [ABSTRACT FROM AUTHOR]

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

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

Objectives: This study aimed at investigating the effect of low-dose ketamine on prevention of hypotension due to positioning after induction of general anesthesia in lumbar disc surgery. Materials and Methods: This double-blind clinical trial was performed during a 3-month period in 2016. A random sample of 84 patients with ASA (American Society of Anesthesiologists), class I, were enrolled in the study and the impact of ketamine on prevention of hypotension due to repositioning was investigated. After induction of anesthesia and intubation, ketamine 0.5 mg/kg of body weight as well as normal saline solution, with equal volumes, were injected to the intervention and control groups, respectively. Patients were repositioned though a similar method to prone position after peak of ketamine (after 1.5 minutes), and then, systolic, diastolic, and mean of the blood pressure were measured as a baseline, once before and 1 minute after the intubation, before repositioning, immediately after repositioning the patient from supine to prone position, and then every 2 minutes until 10 minutes after repositioning. Results: There was significant differences in means (SDs) of systolic pressure and blood pressure in the first, second, and fourth minutes after repositioning, as systolic pressure and mean of the blood pressure in ketamine group was higher than those of control group. The changes of blood pressure in ketamine group was the least amount after repositioning. Conclusions: Ketamine can increase blood pressure, especially systolic pressure of patients, on other hand changes of blood pressure in ketamine group after repositioning was least amount.

Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4–L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4–L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients. [ABSTRACT FROM AUTHOR]

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

Background Context: A potential correlation between surgery for symptomatic adjacent segment degeneration (sASD) and the development of degenerative disease of the lumbar spine or osteoarthritis of the musculoskeletal joints remains to be determined.Purpose: To assess the rate of sASD following anterior cervical discectomy and fusion (ACDF), the rate of lumbar discectomy (LD), and rate of surgery performed for osteoarthritis at the joints of the musculoskeletal in a long term follow-up.Study Design/setting: Cohort study OUTCOME MEASURES: Repeat procedure for sASD, microsurgical LD (MSD), and/or the musculoskeletal joints (shoulder, knee, hip).Patient Sample: Retrospectively, a total of 833 consecutive patients who underwent ACDF for degenerative disorders ≥20 years ago were identified. Charts were reviewed for preoperative neurological status, smoking status, physical labor, and repeat procedures. Missing data lead to exclusion from follow-up assessment.Methods: At final follow-up the need for pain medication, Neck disability index (NDI), and Odoms criteria were evaluated. An MRI was performed to assess the grade of degeneration of the cervical spine via the segmental degeneration index (SDI). Patients without (group 1) and with (group 2) repeat procedure for sASD were compared.Results: Collectively, 313 patients met inclusion criteria and 136 patients were evaluated. The mean follow-up was 26 years. Clinical success rate according to Odoms was 85.3%, mean NDI was 14.4%, the rate of regular intake of pain medication was 14.7%, the rate of repeated procedure for sASD was 10.3%. MSD was performed in 23.5%, surgery for osteoarthritis of the shoulder, the hip, and the knee were performed in 11.8%, 6.9%, and 27.7%, respectively. The rate of MSD (p=.018) was significantly higher in group 2 compared to group 1. Gender, smoking status, surgery of the musculoskeletal joints, and the grade of degeneration of the cranial and caudal adjacent segments were similar between group 1 and group 2.Conclusion: The overall clinical success following ACDF was 85.3%. The rate of repeat procedure for sASD was 10.3% within 26 years. Patients with sASD had a significantly higher rate of MSD and poorer clinical outcome compared to patients without sASD. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3rd lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves. Objective: The objective of this study was to evaluate the analgesic effects gained after performing TLIP block (analogous to the transversus abdominis plane [TAP] block, but intended for the back) in patients undergoing lumbar discectomy. Methodology: This was a prospective, randomized, double-blinded, controlled clinical trial. Computer-generated randomization numbers were used to allocate patients into two groups. A total of 102 patients scheduled for lumbar discectomy were considered eligible, of these 70 patients were randomly included in the analysis: 35 patients (control group) received the standard general anesthetic technique and 35 patients (TLIP group) received TLIP block with 20 ml mixture of 0.25% bupivacaine and 1% lidocaine on each side. The primary outcome was to compare the two groups with regard to pain scores, whereas the secondary outcomes included the time to first analgesic (TFA), 24-h morphine consumption, and side effects associated with morphine such as nausea, vomiting, and sedation. Results: TLIP group compared with the control group showed a significant reduction in the postoperative Visual Analog Scale for pain score both on rest and movement, with no statistically significant difference at 24 h during movement. TFA was significantly shorter in the control group compared to the TLIP group (82.00 ± 69.01 vs. 442.7 ± 126.47 min, P < 0.001). TLIP group had lower cumulative morphine consumption than control group of statistically significant difference (9.7 ± 6.38 vs. 25.88 ± 5.17 mg, P < 0.001). TLIP block group compared with the control group showed a significant reduction of nausea and a lower incidence of sedation. Conclusion: TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy.

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Inadequate pain management after lumbar disc surgery may result in increasing morbidity and duration of hospital stay. This study aimed to evaluate the efficacy of analgesic effect of diclofenac sodium in reducing the total dose of morphine after lumbar disc surgery. Methods: This study was conducted in Shohada Teaching Hospital. Eighty-four patients with mean age of 51.74 ± 5.76 years were included in this double blinded clinical trial study. Patients were premeditated with diclofenac sodium supposition or placebo before surgery. After surgery, patients randomly assigned to 1 of 2 treatment groups: group A: diclofenac sodium supposition and group B: placebo.Visual analog scale and morphine consumption were recorded at 6 hours intervals up to 24 hours. Results: The base line mean pain relief and nausea and urinary retention were not statistically significant between groups (P>0.05). Weakness and fatigue, dry mouth and total morphine dose were statistically different(P<0.05). Conclusion: Premedication with diclofenac sodium supposition in the patients underwent lumbar disc surgery, can reduce total dose of morphine consumption after lumbar disc surgery and some adverse effect of morphine such as dry mouth, weakness and fatigue. [ABSTRACT FROM AUTHOR]

• Breaking response time reduces after sequestrectomy and microdiscectomy surgery. • No driving abstinence is required after sequestrectomy or microdiscectomy surgery. • After 30 days breaking response time of patients are comparable to healthy people. The aim of this study was to compare the effects of sequestrectomy versus conventional microdiscectomy on breaking response time (BRT) for lumbar disc herniation (LDH). BRT is the key factor for return to drive recommendations after surgery. A prospective clinical study was conducted. Patients aged 25–65 years who underwent surgery for lumbar disc herniation and held a valid motorcar driving license were recruited in a single institution. The patients were assessed before surgery, immediately after the surgery and at the follow up examination 30 days post-surgery. BRT was measured using a driving simulator, a visual analogue scale (VAS) was used for pain assessment. BRT values were compared with BRT values of a healthy control group. In patients treated with microdiscectomy BRT reduced from 749 (±223) msec before surgery to 649 (±223) msec immediately after the surgery. In the sequestrectomy group BRT reduced from 852 (±561) msec before surgery to 693 (±173) msec immediately after the surgery. BRT at follow up was 610 (±145) msec for patients treated with microdiscectomy and 630 (±98) msec for patients operated with sequestrectomy. BRT for healthy controls was 487 (±116) msec. Pain improved significantly for both patient samples. Sequestrectomy and microdiscectomy were associated with similar effects on pain and BRT after surgery. There was no statistically significant difference between BRT of both patient samples at 30 days follow up examination. Both surgical techniques showed a positive effect on BRT. No statistically significant difference between sequestrectomy and microdiscectomy on BRT could be found. [ABSTRACT FROM AUTHOR]

Iatrogenic arteriovenous fistulas (AVF) after intervertebral disc surgery are rare. The presentation can be varied from potentially fatal to those, which present years after the index surgery with features of, deep vein thrombosis, leg edema, and cardiac failure. The history and physical findings can be indicative of an AVF and the diagnosis is confirmed by computed tomography (CT) CT angiogram (CTA) or digital subtraction angiogram (DSA). Open surgery and endovascular approach can be both used for the treatment of this condition, both with good results, although the endovascular approach is associated with minimal morbidity.

Objective: To compare preemptive and postoperative analgesic efficacy of tramadol and lornoxicam administered before anaesthesia induction in lumbar discectomy. Methods: This randomised, double-blind trial was conducted on 60 ASA I and II patients undergoing lumbar discectomy. Group L (n=30) received 3×8 mg day-1 lornoxicam, and Group T (n=30) received 3×1.5 mg kg-1 day-1 tramadol. A verbal rating scale (VRS), the duration of effective analgesia, the number of additional analgesics used, adverse effects and patient satisfaction were evaluated at the postoperative 30th minute and 1st, 2nd, 4th, 6th, 8th, 12th and 24th hours. Results: There were no significant differences between Groups L and T regarding demographic and clinical characteristics, the number of additional analgesics and the duration of effective analgesia, adverse effects and patient satisfaction. VRS scores of the patients in Group T were significantly higher than those in Group L at the postoperative 30th minute (p=0.050) and the 1st hour (p=0.005). Conclusion: Lornoxicam, which was used for preemptive and postoperative analgesia in lumbar disc surgery, had provided adequate and effective analgesia such as tramadol. Moreover, preemptive analgesia was quite effective in prevention and treatment of postoperative pain. [ABSTRACT FROM AUTHOR]

Objective: Effective pain management by avoiding side effects in the perioperative period is essential for patient outcome. Lumbar disc surgery is associated with moderate to severe postoperative pain, and opioids are widely used. The primary aim of the present study was to compare the effects of 1 mg and 2 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura on morphine consumption, and the secondary aims were to compare pain scores and opioid-related side effects during postoperative 24 h. Methods: The study included 44 patients (American Society of Anesthesiologists I and II). After the discectomy procedure and before the closure, in Group A (n=15), 1 mg morphine-impregnated absorbable cellulose haemostat material placed over the dura was used. In Group B (n=14), 2 mg morphine was used for the same technique, and in Group C (n=15) (control), normal saline was used. All patients used intravenous morphine patient-controlled analgesia pumps for 24 h following lumbar disc surgery. Morphine consumption, pain scores and opioid-related side effects were recorded at 10 min, 1, 2, 6, 12 and 24 h postoperatively. Results: Morphine consumption, pain scores and opioid-related side effects were similar among the groups. Conclusion: Morphine-impregnated absorbable cellulose haemostat material placement over the dura after single level lumbar discectomy did not reduce postoperative morphine consumption, pain scores and incidence of opioid-related side effects. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed at investigating the effect of low-dose ketamine on prevention of hypotension due to positioning after induction of general anesthesia in lumbar disc surgery. Materials and Methods: This double-blind clinical trial was performed during a 3-month period in 2016. A random sample of 84 patients with ASA (American Society of Anesthesiologists), class I, were enrolled in the study and the impact of ketamine on prevention of hypotension due to repositioning was investigated. After induction of anesthesia and intubation, ketamine 0.5 mg/kg of body weight as well as normal saline solution, with equal volumes, were injected to the intervention and control groups, respectively. Patients were repositioned though a similar method to prone position after peak of ketamine (after 1.5 minutes), and then, systolic, diastolic, and mean of the blood pressure were measured as a baseline, once before and 1 minute after the intubation, before repositioning, immediately after repositioning the patient from supine to prone position, and then every 2 minutes until 10 minutes after repositioning. Results: There was significant differences in means (SDs) of systolic pressure and blood pressure in the first, second, and fourth minutes after repositioning, as systolic pressure and mean of the blood pressure in ketamine group was higher than those of control group. The changes of blood pressure in ketamine group was the least amount after repositioning. Conclusions: Ketamine can increase blood pressure, especially systolic pressure of patients, on other hand changes of blood pressure in ketamine group after repositioning was least amount. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: As an alternative to back surgeries, endoscopic spinal operations is the most effective and safe procedure that does not impose the fear reaction to the patients. Objective: In this study the results, complications, and outcomes of 60 patients complaining from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar discectomy (PELD) were reported. Patients and Methods: This is a prospective study conducted in three sentinel hospitals over a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to preoperative MRI were the main diagnostic methods used for including patients who were suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD. Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24 hours post-operatively. After surgery, patients were followed up for two months to three years with a mean of 18 months. Seven (11.7%) patients developed complications including one (1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified Macnab criteria (excluding patients with long dural tear) showed excellence results for 36 patients, while good results were observed for 17 patients, reasonable results for 3 patients and poor results for 2 patients. The achievement rate was 91.4% . Conclusion:Although endoscopic spinal discectomy is a compelling procedure for management of lumbar disc prolapse, and although its final outcome is reasonable it is not devoid from complications. [ABSTRACT FROM AUTHOR]

Lumbar disc surgery is performed exclusively for disc herniation. Either low back pain, or sciatica or both are common presentations depending upon the levels of compressed nerve roots. Indications for surgery and MRI needs to be carefully judged upon keeping the economic status of our patients into consideration. Open lumbar (micro) discectomy is safe and successful method for lumbar disc herniations at periphery. Results in these hundred thirteen initial cases with minimum follow up of 5 years indicate that this is not only feasible but safe in these 57 males and 56 female patients aged between 12 and 93. Redo surgeries were not that difficult in this series and were safe. There were 18 cases with Multiple and 95 single levels. Of the single levels it gradually increased as the level gradually decreased in terms of the vertebral counts. L3/4: 3 cases, L4/5: 28 cases and L5/S1 : 64 cases . There were 18 cases of more than one level discs. There were 96 (Micro) discectomies, 11 Laminotomies and 6 Laminectomies.

Small bowel injury resulting from the perforation of anterior longitudinal ligament during lumbar disc surgery is very rare, with prompt diagnosis being difficult. In the present study, we present a case of intestinal transection and discuss technical methods to prevent this complication with a review of literature. A 34-year-old woman, who had a history of lumbar disc surgery one day before, presented with abdominal pain. On physical examination, rebound tenderness and muscular rigidity were obtained, with emergency abdominal computed tomography confirming the diagnosis of perforation by showing free air and free fluid. The patient underwent laparoscopic exploration; the small bowel was found transected 60 cm proximally to the ileocecal valve. Since there were no signs of generalized peritonitis, the abdomen was irrigated with sterile saline, and side-to-side ileal anastomosis was performed. Her postoperative course was uneventful and she was discharged on the postoperative fifth day. Although bowel perforation after discectomy rarely occurs, it might be very fatal unless a prompt diagnosis is achieved. Especially, an early postoperative course can mask the symptoms and signs. Therefore, general surgeons should be aware of such a complication after lumbar disc surgery, and spine surgeons must be more cautious while they are using retractors in the intervertebral space. [Arch Clin Exp Surg 2015; 4(4.000): 222-225]

Lomber disk hernisi operasyonu genellikle posterior yaklaşımla yapılmakta olup vasküler yaralanmalar operasyonun komplikasyonları arasında sayılabilmektedir. Sunulan 39 yaşındaki olguda geçirilmiş lomber disk hernisi sonrası başlayan ve bir aydır devam eden bacak ağrısı vardı. Yakınmaları operasyon sonrasında çıktığı öğrenilen hastada çekilen bilgisayarlı tomografi sonrasında iliak arter psödoanevrizması görüldü. Olgu cerrahi olarak başarıyla tedavi edildi.

Vascular complications after spine surgery are rare but potentially fatal. The risk is usually related to the proximity of the surgical field to the retroperitoneal structures. Rapid diagnosis and treatment is essential in the management of this complication which has high mortality and morbidity. However, it may delay the management of this condition because the bleeding is retroperitoneal and limited by abdominal compression. Many clinicians may not be aware of this potentially fatal complication. Morbidity and mortality can be reduced with rapid diagnosis and treatment. Therefore, anesthesiologists and surgeons should be highly suspicious in all patients undergoing vertebral surgery. We report a 53- year-old woman with abdominal aortic injury during L2-L3 lumbar discectomy. [ABSTRACT FROM AUTHOR]

Background: Thoracolumbar interfascial plane (TLIP) block involves injection of local anesthetics between multifidus and longissimus muscles at the 3rd lumbar vertebral level assuming that it can block the dorsal rami of thoracolumbar nerves. Objective: The objective of this study was to evaluate the analgesic effects gained after performing TLIP block (analogous to the transversus abdominis plane [TAP] block, but intended for the back) in patients undergoing lumbar discectomy. Methodology: This was a prospective, randomized, double-blinded, controlled clinical trial. Computer-generated randomization numbers were used to allocate patients into two groups. A total of 102 patients scheduled for lumbar discectomy were considered eligible, of these 70 patients were randomly included in the analysis: 35 patients (control group) received the standard general anesthetic technique and 35 patients (TLIP group) received TLIP block with 20 ml mixture of 0.25% bupivacaine and 1% lidocaine on each side. The primary outcome was to compare the two groups with regard to pain scores, whereas the secondary outcomes included the time to first analgesic (TFA), 24-h morphine consumption, and side effects associated with morphine such as nausea, vomiting, and sedation. Results: TLIP group compared with the control group showed a significant reduction in the postoperative Visual Analog Scale for pain score both on rest and movement, with no statistically significant difference at 24 h during movement. TFA was significantly shorter in the control group compared to the TLIP group (82.00 ± 69.01 vs. 442.7 ± 126.47 min, P < 0.001). TLIP group had lower cumulative morphine consumption than control group of statistically significant difference (9.7 ± 6.38 vs. 25.88 ± 5.17 mg, P < 0.001). TLIP block group compared with the control group showed a significant reduction of nausea and a lower incidence of sedation. Conclusion: TLIP block is an effective and safe method for postoperative analgesia after lumbar discectomy. [ABSTRACT FROM AUTHOR]

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,

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

Study Design: Prospective cohort study.Objective: To determine the effects of insurance type (Medicaid vs. a specific private insurance) on patient access to spine surgeons for lumbar disc herniation as measured by (A) acceptance of insurance, (B) need for a referral, and (C) wait time for appointment.Summary Of Background Data: Limited studies have been conducted to examine the issue of patient access to spine surgeons based on different insurance types (Medicaid vs. a specific private insurance), especially in relation to the Medicaid expansion that resulted from the Affordable Care Act.Methods: Appointment success rates, the need for a referral, and waiting periods were compared between Medicaid and a specific private insurance for patients needing an evaluation for a herniated lumbar disc. The waiting period was studied in the context of comparing states that have expanded Medicaid eligibility to ones that have not, and the surgical training of the spine surgeon (orthopaedic surgeons vs. neurosurgeons).Results: Appointment success rate for patients seeking access to lumbar spine care was significantly higher for patients with BlueCross insurance (95.0%) versus patients with Medicaid insurance (0.8%) (P <0.001). The need for referrals was significantly higher for patients with Medicaid insurance (93.3%) versus patients with BlueCross insurance (4.2%) (P <0.001). Among BlueCross patients, wait times were longer in Medicaid-expanded states. However, the same trend was not seen among patients with Medicaid insurance.Conclusion: Patients with Medicaid were less successful at scheduling an appointment and faced more barriers to care, such as the need for a referral, compared with the private insurance studied. In the states with expanded Medicaid, wait times for appointments were longer for BlueCross patients, but were not longer for patients with Medicaid insurance. Overall, this study suggests that increased coverage resulting from Medicaid expansion does not necessarily equate to increased access to care.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]