Appropriateness of Indications for Surgery of Lumbar Disc Hernia and Spinal Stenosis

Larequi‐Lauber, Tania; Vader, John‐Paul; Burnand, Bernard; Brook, Robert H.; Kosecoff, Jacqueline; Sloutskis, D; Fankhauser, Heinz; Berney, J; Tribolet, N. de; Paccaud, Fred

doi:10.1097/00007632-199701150-00015

Cited by 52 publications

(18 citation statements)

References 35 publications

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“…Regarding lumbar fusion procedures, several studies report on notable regional differences in the number of patients operated, depending on surgeons' beliefs or on other subjective factors, such as organization and financing of health services [18,47], rather than on clinical or demographic criteria. Several studies emphasize the importance of an adequate selection of patients to undergo surgical lumbar interventions [11,12,14,39]. Thus far, there has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications.…”

Section: Discussionmentioning

confidence: 99%

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Soriano

Revuelta²,

Fabregate

et al. 2010

Eur Spine J

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There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of ''disc herniation'', less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.

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Section: Discussionmentioning

confidence: 99%

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Soriano

Revuelta²,

Fabregate

et al. 2010

Eur Spine J

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“…Although surgery is very effective in selected patients [1,27], symptoms may improve without it [4,23] and surgery still fails to relieve symptoms in others [7,9]. One reason for this could be inappropriate patient selection [16]. The potential morbidity and costs [7] of both conservative and surgical management make the clarification of management in these patients essential.…”

Section: Introductionmentioning

confidence: 99%

Self reported health status and magnetic resonance imaging findings in patients with low back pain

Hollingworth

Dixon

Todd

et al. 1998

European Spine Journal

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The authors present a prospective study of quality of life and MRI findings in patients with low back pain (LBP). Disc herniation and nerve root compression contribute to LBP and poor quality of life. However, significant proportions of asymptomatic subjects have disc herniation and neural compromise. Little is known about the influence of disc abnormalities and neural compression on quality of life in symptomatic patients. The purpose of this study was to assess the relationship between the extent of disc abnormality, neural impingement and quality of life. A total of 317 consecutive patients with LBP referred for MRI completed an SF-36 health status questionnaire immediately before imaging and again 6 months later. Patients were grouped according to the most extensive disc abnormality and any neural compromise reported at MRI. The relationship between symptoms, radiological signs and SF-36 scores was assessed. Eighty percent (255/317) and 65% (205/317) of patients completed the initial and 6-month SF-36, respectively. Thirty-six percent of patients (115/317) had one or more herniated discs and 44% (140/317) had neural impingement. There was little relationship between the extent of disc abnormality and quality of life. Patients with radiological evidence of neural impingement reported better general health (P < 0.01). SF-36 scores improved at 6 months in four dimensions, but general health deteriorated (P < 0.01). Patients with neural impingement had improved pain scores at 6 months (P < 0.05). The study results showed that the pain and dysfunction caused by disc herniation and neural compromise are not sufficiently distinct from other causes of back pain to be distinguished by the SF-36. Whilst neural compromise may be the best radiological feature distinguishing patients who may benefit from intervention, it cannot predict quality of life deficits in the diffuse group of patients with LBP.

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“…It must be carried through the complete neurological examination with attention to the force and reflex. Another important data is to observe the behavior of the patient during all the maneuvers and if the complaints agree with the findings of the exam 14 .…”

Section: Discussionmentioning

confidence: 97%

Failed back surgery syndrome: casuistic and etiology

Rodrigues

Dozza

Oliveira

et al. 2006

Arq. Neuro-Psiquiatr.

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OBJECTIVE: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD: The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS: From the 121 patients submitted to spine surgical intervention, 47 (38.8%) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7%) had presented FBSS; of the 83 with disc herniation, 31 (37.3%) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3%) had failure of the back surgery. CONCLUSION: The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.

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Appropriateness of Indications for Surgery of Lumbar Disc Hernia and Spinal Stenosis

Cited by 52 publications

References 35 publications

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Self reported health status and magnetic resonance imaging findings in patients with low back pain

Failed back surgery syndrome: casuistic and etiology

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