BackgroundPatients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome.MethodsA total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy.Results All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group.ConclusionsEpiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.

Objective The relationship of a preoperative Prognostic Nutritional Index (PNI) with perioperative adverse events (PAEs) other than delirium has never been described in patients undergoing spinal surgery. We aimed to evaluate the impact of admission PNI on the outcome of patients undergoing spinal surgery. Methods Medical records of 408 consecutive patients 50 years or older undergoing spinal surgery were reviewed. Patients' information including demographic data, routine preoperative laboratory tests, and PNI were collected to assess the association between these factors and PAEs. The PNI was calculated from this formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count/mm3. Receiver operating characteristic curve analysis was performed to determine the cutoff value of the PNI. Results PAEs occurred in 61 (14.9%) of the patients. Older patients and those with more comorbid conditions such as atrial fibrillation, chronic renal failure, history of malignancy, and diabetes mellitus tended to have a higher rate of PAEs. Patients with PAEs had higher C-reactive protein (4.4 ± 5.4 vs 2.2 ± 3.0 mg/dL; p < 0.001) but had lower hemoglobin levels (12.2 ± 1.57 vs 13.1 ± 1.84 g/dL; p < 0.001) on admission. Patients who had PAEs had a significantly lower preoperative PNI (46.1 ± 4.4 vs 51.9 ± 5.8; p < 0.001) compared with patients without a PAE. Multivariate analysis showed that age (odds ratio [OR]: 1.23; 95% confidence interval [CI] 0.76–1.35; p < 0.04), PNI < 47.7 (OR: 2.51; 95% CI, 1.188–5.477; p = 0.008) and the presence of diabetes (OR: 3.23; 95% CI, 11.326–7.474; p = 0.004) were significant and independent predictors of PAEs. Conclusion This study is the first to demonstrate that a lower preoperative PNI is associated with PAEs in patients undergoing spinal surgery.

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Lumbar disc herniation is the most common cause of the lumbar radicular pain and it is usually encountered on the same side with its symptoms. However, lumbar disc herniation with contralateral symptoms is sometimes observed too. This situation may cause a dilemma for spine surgeons. There are no consensus about cause of the pathophysiology of contralateral radiculopathy, and which surgical approach may suitable for these patients. In here, we present two case reports lumbar disc herniation with contralateral symptoms and discuss this phenomenon in the light of the literature.

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