Clinical and radiological instability following standard fenestration discectomy

Abstract

Background:Post-surgical lumbar instability is an established complication but there is limited evidence in the literature regarding the incidence of lumbar instability following fenestration and discectomy. We analyzed our results following fenestration discectomy with a special focus on instability.Materials and Methods:Eighty-three patients between the age of 17 and 52 years who had undergone fenestration discectomy for a single-level lumbar intervertebral disc prolapse were followed-up for a period of 1–5 years. The criteria for instability included “instability catch,”, “painful catch,” and “apprehension.” The working capacity of the patient and the outcome score of the surgery were assessed by means of the Oswestry disability score and the Prolo economic and functional outcome score. Flexion-extension lateral radiographs were taken and analyzed for abnormal tilt and translation.Results:Of the 83 patients included, 70 were men and 13 were women, with an average age of 37.35 years (17–52 years) at 5 years follow-up. Clinical instability was seen in 10 (12.04%) patients. Radiological instability was noted in 29 (34.9%) patients. Only six (60%) of the 10 patients who demonstrated clinical instability had radiological evidence of instability. Twenty (68.96%) patients with radiological instability were asymptomatic. Three (10.34%) patients with only radiological instability had unsatisfactory outcome. The Oswestry scoring showed an average score of 19.8%. Mild disability was noted in 59 (71.08%) patients and moderate disability was seen in 24 (28.91%) patients. None of the patients had severe disability. These outcomes were compared with the outcomes in other studies in the literature for microdiscectomy and the results were found to be comparable.Conclusion:The favorable outcome of this study is in good agreement with other studies on microdiscectomy. Clinical instability in 12.04% of the patients is in agreement with other studies. Radiological signs of instability are seen even in asymptomatic patients and so are not as reliable as clinical signs of instability. Standard fenestration discectomy does not destabilize the spine more than microdiscectomy.

Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up

“…10 In 10%-20% of cases, iatrogenic lumbar instability may occur after open and microscopic fenestrated discectomy, leading to failed back surgery syndrome or reoperation. [11][12][13] With improvements in instrumentation and advances in minimally invasive surgical techniques, percutaneous endoscopic lumbar discectomy (PELD) has become a popular approach that has several advantages over conventional discectomy including less paravertebral muscle injury, lower risk of iatrogenic instability, and rapid recovery. [14][15][16][17] Meanwhile, percutaneous endoscopic transforaminal lumbar discectomy (PETLD) and percutaneous endoscopic interlaminar lumbar discectomy are alternatives to microscopic discectomy for the treatment of various types of LDH, including severe and extremely difficult cases.…”

Influence of Microsurgical Decompression on Segmental Stability of the Lumbar Spine – One-Year Results in a Prospective, Consecutive Case Series Using Upright, Kinetic-Positional MRI

“…One focus of our work was analysis of the intersegmental motion of the 27 microsurgically decompressed levels. Upright, kinetic-positional MRI was used as diagnostic tool that is in contrast to similar studies in which conventional x-rays in neutral position or in exion-extension had been performed [5][6][7]9]. Only few publications exist dealing with analysis of movement of the spine by upright-MRI [20][21][22].…”

“…Only few studies investigated the correlation between patients' clinical situation and radiological ndings with special interest of instability criteria after decompression. Some authors did not nd any in uence of the extent of the removed spinal structures on segmental stability or on clinical results [5][6][7]. In contrast, in other publications a positive coherency between signs of intervertebral instability and poor clinical outcome was described [8,9].…”

Evaluation of the effectiveness of surgical methods for the treatment of recurrent lumbar disc herniation: a cohort retrospective study

“…2) в настоящее время не существует общепринятых критериев нестабильности в присутствии симптоматической рецидивной грыжи диска, а также отсутствует четкая корреляция между клиническими признаками сегментарной нестабильности и изменениями, выявленными при функциональной рентгенографии [20,21];…”