Endoscopic surgery for herniated disc (original) (raw)
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Turkiye Klinikleri Journal of Medical Sciences, 2010
Percutaneous decompression approach is associated with potential complications, limitations and poor outcome. Nucleotomy is used for suction of disc material. Nucleoplasty (NP) procedure utilizes coblation technology which allows for decompression of the disc using radiofrequency energy. The aim of study is to evaluate the effectiveness of NP versus automatic percutaneous lumbar discectomy (APLD) in pain and disability scores for decompression of contained herniated discs. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A prospective, randomized study was conducted on 189 consecutive patients with complaints of low back pain with or without leg pain secondary to a contained lumbar herniated disc. Patients were ASA I-II physical status, and aged between 19-55 years. There were 96 patients in Group NP (67 females, 29 males), and 93 patients in Group APLD (66 females, 29 males). Control examinations were performed at 1st, 6th, 12th and 18th months and pain scores and Oswestry Disability Questionnaires (ODQ) were evaluated during controls. R Re es su ul lt ts s: : The pre-procedure and post-procedure visual analog scale (VAS) scores in group APLD and NP were 6.95, 2.44 and 7.14, 2.51 respectively. The VAS scores decreased in two groups and the difference between pre-procedure and post-procedure VAS scores were statistically significant (p<0.05). The reduction in VAS score continued in control examinations. The pre-procedure and post-procedure ODQ scores in group APLD and NP were 41.79, 22.81 and 41.48, 22.82 respectively. These differences between pre-procedure and post-procedure scores were also statistically significant (p<0.05). The reduction in ODQ scores continued in control examinations. In the APLD group, there was a statistically significant prolongation in time of procedure. No complications were observed in both groups. C Co on nc cl lu us si io on n: : The results of this study demonstrated a statistically significant improvement in VAS and Oswestry index scores at 1st, 6th, 12th and 18th months in both techniques. Because NP is a short and effective technique, NP should be the first choice for the treatment of symptoms associated with contained lumbar herniated discs. K Ke ey y W Wo or rd ds s: : Low back pain; intervertebral disk displacement; diskectomy, percutaneous Ö ÖZ ZE ET T A Am ma aç ç: : Perkutan dekompresyon sınırlamaları ve komplikasyon potensiyeli olan ve hala sonuçları hakkında az çalışma bulunan bir yaklaşımdır. Nükleotomi disk materyalinin aspire edilmesi için kullanılır. Nükleoplasti (NP) işlemi disk dekompresyonu için radyofrekans enerjisi kullanan koblasyon teknolojisini kullanır. Çalışmanın amacı herniye disklerin dekompresyonunda NP ile otomatik perkütan lumbal diskektominin (APLD) ağrı ve işgöremezlik skorları üzerine etkinliğini karşılaştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışma prospektif ve randomize olarak disk hernisine bağlı bel ağrısı olan ilaveten bacak ağrısı olan veya olmayan 189 hastada değerlendirildi. Hastaların ASA statüleri I-II ve yaşları 19 ile 55 arasındaydı. Grup NP'de 96 (67 kadın, 29 erkek) ve Grup APLD'de 93 (66 kadın, 29 erkek) hasta vardı. Hastalar 1., 6., 12. ve 18. aylarda ağrı skorları ve Oswestry Disability Sorgulaması (ODQ) ile değerlendirilmek için kontrol muayenelerine çağrıldı. B Bu ul lg gu ul la ar r: : İşlem öncesi ve sonrası VAS değerleri Grup APLD ve NP'de 6.95, 2.44 ve 7.14, 2.51 idi. Her iki grupta da işlem sonrası VAS değerleri azalma gösterdi ve işlem öncesi ve sonrası arasındaki VAS değerleri farkı istatistiksel olarak anlamlıydı (p<0.05). VAS değerlerindeki azalma kontrol muayenelerinde de devamlılık gösterdi. İşlem öncesi ve sonrası ODQ değerleri Grup APLD ve NP'de 41.79, 22.81 ve 41.48, 22.82 idi. Her iki grupta da işlem sonrası ODQ değerleri azalma gösterdi ve işlem öncesi ve sonrası arasındaki ODQ değerleri farkı istatistiksel olarak anlamlıydı (p<0.05). ODQ değerlerindeki azalma kontrol muayenelerinde de devam etti. Grup APLD'de işlem süresinde istatistiksel olarak anlamlı bir uzama saptandı. Her iki grupta da herhangi bir komplikasyon gözlenmedi. S So on nu uç ç: : Çalışmamızda her iki teknikte de 1., 6., 12. ve 18. aylarda VAS ve Oswestry disability sorgulamasında istatistiksel olarak anlamlı bir gelişme tespit ettik. Fakat NP daha kısa ve etkili bir teknik olduğundan dolayı herniye diske bağlı semptomların tedavisinde ilk seçenek olarak tercih edilebileceği kanısındayız.
Istanbul University - DergiPark, 2022
Introduction: Lumbar disc herniation (LDH); It is an important disease that is common in society and can cause socioeconomic problems. There are many treatment algorithms for LDH, including medical and surgical. Our aim in this study; To evaluate the clinical results of patients with LDH who did not benefit from conservative treatment after percutaneous intradiscal radiopaque gel ethanol (RGE) procedure in the light of the literature. Methods: A total of 44 levels of percutaneous intradiscal RGE were applied to 41 patients, 14 men and 27 women, hospitalized with the diagnosis of LDH. patients; Demographic characteristics, treatments they received, lumbar magnetic resonance imaging (MRI) taken 6 months later, visual analog scores (VAS) before and 6 months after percutaneous intradiscal RGE procedure, complications, side effects and patient satisfaction after the procedure were evaluated. Results: The VAS values of the patients were 8 before the procedure and 4.2 6 months after the procedure. A 47.5% reduction in pain was observed and these data were evaluated as statistically significant. When patients were asked about their satisfaction with the procedure after the percutaneous RGE procedure; 4 patients answered "poor", 13 patients "moderate", 13 patients "good" and 11 patients "excellent". The rate of those who were satisfied with the procedure was 90.2%, and these data were not considered statistically significant. Conclusion: As a result; Percutaneous intradiscal RGE procedure, in patients with a diagnosis of LDH and who did not benefit from conservative treatment; It can be a minimally invasive technique that reduces pain.
2013
Introduction: The term refers to the intervertebral discs common name for herniated nucleus pulposus of the intervertebral disc of the spine. It consists in highlighting the nucleus pulposus, which causes pressure and irritation of the spinal nerves, spinal cord or other structures of the spinal canal. The mechanism of irritation is twofold. First, the pain is caused by mechanical compression. Another element that could cause pain stimuli of a low pH nucleus pulposus caused poor in oxygen metabolism. Aim: Evaluation of the effects of surgical treatment in patients with intervertebral discs of the spine at the L5-S1z sciatica immediately after surgery, within 14 days and 4 weeks after surgery. Material and Methods: From January 2012 to June 2013 in the Department of Neurosurgical Clinic of the University Hospital No. 1 in Bydgoszcz for surgery spine disc disease L5-S1 with sciatica enrolled 80 sicks diagnosed with unilateral protuberance of the intervertebral disc. Test the effective...
Lomber Disk Hernisinin Radyolojik Evrelemesi Üzerine Mesleksel Faktörlerin Etkisi
Acibadem Universitesi Saglik Bilimleri Dergisi, 2020
Background: Lumbar disc herniation may cause back and/or leg pain, sensory deficits, loss of strength, and even urinary and fecal incontinence. The relationship between lumbar disc herniation (LDH) and occupation was tried to be revealed through various studies. In this study, the association between the radiological stage of LDH on magnetic resonance imaging (MRI) and occupational features of the patients was evaluated. Materials and methods: Sociodemographic and occupational features were collected from medical files of 895 patients with lumbar disc hernia. The occupational groups consisted of housewives, construction workers, health care workers and teachers. Patients were divided into three groups according to the years spent at work as follows: 0-5 years, 5-10 years, 10-15 years and over 15 years. On MRI, LDH was classified as bulging, protrusion, extrusion and sequestration according to Macnab classification. Results: There was no statistically significant relationship between the radiological staging of LDH and occupation (p=0.2) or gender (p=0.4). Increased(advanced) age and more working years had a significant association with the radiological staging of LDH (p <0.001). Conclusion: There is a significant relationship between the progression of the radiological staging of LDH and the increased(advanced) age and working years.
Kafkas Tıp Bilimleri Dergisi, 2021
Aim: The aim of this study is to assess the correlation between the level of disc herniation and pelvic and lumbar vertebral incidences in patients operated for lumbar disc herniation. Material and Method: This retrospective study included those patients whose file records were analyzed. The demographic data and clinical findings of 59 patients diagnosed with single level lumbar disc herniation and underwent unilateral microdiscectomy were recorded. In the analysis of the variables, SPSS 25.0 (IBM Corparation, Armonk, New York, United States) was used. Results: The patients involved 28 men and 31 women whose median age was found as 43.31±4.27 (38-54) years. With regard to location, it was determined that in 28 (47.5%) patients, the herniated discs were located on the right and in 31 patients (52.5%), they were located on the left. In terms of levels, in patients with herniated discs at level L5-S1, the median pelvic index and L4 index were found to be significantly lower than those of patients with herniated discs at levels L4-5 and L3-4 (p=0.002, p=0.001), whereas in patients with herniated discs at level L4-5, the median L5 incidence was found to be significantly high (p=0.001). Conclusion: In this study, the pelvic index and L4 and L5 indexes were found to be significantly low in patients with herniated discs at level L5-S1. It is considered that future prospective and multicentered studies with long-term follow-up are necessary.
TURKISH JOURNAL of CLINICS and LABORATORY, 2019
Aim: In this retrospective study, the diagnostic and therapeutic events of discography and disc-blockage (discoblock) were investigated in patients whose clinical symptoms could not be explained by CT and/or MR images. Material and Methods: The study included patients applied with discography between August 2014 and October 2016. Patient data were recorded, consisting of age, gender, pre-procedure Visual Analogue Scale (VAS) score (PRE-VAS), postprocedure VAS score (POST-VAS), and pre-procedure "Japanese Orthopedic Association" (JOA) score (PRE-JOA), postprocedure JOA score (POST-JOA), long-term follow-up VAS score (FOLLOW-VAS) and JOA score (FOLLOW-JOA), level of herniated disc in the spinal column (L1-2, L2-3, L3-4, L4-5, L5-S1), size of herniated disc ("bulging", "protrusion", "extrusion") and localization of the herniated disc in the spinal canal (median or foraminal). Results: Evaluation was made of a total of 22 patients (11 females, 11 males) aged 32-60 years. Discectomy after discography and/or discoblock was applied to 12 patients. The PRE-VAS scores of patients who underwent discectomy were higher than those of patients who did not undergo surgery, and the scores were lower in the postoperative period than those of the unoperated group. The long term (6 months) follow-up results indicated that patients with discectomy and those without surgery had similar levels of pain. The JOA scores of patients with discectomy were higher than those of patients without surgery. Conclusion: At the end of this study, it was thought that discography and discoblock procedure could be an adjunctive test for decision-making in respect of surgery for patients who were not diagnosed using radiological views and clinical symptoms. Furthermore, it was considered that the VAS score applied before and after discography may identify the patients who will be applied with discectomy.
Endoscopic discectomy as an effective treatment of a herniated intervertebral disc
Bratislavské lekárske listy, 2020
OBJECTIVE: Prospective observational multicentre two-arm parallel study describing clinical outcome after endoscopic discectomy provided via transforaminal and interlaminar approach. BACKGROUND: Endoscopic lumbar discectomy (ELD) is a percutaneous minimally invasive procedure for the treatment of herniated lumbar discs. Herniations at lumbar intervertebral disc levels of L1/2, L2/3, L3/4 and L4/5 are mostly accessed by the transforaminal (TF) approach. However, due to the anatomic position of the iliac crest, the L5/S1 level might not be reachable by the transforaminal approach, while the interlaminar (IL) percutaneous approach should be a suitable alternative. METHODS: In a prospective observational multicentre clinical trial NCT0274311, we compared the clinical outcomes of two groups of patients who underwent ELD via IL (83) and TF (103) approach. The subjects were followed for 12 months via planned examinations by pain physicians. The levels of leg pain and back pain intensity were assessed by an 11-point numerical ratings scale (NRS). Patient's functional disability was assessed by the Oswestry Disability Index (ODI). RESULTS: Study subjects showed a signifi cant decrease in ODI scores in both groups (p < 0.001) The values of mean preoperative ODI in TF and IL groups were 39.1 ± 15.7 and 43.4 ± 16, respectively. Postoperative values in the latter groups were 14.8 ± 14.9 and 17.5 ± 14.3, respectively. Signifi cantly lower pain scores for leg pain (p<0.001) and back pain (p < 0.001) were also recorded at 12-month follow-ups. CONCLUSION: Because both procedures are strictly percutaneous; they are now more commonly performed by interventional pain physicians as a safe and effective alternative to open surgical spine procedures (Tab.
Evaluation Of Surgical Outcomes Of Cervical Disc Disease By Using X-Ray
2014
This study investigated symptoms, physical examination findings and cervical roentgenograms of patients who were surgically treated for single level cervical disc disease. The purpose of our study is to compare and present radiological and clinical findings in preoperative and postoperative groups. Anterior cervical microdiscectomy and fusion with using peek cage was applied to patients. Verbal definition scale was used for clinical evaluation of 44 patients that were operated at Tepecik Education and Research Hospital between September 2008 to September 2009. Pretreatment and post treatment data were compared. According to verbal definition scale, 19 patients had unbearable pain, 23 patients had severe pain, 1 patient had moderate pain before surgery. After the operation, 1 patient had moderate, 1 patient had mild pain. There was no significant difference between preoperative and postoperative lordosis angles and neighbor lower disc height. However comparison of pretreatment and post treatment disc height, neighbor upper disc height and segment angles revealed statistically significant difference. Anterior cervical discectomy and fusion with peek cage is withstanding treatment method for cervical disc disease. This procedure provides both clinical and radiological improvement.
Medicinski arhiv, 2021
Backgroud:Intervertebral disc herniations are caused by rupture of the fibrous ring and migration of one part of the nucleus pulposus towards the spinal canal. The most commonly affected levels are C5-C6 and C6-C7. Surgical treatment of cervicobrachialgia is indicated in the presence of long-term intense pain syndrome with or without radicular sensory-motor deficit and magnetic resonance (MRI) verified disc herniation with a compressive effect.Objective:The most common surgical treatment is anterior lateral microdiscectomy with or without the use of implants. In addition to this method, dorsolateral microsurgical treatment can be used for foraminal hernias.Methods:This retrospective study included 110 (58 / 52.7% male and 52 / 47.3% female) patients with cervical disc herniations who were surgically treated at the Neurosurgery clinic of Clinical Center of Sarajevo University (CCUS) in a five-year period. Stability, postoperative curvature, arthrodesis, implants, and changes in adjacent segments were radiographically analyzed. In the outcome assessment, functional outcome and patient satisfaction were analyzed using the Pain Self-Evaluation Scale (VAS), Prolo functional and economic score, and White’s classification of treatment outcomes.Results:The dominant prevalence of changes was recorded at the levels of C5-C6 (58%) and C4-C5 (28%) with a ventrolateral approach performed in 90% of patients. The largest representation is hard dorsolateral discs (n = 77). In the group of patients with placed implant, hard discs were present in 96 (90%) cases (p <0.001), while soft discs were dominant in patients without implant placement (p <0.001). In the group of subjects with implant, the most common are hard dorsolateral discs and those of mixed localization in 41 of 55 patients (65.5%; p = 0.001). The most common implant is PEEK cage (74.5%). From complications, we had partial vertebral body fractures in 4.5% of patients. Furtehr, the most common are sensory disturbances in 2.73% of respondents. Reduction of symptoms and improvement of preoperative neurological status were observed in over 95% of patients.Conclusion:Surgical treatment of cervical disc herniation is a safe method with a minimal percentage of complications. Microsurgical discectomy significantly contributes to the improvement of the functional status of patients, the reduction of pain, and the improvement of neurological deficit and overall mobility.
The Egyptian Journal of Hospital Medicine, 2021
Background: Lumbar disc herniation is a localized displacement of disc material beyond the normal margins of the intervertebral disc space and is the most common cause of sciatica. Lumbar microdiscectomy (MD) and open discectomy (OD) are commonly performed surgical procedures for patients with lumbar disc herniation. Objective: The aim of the current work was to compare the benefits and harms of minimally invasive discectomy (MID) versus MD/OD for management of lumbar intervertebral discopathy. Patients and Methods: This cross-sectional study was conducted at Menoufia university hospitals & Al-Haram Specialized Hospital including 36 Patients (with single or double level disc prolapse (L4-L5 or L5-S1) who underwent discectomy using microscopic/or conventional discectomy. Results: In group (1): 75% of the patients had good pain improvement (60-90%) and the rest had moderate improvement (40-60 %). In group (1) only 30% experienced intermittent pain while the rest have no pain. While in group (2) about 50% had an intermittent pain. There is no significant difference. In group (1) the mean days of hospital stay was (6.10 + 1.6) while in Group (2) the mean days of hospital stay was (1.60 + 0.12). The group (2) has significant short hospital stay length than group (1). Conclusion: It could be concluded that endoscopic approach was associated with similar postoperative pain improvement and frequency and lower operating time, blood loss and hospital stay in comparison to open approaches. We believe that both techniques are safe, and both can be used to lumber disk surgery, but microscopic technique is preferred for its better outcomes.