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Cost Effectiveness Studies in Spine Surgeries: A Narrative Review.
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Authors: Lu Y, Qureshi S
BACKGROUND CONTEXT: Although the pathologic processes that …

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YouTube™ as a source of patient information for lumbar discectomy.

Ann R Coll Surg Engl. 2014 Mar;96(2):144-146

Authors: Brooks F, Lawrence H, Jones A, McCarthy M

INTRODUCTION: YouTube™ contains more than 60% of all videos on the internet. Its popularity has increased, and it has now become a source of patient education and information. It is unregulated for the quality of its videos. This project was designed to assess the quality of videos on YouTube™ on lumbar discectomy.
METHODS: A systematic search of YouTube™ was performed. The search terms used were ‘lumbar’ and ‘discectomy’. The first ten pages were reviewed. Information was recorded relating to the date of publishing, the publisher and the number of viewings. The content was reviewed using criteria based on recommendations from the British Association of Spine Surgeons website. Content was assessed and points were awarded for information relating to management options, description of the procedure (including anaesthetic, likely recovery and outcome) and complications as well as information relating to the author and his or her institute. An overall rating of ‘inadequate’, ‘poor’, ‘average’ or ‘good’ was given.
RESULTS: Overall, 81 videos were identified. The total number of viewings was 2,722,964 (range: 139-111,891), with an average number of 34,037 viewings per video. There were 16 with a rating of ‘good’, 25 with a rating of ‘average’ and 40 with a rating of ‘poor’ or ‘inadequate’. The most common missing information related to anaesthesia or complications. Most videos (69/81) were broadcast by surgeons or surgical institutes.
CONCLUSIONS: The quality of YouTube™ videos is variable and we believe this represents the unregulated nature of broadcasts on YouTube™. Thought should be given to information in videos prior to placement.

PMID: 24780674 [PubMed – as supplied by publisher]

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Korean J Spine. 2013 Jun;10(2):61-4
Authors: Wang ES, Lee CG, Kim SW, Kim YS, Kim DM
OBJECTIVE: The purpose of this …

Risk Factors for Recurrent Lumbar Disc Herniations.
Asian Spine J. 2014 Apr;8(2):211-215
Authors: Shin BJ
The most common complication after lumbar discectomy is reherniation. As the first …

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A History of Lumbar Disc Herniation From Hippocrates to the 1990s.
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The timing of surgery in lumbar disc prolapse: A systematic review.
Indian J Orthop. 2014 3;48(2):127-135
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Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up.

Eur Spine J. 2014 Apr 16;

Authors: Hussein M, Abdeldayem A, Mattar MM

BACKGROUND: There is a long-held concept among spine surgeons that endoscopic lumbar discectomy procedures are reserved for small-contained disc herniation; 8-year follow-up has not been reported. The purpose of this study is to assess microendoscopic discectomy (MED) in patients with large uncontained lumbar disc herniation (the antero-posterior diameter of the extruded fragment is 6-12 mm or more on axial cuts of MRI) and report long-term outcome.
METHODS: One hundred eighty-five patients with MED or standard open discectomy underwent follow-up for 8 years. Primary (clinical) outcomes data included Numerical Rating Scale (NRS) for back and leg symptoms and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary (objective) outcomes data included operative time, blood loss, postoperative analgesics, length of hospital stay, time to return to work, reoperation and complication rate, patient satisfaction index (PSI), and modified (MacNab) criteria.
RESULTS: At the end of the follow-up, the leg pain relief was statistically significant for both groups. NRS back pain, ODI, PSI and MacNab criteria showed significant deterioration for control group. Secondary outcomes data of MED group were significantly better than the control group.
CONCLUSIONS: Large, uncontained, lumbar disc herniations can be sufficiently removed using MED which is an effective alternative to open discectomy procedures with remarkable long-term outcome. Although the neurological outcome of the two procedures is the same, the morbidity of MED is significantly less than open discectomy. Maximum benefit can be gained if we adhere to strict selection criteria. The optimum indication is single- or multi-level radiculopathy secondary to a single-level, large, uncontained, lumbar disc herniation.

PMID: 24736930 [PubMed – as supplied by publisher]

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The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomised controlled trials.

Int Orthop. 2014 Apr 11;

Authors: Chang X, Chen B, Li HY, Han XB, Zhou Y, Li CQ

PURPOSE: The objective of this study was to compare the safety and efficacy of minimally invasive discectomy (MID) with standard discectomy (SD) and determine whether the use of the MID technique could decrease the recurrence of lumbar disc herniation (LDH) after the surgery.
METHODS: In February 2014, a comprehensive search was performed in PubMed, EMBASE, Web of Science, Cochrane Library and the Chinese Biological Medicine Database. Only randomised controlled trials (RCT) that compared MID with SD for the surgical management of LDH were included. These trials were carefully picked out following the inclusion and exclusion criteria. Using the Cochrane Collaboration guidelines, two authors independently extracted data and assessed these trials’ quality. The age of the patients, size of incision, surgical time, blood loss, visual analogue scale (VAS) score after the surgery, hospital stay, disc herniation recurrence, X-ray exposure and surgical costs in these studies were abstracted and synthesised by a meta-analysis with RevMan 5.2.0 software, and the main results (VAS score after the surgery and disc herniation recurrence) of publication bias were examined by Stata 12.0.
RESULTS: Overall, 16 trials involving 2,139 patients meeting our criteria were included and analysed. Comparing MID and SD, the former was more likely to increase disc herniation recurrence [relative risk (RR) = 1.95, 95 % confidence interval (CI) 1.19-3.19, p = 0.008], and it involved a smaller size of incision [mean difference (MD) = -1.91, 95 % CI -3.33 to -0.50, p = 0.008], shorter hospital stay, longer operating time (MD = 11.03, 95 %C I 6.62-15.44, p < 0.00001) and less blood loss (MD = -13.56, 95 % CI -22.26 to -4.87, p = 0.002), while no statistical difference appeared with regard to the age of the patients, VAS score after the surgery, X-ray exposure, hospital stay and surgical costs.
CONCLUSIONS: Based on available evidence, MID results in less suffering for patients during the hospital course with a similar clinical efficacy compared to SD. This makes MID a promising procedure for patients with LDH; however, to popularise it greater effort is required to reduce disc herniation recurrence.

PMID: 24722785 [PubMed – as supplied by publisher]

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