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Lumbosacral microdiscectomy

Isabel Tulloch, Riaz Ali, Marios C Papadopoulos
We describe the unique case of a 51-year-old lady who developed a contralateral lumbosacral plexopathy two days after a lumbar microdiscectomy. This is the first report to date of this complication occurring following this procedure. We review the literature regarding lumbosacral plexopathy and discuss the evidence base behind investigating and managing this condition and the potential pathophysiological mechanisms which underlie its development. We draw comparisons with the more widely recognised post-operative brachial neuritis, characterised by delayed onset brachial plexopathy developing after cervical decompression, and propose an immune-mediated inflammatory mechanism linking the two conditions...
January 26, 2018: British Journal of Neurosurgery
Ankie Seiger, Pravesh S Gadjradj, Biswadjiet S Harhangi, Job Lc van Susante, Wilco C Peul, Maurits W van Tulder, Michiel R de Boer, Sidney M Rubinstein
INTRODUCTION: Lumbosacral radicular syndrome is often caused by a disc herniation. The standard surgical technique to remove a disc herniation is open microdiscectomy. An alternative technique is percutaneous transforaminal endoscopic discectomy (PTED), which is less invasive. In the Netherlands, PTED is not currently considered as standard care, and therefore not reimbursed within public health insurance. A pragmatic, multicentre, non-inferiority, randomised controlled trial has been designed to determine the effectiveness and cost-effectiveness of PTED versus open microdiscectomy for the treatment of lumbar disc herniation...
December 21, 2017: BMJ Open
Nitin Garg, Pankaj Panwar, Sudheer Kumar Devana, S M Ravi Mohan, A K Mandal
Microdiscectomy is considered a very safe procedure with few serious complications. Ureteric injury following microdiscectomy is rarely reported in the literature. We report a rare case of iatrogenic ureteric injury following L5-S1 microdiscectomy for prolapsed intervertebral disc which was detected early and managed in time.
April 2017: Urology Annals
C Raftopoulos, S Koenig, V Joris, T Duprez
Cauda equina syndrome is a serious condition resulting from dysfunction of the lumbosacral nerve roots and characterized by impairment of bladder, bowel, sexual and lower limb functions. We report the case of a 48-year-old woman who had Crohn's disease for more than twenty years. The patient was undergoing immunotherapy with infliximab and developed a partial cauda equina syndrome after an uneventful minimally invasive microdiscectomy (L5-S1) that completely cured her sciatica. A postoperative magnetic resonance imaging examination showed root clumping but no compressive lesion...
March 2017: Neuro-Chirurgie
Sang-Soak Ahn, Dong-Kyu Chin, Sang-Hyeon Kim, Dong-Won Kim, Byung-Hun Lee, Min-Geun Ku
OBJECTIVE: To evaluate whether the presence of lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of microdiscectomy (MD) in young adults with lumbar disc herniation. METHODS: We retrospectively included 398 patients who were followed-up for at least 2 years after MD for lumbar disc herniation at L4/5 (disc above the LSTV). The patients were divided into 2 groups. Group A was made up of 31 patients in whom LSTV was detected. Group B, in contrast, was made up of 35 patients in whom LSTV was not detected...
March 2017: World Neurosurgery
Lotte Janssens, Simon Brumagne, Kurt Claeys, Madelon Pijnenburg, Nina Goossens, Sofie Rummens, Bart Depreitere
BACKGROUND: Individuals with non-specific low back pain show decreased reliance on lumbosacral proprioceptive signals and slower sit-to-stand-to-sit performance. However, little is known in patients after lumbar microdiscectomy. METHODS: Patients were randomly assigned into transmuscular (n=12) or paramedian lumbar surgery (n=13). After surgery, the same patients were randomly assigned into individualized active physiotherapy starting 2 weeks after surgery (n=12) or usual care (n=13)...
February 2016: Clinical Biomechanics
Naime Altinkaya, Melih Cekinmez
OBJECTIVE: To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. MATERIALS AND METHODS: In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI...
January 2016: Skeletal Radiology
S O Arestov, A V Vershinin, A O Gushcha
The issue of advantage of endoscopic treatment of spinal disc herniations is debatable. Throughout the development, endoscopic technologies have been compared to microsurgical methods. The two-year experience of applying endoscopic methods was analyzed. The study included 183 patients. The effectiveness of the performed treatment was evaluated according to the MacNab scale of surgical treatment outcomes. Good and excellent results were obtained in 170 cases, which amounted to 92.9%. This cure rate was compared to the similar rate for good and excellent results of the microsurgical treatment method derived from the literature data...
2014: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
G I Nazarenko, A M Cherkashov, I N Shevelev, V I Kuz'min, N A Konovalov, A G Nazarenko, D S Asiutin, M A Gorokhov, T G Sharamko
The article analyzes of the early and long-term outcomes in 113 patients who underwent surgical treatment for lumbosacral disc herniations. The first group of patients (n=32) underwent microdiscectomy in a combination with radiofrequency destruction (RFD) of the facet nerves. The control group patients (n=81) underwent microdiscectomy. This study demonstrates the advantage of combining RFD with open surgery. In this case, regression of both nerve root and back pain is achieved, which greatly accelerates rehabilitation of patients, restoration of their work ability, and therefore their return to normal life...
2014: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Mohammad R Rasouli, Vafa Rahimi-Movaghar, Farhad Shokraneh, Maziar Moradi-Lakeh, Roger Chou
BACKGROUND: Microdiscectomy or open discectomy (MD/OD) are the standard procedures for symptomatic lumbar disc herniation and they involve removal of the portion of the intervertebral disc compressing the nerve root or spinal cord (or both) with or without the aid of a headlight loupe or microscope magnification. Potential advantages of newer minimally invasive discectomy (MID) procedures over standard MD/OD include less blood loss, less postoperative pain, shorter hospitalisation and earlier return to work...
2014: Cochrane Database of Systematic Reviews
Stephen M Pirris, Eric W Nottmeier, Gazanfar Rahmathulla, H Gordon Deen, Ronald Reimer, Robert E Wharen
BACKGROUND CONTEXT: Achieving a posterolateral fusion in conjunction with performing decompressive laminectomies can prevent recurrence of stenosis or worsening of spondylolisthesis. Facet bone dowels have been introduced and marketed as a less invasive alternative to pedicle screws. Surgeons have been placing them during lumbar laminectomy surgery and coding for intervertebral biomechanical device and posterolateral fusion. These bone dowels have also been placed percutaneously in outpatient surgery centers and pain clinics for facet-mediated back pain...
September 1, 2014: Spine Journal: Official Journal of the North American Spine Society
Sunny Ogbonnaya, Chandrasekaran Kaliaperumal, Abdulla Qassim, Michael O'Sullivan
BACKGROUND: Nucleoplasty (percutaneous lumbar disc decompression) is a minimally invasive procedure that utilizes radiofrequency energy as a treatment for symptomatic lumbar disc herniation, against open microdiscectomy, which would be the mainstay treatment modality. The literature reports a favorable outcome in up to 77% of patients at 6 months. AIM: To evaluate the effectiveness of nucleoplasty in the management of discogenic radicular pain. MATERIALS AND METHODS: The medical notes of 33 patients, admitted for nucleoplasty between June 2006 and September 2007, were reviewed retrospectively...
January 2013: Journal of Natural Science, Biology, and Medicine
Muhammad Shahzad Shamim, Maria Adnan Parekh, Muhammad Ehsan Bari, Syed Ather Enam, Faraz Khursheed
BACKGROUND: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including patient demographics. Failed disc surgery refers to failure of improvement in patient's symptoms following microdiscectomy, and has been observed to occur in up to 12% of patients. To date, no study form Pakistan has looked into patient demographics and failed disc surgery rates within the local context...
December 2010: World Neurosurgery
Dong Yeob Lee, Sang-Ho Lee
OBJECTIVE: The purpose of this study was to analyze the surgical outcomes of carbon dioxide (CO(2)) laser-assisted microdiscectomy for extraforaminal lumbar disc herniations (EFLDH) at the L5-S1 level. BACKGROUND DATA: Microdiscectomy via the lateral transmuscular route is beneficial for treating EFLDH at the L5-S1 level. However, this technique may not effectively remove concomitant foraminal lumbar disc herniation (FLDH), resulting in persistent leg pain and a necessity for revision surgery...
August 2011: Photomedicine and Laser Surgery
Sang-Ho Lee, Han Sug Kang, Gun Choi, Byoung Joon Kong, Yong Ahn, Jin-Sung Kim, Ho-Yeon Lee
The 'foraminoplastic' ventral epidural approach and its advantages in the treatment of extruded disk herniation at the L5-S1 level are described. Percutaneous endoscopic lumbar discectomy is a minimally invasive procedure applicable to various types of lumbar disk herniation, but the L5-S1 disk space is still challenging to access due to anatomic limitations such as high iliac crest or severely narrowed foramen. The 'foraminoplastic' ventral epidural approach was performed in 25 patients with herniated disk radiculopathy at L5-S1 from March 2003 to May 2004...
2010: Neurologia Medico-chirurgica
F Postacchini, R Postacchini
Removal of a herniated disc with the use of the operative microscope was first performed by Yasargil (Adv Neurosurg. 4:81-2, 1977) in 1977. However, it began to be used more and more only in the late 1980s (McCulloch JA (1989) Principles of microsurgery for lumbar disc disease. Raven Press, New York). In the 1990s, many spinal surgeons abandoned conventional discectomy with naked-eye to pass to the routine practice of microdiscectomy. The merits of this technique are that it allows every type of disc herniation to be excised through a short approach to skin, fascia and muscles as well as a limited laminoarthrectomy...
2011: Acta Neurochirurgica. Supplement
R Lotan, A Al-Rashdi, A Yee, J Finkelstein
Unidentified nerve root anomalies, conjoined nerve root (CNR) being the most common, may account for some failed spinal surgical procedures as well as intraoperative neural injury. Previous studies have failed to clinically discern CNR from herniated discs and found their surgical outcomes as being inferior. A comparative study of CNR and disc herniations was undertaken. Between 2002 and 2008, 16 consecutive patients were diagnosed intraoperatively with CNR. These patients were matched 1:2 with 32 patients diagnosed with intervertebral disc herniations...
July 2010: European Spine Journal
K Bosković, T Cigić, M Grajić, S Todorović-Tomasević, A Knezević
INTRODUCTION/AIM: Health-conditioned quality of patients' life is equally a result of their subjective perception of the disease and their objective condition. The aim of this paper is to evaluate the quality of life of surgically treated lumbar radiculopathy patients by using a generic and a lumbar disease-specific questionnaire. METHODOLOGY: 50 patients were evaluated (average age: 44.9 years; 52 male and 48 female). Two questionnaires were used for this purpose: the SF36 generic questionnaire, measuring eight quality of life domains divided into two sub-domains (overall physical and overall mental health), and the NASS LBP lumbar disease-specific questionnaire measuring four domains (pain and disability, motor and sensory neurogenic symptoms, expectations from the treatment and satisfaction with it)...
September 2010: Clinical Neurology and Neurosurgery
S E Celik
Postsurgical pyogenic spondylodiscitis is a well known complication of lumbar microdiscectomy. However; Pott disease after the early period of lumbar microdiscectomy has not been reported so far. Pott disease may mimic infectious complications of surgery and may be a reason of misdiagnosis. The author reports a 51 years old case nonresponsive to nonspecific antibiotic administration with diagnostic difficulty. To the author's knowledge this is the first Pott case that mimics postsurgical pyogenic spondylodiscitis...
December 2009: Journal of Neurosurgical Sciences
Sveva Ambrosetti-Giudici, Alois Pfenniger, Michael H Krenn, Wolfgang P Piotrowski, Stephen J Ferguson, Juergen Burger
The definition of spinal instability is still controversial. For this reason, it is essential to better understand the difference in biomechanical behaviour between healthy and degenerated human spinal segments in vivo. A novel computer-assisted instrument was developed with the objective to characterize the biomechanical parameters of the spinal segment. Investigation of the viscoelastic properties as well as the dynamic spinal stiffness was performed during a minimally invasive procedure (microdiscectomy) on five patients...
November 2009: Medical Engineering & Physics
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