Menu
Menu
19 Harley St, London, W1G 9QJ, UK

Day: May 19, 2018

Long-term Follow-up Results of Percutaneous Endoscopic Lumbar Discectomy.

By Kamruz Zaman
Related Articles

Long-term Follow-up Results of Percutaneous Endoscopic Lumbar Discectomy.

Pain Physician. 2016 Nov-Dec;19(8):E1161-E1166

Authors: Eun SS, Lee SH, Sabal LA

Abstract
BACKGROUND: Open lumbar microdiscectomy (OLM) has been considered the gold standard in the management of lumbar disc herniation (LDH) for its favorable outcomes in long-term follow-up. Nowadays, percutaneous endoscopic lumbar discectomy (PELD) is gaining recognition. However, greatest limitation of studies of PELD is the lack of long-term follow-up outcomes.
OBJECTIVE: To investigate the long-term outcomes of PELD in terms of clinical and radiographic findings and revision surgery rate.
STUDY DESIGN: Retrospective study.
SETTING: Spine hospital.
METHODS: Sixty-two patients who underwent PELD 10 years previously were contacted for follow-up. Clinical parameters such as the visual analog scale scores for the back and legs (VAS-B and VAS-L, respectively), the Oswestry disability index (ODI), and radiographic findings such as the disc-height ratio and change in the difference between flexion and extension were recorded and compared to the preoperative values.
RESULTS: For 62 followed patients, 38 met our inclusion criteria (35 transforaminal, 3 interlaminar). Excluded were 6 patients (9.4%) who underwent revision OLM at same level and 17 patients (26.6%) who underwent lumbar spine surgery at other levels. The average follow-up period was 11.22 (± 0.83) years. For the remaining 38 patients who had no further surgery, the postoperative VAS-B (2.53 ± 1.98), VAS-L (1.82 ± 1.92), and ODI (12.69 ± 11.26) were significantly different from the pre-operative values (8.45 ± 1.52, 7.40 ± 3.04, and 55.33 ± 24.63, respectively; all P = 0.01). The average disc-height ratio was 81.54% of the original disc height. There was no evidence of instability after long-term postoperative follow-up.
LIMITATION: Retrospective nature of data collection.
CONCLUSION: PELD has favorable long-term outcomes.Key words: Long-term, PELD, endoscopic lumbar discectomy, revision rate, disc height, instability.

PMID: 27906946 [PubMed – in process]

Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome.

By wp_zaman
Related Articles

Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome.

Anesth Analg. 2014 Jan;118(1):215-24

Authors: Hsu E, Atanelov L, Plunkett AR, Chai N, Chen Y, Cohen SP

Abstract
BACKGROUND: Failed back surgery syndrome (FBSS) is a challenging problem. One treatment advocated to treat FBSS is epidural lysis of adhesions (LOA). The results of studies examining LOA for FBSS have been mixed, but are limited because no study has ever sought to identify factors associated with outcomes.
METHODS: We performed this multicenter, retrospective study in 115 patients who underwent LOA for FBSS (n = 104) or spinal stenosis (n = 11) between 2004 and 2007. Twenty-seven demographic, clinical, and procedural variables were extracted from medical records and correlated with the outcome, defined as ≥50% pain relief lasting ≥1 month. Univariable analysis was performed, followed by multivariable logistic regression.
RESULTS: Overall, 48.7% (95% confidence interval [CI], 39.3%-58.1%) of patients experienced a positive outcome. In univariable analysis, those who had a positive outcome were older (mean age 64.1 years; 95% CI, 59.7-68.6 vs 57.2; 95% CI, 53.0-61.4 years; P = 0.02), while higher baseline numerical rating scale pain scores were associated with a negative outcome (mean 6.7 years; 95% CI, 6.0-7.3 vs 7.5; 95% CI, 6.9-8.0; P = 0.07). Use of hyaluronidase did not correlate with outcomes in univariable analysis (odds ratio [OR], 1.2; 95% CI, 0.6-2.5; P = 0.65). In multivariable analysis, age ≥81 years (OR, 7.8; 95% CI, 1.4-53.7), baseline numerical rating scale score ≤9 (OR, 4.4; 95% CI, 1.4-16.3, P = 0.02), and patients on or seeking disability or worker’s compensation (OR, 4.4; 95% CI, 1.1-19.5, P = 0.04) were significantly more likely to experience a positive outcome.
CONCLUSIONS: Considering our modest success rate, selecting patients for epidural LOA based on demographic and clinical factors may help better select treatment candidates. Procedural factors such as the use of hyaluronidase that increase risks and costs did not improve outcomes, so further research is needed before these become standard practice.

PMID: 24356168 [PubMed – in process]

Symptomatic compressive pneumocephalus following lumbar decompression surgery.

By wp_zaman
Related Articles

Symptomatic compressive pneumocephalus following lumbar decompression surgery.

Orthop Traumatol Surg Res. 2016 Jan 12;

Authors: Gauthé R, Latrobe C, Damade C, Foulongne E, Roussignol X, Ould-Slimane M

Abstract
We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2-L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, computed tomography was performed to explore intense lumbar pain and revealed a voluminous pneumorachis. Then, the patient experienced a generalized tonic-clonic seizure. Imaging revealed a voluminous pneumocephalus responsible for a significant space-occupying effect on the frontal lobe. A conservative treatment was initiated, including bed rest, oxygen therapy, neurological monitoring and anti-epileptic therapy. Symptoms gradually improved and he was discharged without any deficit after 10 days. A total radiological regression was noted in 21 days. Prevention of postoperative pneumocephalus should include a systematic repair of iatrogenic dural tear. Even in presence of severe symptomatic manifestations, a conservative treatment is possible.

PMID: 26796946 [PubMed – as supplied by publisher]