Differences in the surgical treatment of recurrent lumbar disc herniation among spine surgeons in the United States

Therapeutic effect of percutaneous endoscopic lumbar discectomy on lumbar disc herniation and its effect on oxidative stress in patients with lumbar disc herniation

“…Compared with preoperative levels, ODI and VAS scores of the two groups were significantly decreased, but the decreases in observation group was lower than those in control group. This finding is consistent with the results of Mroz et al (11), indicating that treatment of lumbar disc herniation with percutaneous endoscopic lumbar discectomy can avoid large surgical trauma, reduce blood loss, promote postoperative recovery, shorten hospitalization and reduce economic burden of patients' families. The possible explanations may be that the working channel in percutaneous endoscopic lumbar discectomy can be used to directly access the prominent disc to remove the nucleus pulposus, so as to directly cut the prominent part.…”

Differences in the Surgical Treatment of Lower Back Pain Among Spine Surgeons in the United States

“…Details of this national survey have been previously published. 4 Briefly, those surveyed were asked to provide details regarding the geographical location of their practice (based on regions), their specialty, fellowship training, type of practice (private, academic, hybrid), practice volume, years in practice, use of discograms, and whether or not the surgeon typically surgically treats back pain due to degenerative disc disease. The demographics queried were determined collectively by the authors based on their experience as well as the published evidence.…”

“…The differences in treatment decisions for disc herniation in the previous study, however, stemmed from differences in duration in practice and annual case volume. 4 In contrast, the differences seen in the treatment of LBP were based on practice type (private vs. academic), specialty, and fellowship training.…”

“…The variability in approaches and indications for surgery is likely related to the limited available scientific evidence, financial incentives, different specialty and training backgrounds, and different practice cultures based on geographical region and practice setting (e.g., academic vs. private practices). [1][2][3][4] In the current era of value-based health care, there is increased scrutiny regarding surgical decision making and resource utilization, particularly with regard to cost-effective treatments. However, with little high-level evidence and substantial heterogeneity in indications and treatment of axial LBP, it is difficult to determine the optimal treatment paradigm.…”

Recurrent disc herniation: Etiology, evaluation, treatment, outcomes, and prevention (annular repair)

“…Mroz et al 34 recently surveyed 2460 orthopedic and neurosurgical spine surgeons regarding their choice of surgery for recurrent disc herniation presenting after one or two microdiscectomies. Surgical options presented were, "… revision microdiscectomy, revision microdiscectomy with in situ fusion, revision microdiscectomy with posterolateral fusion using pedicle screws, revision microdiscectomy with posterior lumbar interbody fusion/transforaminal lumbar interbody fusion (PLIF/TLIF), anterior lumbar interbody fusion (ALIF) with percutaneous screws, ALIF with open posterior instrumentation, or none of these."…”