Evaluation of Treatment of Recurrent Lumbar Disc Prolapse: Fusion Versus Non Fusion

Khayat, Roshdy; Khallaf, Mohamed; Hassan, Hassan M.A.; Gamal, Mahmoud

doi:10.24087/iam.2017.1.9.273

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Almost similar to the findings observed by the various investigators from different countries [23,24]. Majority of the study subjects 15 (68.2%) were male and only 7(31.8%) were female which was similar to the JMRHS 6 (11), 2846-2853 (2023) findings of Khayat et al [24]; Mashhadinezhad et al [25]. To the best of our knowledge, no published study has investigated whether the ODI and the LBOS reflects true patient satisfaction after discectomy.…”

Section: Discussionsupporting

confidence: 89%

Low-Back Outcome Scale and the Oswestry Disability Index They Reflective of Patient Satisfaction

Hossain

2023

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Background: Low back pain is the most common type of pain. The causes of many painful conditions of the low back remain obscure. Low back pain bothers not only patients but also the experts about its multidisciplinary approaches. The typical background of a low back incidence is a faulty postural pattern. A mechanical or functional strain causing muscular misbalance in one part of the body may soon result in compensatory changes in other parts. The Low-Back Outcome Scale (LBOS) of Greenough and Fraser and the Oswestry disability index (ODI) were compared to the patient satisfaction index (PSI) in lumbar disc herniation (LDH) surgery. Methods: This prospective interventional study was conducted in department of Orthopaedic Surgery, BSMMU, Dhaka from October 2017 to September 2019. A total of 22 patients who underwent discectomy were followed through assessment of preand post-surgical satisfaction by the PSI, the LBOS, and the ODI. The LBOS were rated as satisfied if the outcomes were excellent or good and as dissatisfied if fair and poor. Considering the ODI, clinically satisfied was defined as a 13-point improvement from the baseline ODI scores. Phi (Φ) correlation analysis was used to study the correlation among the PSI, the LBOS and the ODI scores as proxy for patients' satisfaction. Results: In this study, out of 22 patients 8 (36.4%) were 35-45 years of age, 8 (36.4%) were 46-55years, 4 (18.2%) were 56-65 years and 2 (9.1%) were 66-70 years old. The mean (± SD) age of the patients was 51.1±9.7 years and the youngest and the oldest patients were 35 and 70 years respectively. Among 22 subjects, majority of the study subjects 15 (68.2%) were male and only 7 (31.8%) were female. Significant improvement from the pre-to postoperative ODI scores was observed. Post-surgical satisfaction based on the PSI, the ODI, and the LBOS were 72.7%, 68.1%, and 81.1%, respectively. Regarding patient satisfaction, there were weak associations between LBOS

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Section: Discussionsupporting

confidence: 89%

Low-Back Outcome Scale and the Oswestry Disability Index They Reflective of Patient Satisfaction

Hossain

2023

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“…On the other hand, significant blood transfusion was required (44% cases) for the fusion group. There was a statistically significant difference between the two groups with regard to the intraoperative blood loss, operation time, length of postoperative hospital stays, and total cost of the procedure which were significantly less in in Group A than in Group B [ Table 5 ] which were almost similar to other studies[ 1 6 15 21 27 28 ]…”

Section: Discussionsupporting

confidence: 81%

“…[ 5 ] The symptoms and signs of patients with RLDH were not different from those with primary disc prolapse and the typical sciatic pain was often the predominant complaint of the patients. [ 6 ] The incidence of RLDH is reported in the range of 0.5%–25% of patients. [ 7 8 ] Options of surgical treatment of a symptomatic RLDH include simple conventional revision discectomy or discectomy with instrumented fusion.…”

Section: Introductionmentioning

confidence: 99%

Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Ahsan

Khan

Zaman³

et al. 2021

Journal of Craniovertebral Junction and Spine

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Background: Recurrent lumbar disc herniation (RLDH) is one of the major causes for failure of primary surgery. The optimal surgical treatment of RLDH remains controversial. Aim: Retrospectively, we evaluate 135 patients and compare the clinical outcomes between fusion and nonfusion treatment of RLDH. Methods: Records of 75 men and 35 women aged 28–60 years for conventional revision discectomy alone (nonfusion) and 15 men and 10 women aged 30–65 years for revision discectomy with transforaminal lumbar interbody fusion (TLIF) and transpedicular screw fixation (fusion) were reviewed. Demographics, surgical data, and complications were collected and pre- and postoperative assessment were done by the Visual Analogue Scale (VAS) scale and Japanese Orthopaedic Association (JOA) score. The results after surgery were assessed according to the recovery rate as excellent, good, fair, and poor. Results: The mean follow-up period was 28.8 and 24.6 months in Group A (nonfusion) and Group B (fusion group), respectively. The preoperative data between both the groups showed no statistically significant difference. The postoperative mean VAS and JAO scores, recovery rate, and satisfaction rate showed no statistically significant difference except postoperative low back pain and occasional radicular pain and neurological deficit in nonfusion group which was significantly higher than that of fusion group. In comparison to fusion group, nonfusion group required significantly less operative time, less intraoperative blood loss, less postoperative hospital stay, no blood transfusion, and less total cost of the procedure. Satisfaction rate was 80% and 88% in nonfusion and fusion groups, respectively. Conclusions: Both convention revision discectomy (nonfusion) and discectomy with instrumented fusion (TLIF) surgery are effective in patients with RLDH.

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“…Awad and Faisel [23] compared conventional redo-discectomy to TLIF with unilateral pedicle screw fusion as surgical procedure for RDH and observed that the conventional re-discectomy group had less intraoperative blood loss and shorter operative time and hospital stay. Similarly, Khayat et al [24] who assessed fusion versus nonfusion to identify the ideal treatment method for RDH reported comparable findings. Furthermore, a systematic review and meta-analysis in 2019 comparing outcomes of fusion versus repeat discectomy in RDH reported that operative time and postoperative hospital stay were significantly lower in the re-discectomy group [25].…”

Section: Discussionmentioning

confidence: 86%

“…However, Khayat et al [24] reported that revision discectomy with fusion showed slightly higher incidence of dural tears without statistical significance, but a significantly greater need for blood transfusions compared to redo-discectomy alone group. On the other hand, Arif et al [22] reported that redo-discectomy alone led to a lower complication rate (3.2% lower, p>0.05) than redodiscectomy with fusion group.…”

Section: Discussionmentioning

confidence: 98%

Recurrent Lumbar Disc Herniation: Does Transforaminal Lumbar Interbody Fusion Lead to Better Clinical and Radiological Outcomes than Redo-Discectomy?

Mosaad,

Khozamy,

Barakat

et al. 2023

Asian Spine J

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Study Design: randomized, prospective, and level I clinical study.Purpose: To compare the clinical outcomes and radiological findings of revision discectomy alone versus revision discectomy with fusion as surgical treatment for recurrent lumbar disc herniation (RDH).Overview of Literature: RDH is a common complication following a primary discectomy. The optimal surgical procedure for RDH is still debated.Methods: Sixty patients with RDH were randomly divided into two equal groups: the first group underwent revision discectomy alone and the second underwent revision discectomy with fusion. The primary outcomes evaluated were Visual Analog Scale (VAS) for low back and limb pains, Oswestry Disability Index (ODI), disc height indexes, foraminal height index, and disc height subsidence. Secondary outcomes included operative time, blood loss, postoperative hospital stay, and complications.Results: Revision discectomy with fusion showed superior pain relief and improved functional outcomes, including better VAS scores for both back and leg pain and ODI at 24-month follow-up. Additionally, it restored the stability of the spine better with lower disc height subsidence without significant complications. However, these advantages came at the cost of increased blood loss and longer operative time and hospital stays.Conclusions: Revision discectomy with fusion is recommended for RDH; however, the choice of the procedure should be made caseby- case basis, considering many factors related to the patient and surgical facilities.

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Evaluation of Treatment of Recurrent Lumbar Disc Prolapse: Fusion Versus Non Fusion

Cited by 3 publications

References 12 publications

Low-Back Outcome Scale and the Oswestry Disability Index They Reflective of Patient Satisfaction

Low-Back Outcome Scale and the Oswestry Disability Index They Reflective of Patient Satisfaction

Fusion versus nonfusion treatment for recurrent lumbar disc herniation

Recurrent Lumbar Disc Herniation: Does Transforaminal Lumbar Interbody Fusion Lead to Better Clinical and Radiological Outcomes than Redo-Discectomy?

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