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Role of surgery in primary lumbar disk herniation: WFNS spine committee recommendations – Lumbar Fusion

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The article published in World Neurosurgery X in February 2024 aimed to provide updated recommendations on the role of surgery in first-time lumbar disk herniations (LDH) for standardizing surgical management. Through a literature search and expert discussions at international meetings, the World Federation of Neurosurgical Societies (WFNS) Spine Committee developed guidelines covering the timing of surgery, minimally invasive techniques, extent of disk resection, and the role of lumbar fusion in LDH cases. The consensus statements highlighted that surgery for LDH is recommended in specific cases such as failure of conservative treatment, cauda equina syndrome, and progressive neurological impairment. Minimally invasive techniques have advantages over open procedures, and there is no specific recommendation for a surgical procedure choice. Sequestrectomy and standard microdiscectomy were found to have similar clinical outcomes, while lumbar fusion is not routinely recommended but may be considered in certain cases

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest day surgery unit on Harley Street UK

Published article

OBJECTIVE: To provide the most up-to-date recommendations on the role of surgery in first-time lumbar disk herniations (LDH) in order to standardize surgical management.

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World Neurosurg X. 2024 Feb 23;22:100276. doi: 10.1016/j.wnsx.2024.100276. eCollection 2024 Apr.ABSTRACTOBJECTIVE: To provide the most up-to-date recommendations on the role of surgery in first-time lumbar disk herniations (LDH) in order to standardize surgical management.METHODS: We performed a literature search in PubMed, Scopus, and Embase from 2012 to 2022 using the following keywords: “lumbar disk herniation,

World Neurosurg X. 2024 Feb 23;22:100276. doi: 10.1016/j.wnsx.2024.100276. eCollection 2024 Apr.

ABSTRACT

OBJECTIVE: To provide the most up-to-date recommendations on the role of surgery in first-time lumbar disk herniations (LDH) in order to standardize surgical management.

METHODS: We performed a literature search in PubMed, Scopus, and Embase from 2012 to 2022 using the following keywords: “lumbar disk herniation AND surgery”. Our initial search yielded 2610 results, which were narrowed down to 283 papers after standardized screening critera were applied. The data from these 283 papers were presented and discussed at two international meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee, where the Delphi method was employed and ten spine experts voted on five final consensus statements.

RESULTS: and s: The WFNS Spine Committee’s guidelines cover four main topics: (1) role and timing of surgery in first-time LDH; (2) role of minimally invasive techniques in LDH; (3) extent of disk resection in LDH surgery; (4) role of lumbar fusion in the context of LDH. Surgery for LDH is recommended for failure of conservative treatment, cauda equina syndrome, and progressive neurological impairment, including severe motor deficits. In the latter cases, early surgery is associated with faster recovery and may improve patient outcomes. Minimally invasive techniques have short-term advantages over open procedures, but there is insufficient evidence to make a recommendation for or against the choice of a specific surgical procedure. Sequestrectomy and standard microdiscectomy demonstrated similar clinical results in terms of pain control, recurrence rate, functional outcome, and complications at short and medium-term follow-up. Lumbar fusion is not recommended as a routine treatment for first-time LDH, although it may be considered in specific patients affected by chronic axial pain or instability.

PMID:38496347 | PMC:PMC10943953 | DOI:10.1016/j.wnsx.2024.100276

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Role of surgery in primary lumbar disk herniation: WFNS spine committee recommendations

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World Neurosurg X. 2024 Feb 23;22:100276. doi: 10.1016/j.wnsx.2024.100276. eCollection 2024 Apr.ABSTRACTOBJECTIVE: To provide the most up-to-date recommendations on the role of surgery in first-time lumbar disk herniations (LDH) in order to standardize surgical management.METHODS: We performed a literature search in PubMed, Scopus, and Embase from 2012 to 2022 using the following keywords: "lumbar disk herniation

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