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PubMed1994

[Long-term results of diskectomy and primary spondylodesis in treatment of lumbar disk hernia].

The indication for spine fusion in combination with diskectomy it neither clearly defined nor widely accepted. It largely depends on the specialist to whom the patient is referred. While orthopedists often perform primary fusions, neurosurgeons hardly ever do so, no matter what the nature of the complaint is. Therefore, the selection of the procedure seems to be a rather random choice. The question is not whether the combined operation or the simple disc excision is superior in itself, but which of the two should be chosen in a given case. For patients with disc displacement and radicular pain as the predominant symptom, undercutting hemilaminectomy and disc excision will generally yield satisfying results. The main indication for a combined operation is a history of instability complaints long before radicular pain caused by the disc displacement appears. Since the number of patients (of all age groups) that require a disc operation is ever increasing, the selection of patients suited for a combined operation is becoming more and more important, so as to bring down the number of secondary fusions for the treatment of invalidating low back pain after disc excision. The aim of our clinical research is to test the criteria for the selection of patients for the combined operation by taking into account both patients who underwent a combined operation and others whose postoperative condition was such as to require a secondary fusion within one year after diskectomy. In the majority of these cases, one can presume that the fusion should have been carried out on the occasion of the first operation. 26 (90%) out of 29 patients showed a good result three months after the combined operation; 25 (86%) were still satisfied four years later. This confirms that patients with a long history of low back pain as a symptom of instability--in addition to the recent symptoms of the herniation--and those with a significant dislocation of one vertebral body (retrolisthesis, spondylolisthesis and pseudospondylolisthesis), too, should be examined in view of a possible combined operation. However, the combined operation is needed in no more than about three to four per cent of all diskectomies.

Activities of Daily Living↗

PubMedDate not supplied

Supervised endurance exercise training compared to home training after first lumbar diskectomy: a clinical trial.

OBJECTIVE: We performed a randomised trial to evaluate if intensive supervised training of the back should be offered to all patients after a first lumbar diskectomy. METHODS: Forty consecutive patients were, after a first lumbar diskectomy, randomly allocated to 2 groups undergoing "supervised training" twice a week for 3 months in an outpatient clinic or "home training" after 2 hours of instruction. RESULTS: The two rehabilitation models both showed a significant effect on spinal mobility, isokinetic trunk flexion strength, isokinetic trunk extension strength and daily function. These improvements were unchanged at follow up 3 months later. The pain score remained unchanged, however, throughout the trial in both groups. No differences in effect between the two rehabilitation models could be found for any of the assessed parameters. Thirteen patients did not complete the trial, including 9 from the supervised endurance trained group, mainly because of increased pain and reprolaps (n = 4). Four patients dropped out of the home trained group, only one because of increased pain. The differences in drop-out rate and training side effects were, however, not statistically significant. CONCLUSION: We conclude that it is not worthwhile to implement 3 months of supervised intensive endurance training as opposed to home training in all cases of first lumbar diskectomy, although a beneficial effect and better compliance might be found for a selected group of such patients.

Adult↗

PubMed1995

[Imaging of the lumbar spine after diskectomy].

The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy.

Diskectomy↗

PubMed1992

Temporomandibular joint diskectomy. No positive effect of temporary silicone implant in a 5-year follow-up.

The purpose of this study was to evaluate the long-term clinical and radiologic effects of a temporary silicone implant after diskectomy of the temporomandibular joint. Forty-three temporomandibular joints in 43 patients with painful disk displacement underwent a diskectomy. A sheet of medical-grade silicone was temporarily placed in 22 patients; 21 patients did not receive an implant. The patients were clinically and radiologically examined 5 years after surgery. On the basis of symptoms and jaw function, they were classified as having good (30 patients), acceptable (8 patients), and bad (5 patients) results. All the patients with bad results and five of the eight patients with acceptable results had received implants. Erosive changes of the condyle or fossa were seen radiographically at follow-up in eight patients, each of whom had received an implant. No positive clinical or radiologic effects of the implants could be identified. The use of a temporary silicone implant after diskectomy of the temporomandibular joint in patients with internal derangement should be seriously questioned.

Adult↗

PubMed1988

Percutaneous diskectomy in the treatment of pediatric lumbar disk disease.

Intervertebral lumbar disk herniation in children and adolescents is rare. The incidence varies between 0.8% and 3.8% of all disks treated surgically. The uncertainty concerning operative or conservative treatment of this rare clinical entity has led to considering the use of atraumatic techniques, such as chemonucleolysis or percutaneous diskectomy. We report the unusual case of an 11-year-old girl with herniated disk at the L4-5 level treated by percutaneous diskectomy. This is, to our knowledge, the first case of a child treated by this technique. The technical simplicity, the minimal trauma it causes, and the excellent clinical result show that percutaneous diskectomy is a reasonable therapeutic alternative in the treatment of juvenile disks.

Child↗

PubMed1997

Diskectomy in temporomandibular joints with internal derangement: a follow-up study.

OBJECTIVE: To follow up a series of patients treated consecutively who had undergone a diskectomy 2 years previously because of persistent pain and disk displacement in the temporomandibular joint. STUDY DESIGN: Sixteen subjects rated their current symptoms during 1 week and were systematically examined for signs of temporomandibular disorders clinically and radiographically by independent observers. RESULTS: Subjectively, all subjects were satisfied with the operation. Five rated their current pain as significant during masticatory function. Some signs of temporomandibular disorders, usually related to function, were registered in all subjects. Postoperative mandibular movements were improved but still below normal range. Signs and symptoms correlated significantly. Surgical complications were nonexistent, but radiographic changes were extensive. Erosion and flattening of the condyle were common. CONCLUSIONS: It was verified that subjects with persistent pain and disk displacement benefit subjectively and clinically from diskectomy. The radiographic outcomes appear less encouraging. Only prospective, randomized, and controlled studies can eventually clarify the effectiveness of diskectomy in relieving pain caused by displacements in the temporomandibular joint.

Adult↗

PubMed1996

Radiographic morphology in the temporomandibular joint after diskectomy.

The purpose of the study was to evaluate the radiographic appearance in the temporomandibular joint after diskectomy in patients refractory to conservative treatment. The diskectomies were performed in patients in which the common diagnosis were internal derangement or symptoms of osteoarthrosis. Postoperative radiographs were taken in 25 patients after 1-17 yrs and compared with the preoperative from both the operated and the nonoperated joints. Moderate to severe osteoarthrotic changes were found on the operated side in all but two patients in contrast to on the nonoperated side where such changes were absent in all patients except in one who had minor to moderate changes. The radiographic examinations showed flattening of the condylar head but also irregularities and bone apposition. In almost all patients the fossa showed a sclerotic surface, flattening but only occasionally bone apposition and irregularities. Sclerotic changes were found in about 50% of the patients but erosions only rarely. Similar postsurgical changes were also seen on the articular eminence. A reduced joint space was seen in 18 patients. The postsurgical radiographic changes are the normal out come of diskectomy and do not have clinical significance even though they resemble degenerative joint disease.

Adult↗

PubMed1989

Long-term strength assessment of postoperative diskectomy patients.

A test battery was used to measure abdominal and back muscle strength and endurance in 20 patients at least 1 year after surgical diskectomy. There were ten men and ten women. Data on isometric and isokinetic performance were compared with previously reported normal values. The data showed that every strength parameter tested except male isokinetic flexion strength showed at least a 30% decrease when compared with normal values. Compared with strength data on these same patients immediately after surgery, a 2-tailed Student t test demonstrated a significant difference only in male isokinetic strength (P less than 0.10) and in female isokinetic strength (P less than 0.05). No other difference was found in isometric strength or endurance compared with data obtained from these patients 4 to 6 weeks postoperatively. From these data, it is obvious that more intensive physical therapy is necessary to improve postoperative strength in patients undergoing surgical diskectomy. These data allow for the design of specific isometric, isokinetic, and endurance rehabilitation programs for the postoperative diskectomy patient.

Adult↗

PubMed1989

Retrorenal colon: implications for percutaneous diskectomy.

It has been recommended that computed tomography (CT) with the patient prone be performed in every patient undergoing percutaneous diskectomy; this would enable detection of a retrorenal location of the colon, which could interfere with the percutaneous procedure. In this evaluation of 346 prone CT studies, only one patient (0.29%) was found to have retrorenal or retropsoas bowel that would have been perforated at diskectomy. Because of this extremely low prevalence, the performance of prone CT in every patient undergoing percutaneous lumbar diskectomy is not believed to be necessary.

Adolescent↗

PubMedDate not supplied

Percutaneous laser diskectomy. An alternative method.

1. The percutaneous posterior approach with laser to a herniated lumbar intervertebral disc--heralded as a "minimal invasion" treatment for the symptomatic relief of discogenic back pain and sciatica--is an alternative method for the treatment of protrusion of a lumbar disc and its associated radiculopathy. 2. Percutaneous diskectomy is considered in patients who have unremitting radiculopathy with a contained disc herniation. The particular criteria for patient selection includes: evaluation of the patient's pain, performance status, medication dependence, and duration of symptoms. The patient must have demonstrable neurological impairment, positive nerve root tension signs, and correlative findings on imaging studies. 3. Percutaneous laser diskectomy has multiple advantages: it is an outpatient procedure performed under local anesthetic; it is less traumatic than open diskectomy; there is no epidural fibrosis; and there is a quick functional recovery with minimal pain and few complications.

Humans↗

PubMed1996

[CT-assisted definition of puncture site and penetration angle for percutaneous lumbar diskectomy].

In 20 consecutive patients submitted to CT evaluation of a suspected disk protrusion at level L4-5, CT measurements to define entry point and penetration angle for percutaneous diskectomy were performed. It was shown that in order to reach the disk center, the entry point had to be more lateral than recommended by most authors. Body height, weight and body surface area were not significantly correlated to entry point position or penetration angle. In particular, the extension of the intervertebral facet joint determined the route of the probe to the disk center. Therefore, CT-assisted planning of the instrument route prior to percutaneous lumbar diskectomy is helpful in defining the proper entry point and penetration angle for safe and effective instrument positioning.

Adult↗

PubMed1994

Intraosseous screw fixation of anterior cervical graft construct after diskectomy.

This article describes a new technique of intraosseous screw fixation of the cervical spine, as well as a retrospective review of 27 patients who had anterior cervical interbody fusion after diskectomy and fixation with one intraosseous Herbert screw, with a minimum follow-up of 1 year. The study included 19 men and eight women. There were no neurologic complications at final follow-up evaluation. All patients had radiographic evidence of fusion. No screw breakage, back-out, or dislodgement occurred. Optimal intraoperative radiographic evaluation for accurate intraosseous screw placement is recommended. The use of intraosseous screw fixation is a useful addition to the armamentarium of the spine surgeon when fixation of anterior cervical graft after diskectomy is required. One hundred percent rate of union and prevention of complications related to the currently used anterior fixation systems are the major advantages of this method.

Adult↗

PubMed2005

Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study.

We evaluated the optimal preemptive dose of gabapentin for postoperative pain relief after single-level lumbar diskectomy and its effect on fentanyl consumption during the initial 24 hours in a randomized, double-blinded, placebo-controlled study in 100 patients with American Society of Anesthesiologists physical status I and II. Patients were divided into five groups to receive placebo or gabapentin 300, 600, 900, or 1200 mg 2 hours before surgery. After surgery, patients were transferred to the postanesthesia care unit (PACU). A blinded anesthesiologist recorded the pain scores at time points of 6, 12, 18, and 24 hours in the PACU on a Visual Analog Scale (VAS; 0-10 cm) at rest. Patients received patient-controlled analgesia (fentanyl 1.0 mug/kg on each demand with lockout interval of 10 minutes); total fentanyl consumption during initial 24 hours was recorded. Data were entered into the statistical software package SPSS 9.0 for analysis (one-way analysis of variance and Student-Newman-Keuls test). Patients who received gabapentin 300 mg had significantly lower VAS score at all time points. They consumed less fentanyl (patients who received placebo processed 1217.5 +/- 182.0 versus 987.5 +/- 129.6 mug; P < 0.05). Patients who received gabapentin 600, 900, and 1200 mg had lower VAS scores at all time points than patients who received gabapentin 300 mg (P < 0.05). Increasing the dose of gabapentin from 600 to 1200 mg did not decrease the VAS score, nor did the increasing dose of gabapentin significantly decrease fentanyl consumption (702.5, 635, and 626.5 microg). Thus, gabapentin 600 mg is the optimal dose for postoperative pain relief following lumbar diskectomy.

Adult↗

PubMed2005

Lumbar disk herniation: do MR imaging findings predict recurrence after surgical diskectomy?

PURPOSE: To retrospectively evaluate if the degree of disk degeneration and disk herniation volume at magnetic resonance (MR) imaging are risk factors for recurrent disk herniation. MATERIALS AND METHODS: The institutional review board permits such retrospective studies, and individual informed consent was not required. MR imaging findings obtained before initial diskectomy in 30 patients (mean age, 42.8 years; 10 women, 20 men) with recurrent disk herniation (study group) and 30 patients (mean age, 42.2 years; nine women, 21 men) without recurrence for at least 2 years after surgery (control group) were compared. Disk degeneration was assessed on T2-weighted sagittal MR images with a five-point grading system (grade I indicated no degeneration; grade II, horizontal hypointense bands within disk; grade III, inhomogeneous disk with intermediate signal intensity; grade IV, no distinction between inner and outer parts of disk; and grade V, collapsed hypointense disk). Disk herniation was classified as representing protrusion, extrusion, or sequestration. The volume of both the affected intervertebral disk and the herniated disk material was measured. Qualitative and quantitative analyses were performed by two readers. The chi(2) test was used for comparison of categorical variables. For comparison of disk degeneration and volumes between patients with and those without recurrence, a paired two-tailed t test was used. Odds ratios based on the extent of disk degeneration were calculated for the entire sample. RESULTS: Advanced disk degeneration (grades IV and V) was significantly less frequent in the study group than in the control group (P < .006). The risk of recurrent disk herniation decreased by a factor of 3.4 for each increase in grade of disk degeneration (odds ratio: 3.58; 95% confidence interval: 1.3, 9.6; P = .011). Mean disk herniation volume as a percentage of intervertebral disk volume was 10.59% +/- 3.41 in the study group and 11.56% +/- 3.84 in the control group. This difference was not significant (P = .31). CONCLUSION: Minor disk degeneration but not herniation volume represents a risk factor for the recurrence of disk herniation after diskectomy.

Adult↗

PubMed2003

Dysphagia, hoarseness, and unilateral true vocal fold motion impairment following anterior cervical diskectomy and fusion.

The charts of 100 patients who underwent anterior cervical diskectomy with fusion performed at our institution between January 1996 and February 1999 were reviewed. The incidences of hoarseness, dysphagia, and unilateral true vocal fold motion impairment were calculated. Univariate logistic regression was used to estimate the relationship of several patient and technical factors to the rates of occurrence of hoarseness and dysphagia. Patient age was found to be a significant predictor of postoperative dysphagia (p < .006), with an odds ratio of 1.113 (95% confidence limits, 1.04, 1.21) per year of age. Other factors studied were not found to be significant predictors. The overall incidence of these complications from the world literature was also calculated. The overall incidences of dysphagia, hoarseness, and unilateral true vocal fold motion impairment in the literature were calculated as 12.3%, 4.9%, and 1.4%, respectively. We conclude that dysphagia, hoarseness, and unilateral vocal fold motion impairment continue to remain significant complications of anterior cervical diskectomy with fusion. Older patients may be at higher risk for dysphagia.

Adult↗

PubMed1999

MR imaging of subchondral osteonecrosis of the vertebral body after percutaneous laser diskectomy.

OBJECTIVE: We describe four cases of subchondral osteonecrosis of the vertebral body that occurred after percutaneous laser diskectomy. Follow-up MR imaging after laser intervention showed abnormal findings in the vertebral body immediately adjacent to the site of diskectomy that are consistent with subchondral osteonecrosis. CONCLUSION: MR imaging features of this complication include a wedge-shaped low signal intensity on T1-weighted images, high and low signal intensities on T2-weighted images, and a contrast-enhanced area corresponding to high signal intensity on T2-weighted images. Possible causative mechanisms include thermal injury and photoacoustic shock.

Adolescent↗

PubMed2003

Diskography outcomes in patients following lumbar diskectomy.

The results of lumbar diskography at post-diskectomy and nonoperative disk levels in postoperative patients and patients without prior back surgery were reviewed over 3 years. Other possible predictive factors, including disk degeneration (per the Adam's classification), end-point resistance, gender, and age, also were reviewed. The results revealed that no statistically significant association was noted between the presence of a prior diskectomy and the outcome of diskography. However, disk degeneration classified as ruptured and fissured correlated statistically with positive diskography. Additionally, age between 30 and 39 years and male gender were statistically associated with a positive diskogram. Disk levels displaying a poor end point during diskography injection (not amendable to pressurization) were statistically related to ruptured or fissured disk levels and thus positive diskography. Based on these results, the assumption that disabling low-back pain presenting after lumbar procedure is due to diskogenic disease arising from the surgical level is not supported.

Adult↗

PubMedDate not supplied

[Percutaneous lumbar endoscopic diskectomy in discogenic lumbosacral radiculitis].

The paper presents the results of percutaneous lumbar endoscopic diskectomy in 96 patients with discogenic lumbosacral radiculitis. Indications, contraindications, and surgical techniques are discussed. The intervention is shown to be highly effective (91.1%) in young patients with a relatively short history of the disease and hernias measuring as large as 8 mm. The paper analyzes complications and poor results of treatment using percutaneous lumbar endoscopic diskectomy.

Adolescent↗