Recurrence of Lumbar Disc Herniation after Microendoscopic Discectomy.

By London Spine
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Recurrence of Lumbar Disc Herniation after Microendoscopic Discectomy.

J Neurol Surg A Cent Eur Neurosurg. 2012 Dec 18;

Authors: Matsumoto M, Watanabe K, Hosogane N, Tsuji T, Ishii K, Nakamura M, Chiba K, Toyama Y

Abstract
Background Although microendoscopic discectomy (MED) is a minimally invasive surgical method for lumbar disc herniation (LDH), early postoperative recurrence may outweigh that advantage. The purpose of the present study was to retrospectively investigate the recurrence rate after MED for LDH and to determine the risk factors for recurrence in patients treated by a single surgeon.Materials and Methods The study included 344 patients who underwent MED (213 males and 131 females; mean age, 39.3 years; age range, 11-82 years; mean follow-up, 3.6 years; follow-up range, 2.0-6.5 years). The clinical outcomes were evaluated using the Japanese Orthopedic Association Score for Low Back Pain (JOA score). Recurrence factors investigated by logistic regression analysis included age; sex; level, laterality, and classified type of LDH; occupation; sports activity; and learning curve of the surgeon.Results LDH recurrence was observed in 37 patients (10.8%). It was observed at the same level in the ipsilateral side as the original LDH in 30 patients, in the contralateral side in three patients, and at a level adjacent to the original level in four patients. The mean time interval between MED and the recurrence was 16.6 months (range, 0.5-52 months). Twenty patients (54.1%) developed recurrence within 1 year after MED. Twenty-two patients (59.5%) were treated by revision surgery (MED in 20 patients and microdiscectomy in two patients), and 15 patients (40.5%) were treated conservatively. The mean JOA score of all the patients was 14.7 ± 3.5 before surgery and 26.5 ± 2.2 at the final follow-up, yielding an average recovery rate of 82.3 ± 15.7%. The recovery rate was 83.1 ± 14.8% in patients without recurrence and 75.7 ± 20.4% in patients with recurrence (p = 0.006). By logistic regression analysis, we identified migration of LDH as a significant factor related to recurrence. The patients with caudal migration of LDH had recurrence more frequently (19.0%) than those with rostral migration (12.5%) or without migration (10.2%) (p = 0.04; odds ratio, 2.0; 95% confidence interval, 1.0-3.8).Conclusion The recurrence rate and reoperation rate for LDH after MED were comparable to those of conventional discectomy. More than half of the cases of recurrence occurred at an early postoperative phase, and patients with caudally migrated LDH experienced recurrence significantly more often than those with rostrally migrated or nonmigrated LDH.

PMID: 23250873 [PubMed – as supplied by publisher]

Clinical Outcomes of Microendoscopic Foraminotomy and Decompression in the Cervical Spine.

By London Spine
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Clinical Outcomes of Microendoscopic Foraminotomy and Decompression in the Cervical Spine.

World Neurosurg. 2012 Dec 12;

Authors: Lawton CD, Smith ZA, Lam SK, Habib A, Wong RH, Fessler RG

Abstract
OBJECTIVE: Few reports have addressed long-term outcomes, as well as the safety and efficacy of the cervical microendoscopic foraminotomy (CMEF) and cervical microendoscopic diskectomy (CMED) procedures used in modern spinal practice to treat degenerative disease of the cervical spine. Accordingly, we present long-term outcomes from a cohort of patients treated for foraminal stenosis or disk herniation in the cervical spine. METHODS: A total of 38 patients were included in the study, with a mean follow-up of 24.47 ± 12.84 months. Patients were monitored prospectively with questionnaires consisting of a visual analog scale for the neck (VASN) and arm (VASA), and a neck disability index (NDI) form. Operative time, estimated blood loss, and hospitalization stay also were collected. Data were analyzed with Microsoft Office Excel 2007. RESULTS: The mean 1 year follow-up scores all showed statistically significant improvements: NDI (P = 0.0019), VASN (P = 0.0017), VASA (P ≤ 0.0001). Similar results were seen at 2-year follow-up: NDI (P = 0.0011), VASN (P = 0.0022), and VASA (P ≤ 0.0001); and at 3- to 6-year follow-up: NDI (P = 0.0015), VASN (P = 0.0200), and VASA (P = 0.0034). The average operation time, hospitalization stay, and estimated blood loss were 154.27 ± 26.79 minutes, 21.22 ± 14.23 hours, and 27.92 mL, respectively. There were no statistically significant differences when patients were compared by age (over 50 vs. under 50), operative level (above C6 vs. below C6), or sex. One complication was reported in this study consisting of duratomy, which required no further intervention. CONCLUSION: Posterior CMEF and CMED are safe and effective procedures for minimally invasive decompression in the cervical spine.

PMID: 23246739 [PubMed – as supplied by publisher]