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Discectomy – Lumbar Spinal Stenosis

The article discusses lumbar disc herniations (LDH), which are a common manifestation of degeneration in the lumbar spine. The prevalence of LDH is reported to be around 12%, with the most common site being at L4-L5 and/or L5-S1. Surgery for LDH is the most common reason for spinal surgery. The pathophysiology involves the extrusion of the nucleus pulposus through the annulus fibrosus, leading to symptoms resulting from stimuli to the disc material, inflammation, and compression of nerve roots. Treatment options include conservative methods such as medication and physical therapy. The article also describes different surgical strategies for LDH, including open surgery, minimally invasive techniques, and endoscopic approaches. The history of discectomy is also discussed, highlighting the evolution of surgical techniques over the years

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best rated spine facility in UK

Published article

Lumbar disc herniations (LDH) are a relatively common and early manifestation of degeneration of the lumbar spine. The reported incidence of LDH is 2% ~3% and the prevalence is around 12%. Prevalence of 4.8% among men and 2.5% among women above 35 years of age.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
2023 Aug 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.ABSTRACTLumbar disc herniations (LDH) are a relatively common and early manifestation of degeneration of the lumbar spine. The reported incidence of LDH is 2% ~3% and the prevalence is around 12%. Prevalence of 4.8% among men and 2.5% among women above 35 years,

2023 Aug 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.

ABSTRACT

Lumbar disc herniations (LDH) are a relatively common and early manifestation of degeneration of the lumbar spine. The reported incidence of LDH is 2% ~3% and the prevalence is around 12%. Prevalence of 4.8% among men and 2.5% among women above 35 years of age.

The most common site of LDH is at L4–L5 and/or L5–S1.

Surgery for LDH accounts for the most common indication for performing spinal surgery.

Relevant pathophysiology involves extrusion of the central nucleus pulposus through the compromised outer annulus fibrosus. Symptoms are thought to result from a multifactorial mechanism with components of noxious stimuli to the disc material itself, an inflammatory cascade impacting local nerve roots, and direct compression of nerve roots by extruded disc material. Treatment options include conservative treatment, the mainstays of which are oral medication and physical therapy. The potential efficacy of these modalities is well established. Rigorous adherence to the objective association between the patient’s symptoms, physical exam findings, and diagnostic imaging is essential to predict the effectiveness of any planned surgery.

Different surgical strategies for LDH:

  1. Open.

  2. Minimally Invasive Open Lumbar Discectomy (MIOLD).

  3. Microlumbar discectomy (MLD).

  4. Micro-endoscopic discectomy (MED).

  5. Fully endoscopic (FE).

The core principle of the surgery in eliminating the nerve impingement remains the same, the dictum of the newer surgical strategies only focuses on reducing assess trauma to the multifidus and improving surgical vision.

History of discectomy

Mixter and Barr first described laminectomy for LDH in 1934 through L3 to sacrum approach. Hemi-laminectomy came into practice in the 1970s.

Caspar and Williams described microdiscectomy via a 3 cm incision in 1977.

Wiltse and Spencer described the paraspinal approach for managing extra-foraminal discs in 1988. In the same year, Kambin and Sampson described a fully endoscopic approach [FE]) for an extra-foraminal approach

In 1993, Mayer and Brock reported the use of tubular retractors. Foley and Smith performed a video-assisted technique using a tubular work canal (Micro-endoscopic discectomy: MED) via a 2-cm incision adopting a trans-muscular approach without multifidus release from its insertion in 1997.

PMID:31335001 | Bookshelf:NBK544281

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Discectomy

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2023 Aug 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.ABSTRACTLumbar disc herniations (LDH) are a relatively common and early manifestation of degeneration of the lumbar spine. The reported incidence of LDH is 2% ~3% and the prevalence is around 12%. Prevalence of 4.8% among men and 2.5% among women above 35 years
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