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Our long-term outcome study shows that a minimally invasive approach to microdiscectomy with removal of the fragment only is an effective way to treat lumbar disk herniation. The rate of recurrence in our long-term study seems slightly higher compared with previously published studies, which generally had shorter follow-up periods. Long-term patient outcomes for back and leg pain were also very low. No appreciable difference in operative reherniation could be found with patients who had contained verses extruded fragments. It is difficult to predict from this study whether a simple fragmentectomy was the cause of the progression to further surgeries or whether this was the natural progression of a degenerative spine. Further prospective trials are necessary to fully understand the factors associated with limited microdiscectomy.

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This study is an adjunct to a research effort focused on a mathematical curricular innovation in four non-governmental schools in Tehran, Iran. This study queried balanced, random sample of 100 educational personnel from the schools concerning dynamic capabilities associated with change (sensing opportunities, seizing opportunities, and reconfiguring assets) and issues surrounding organizational inertia (finding resources, confronting path dependency in change, and establishing new processes). Additional data collected described the personnel's perceptions about innovations and new processes instituted in their schools. Student performance data from the prior year's final mathematical examination were also gathered. The data describe a portion of the educational change potential of the schools, including improved student achievement. The variables informed by all of the data were evaluated by multivariate methods. The findings showed that beliefs about dynamic capabilities had a significant positive impact on educational performance and that educational performance had a positive impact on the final mathematical exam scores. The results also indicate that the organizational inertia of the schools had a significant negative impact on the educational performance of the schools. Conclusions were formed based on the analysis of the defining factors of the variables mentioned above and recommendations given for implementing change are proposed.

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