Long-Term Outcomes of Surgical and Nonsurgical Management of Sciatica Secondary to a Lumbar Disc Herniation: 10 Year Results from the Maine Lumbar Spine Study

Atlas, Steven J.; Keller, Robert B.; Wu, Yen A.; Deyo, Richard A.; Singer, Daniel E.

doi:10.1097/01.brs.0000158954.68522.2a

Cited by 490 publications

(385 citation statements)

References 33 publications

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“…[1][2][3] Specific clinical outcome of spine surgery with fusion for degenerative lumbar spine conditions in 208 patients showed 62.5% satisfied, 19.7% partially satisfied, and 17.8% of patients dissatisfied. 4 Postsurgical continued pain (PSCP) sends patients to the offices of physicians, surgeons, and pain specialists alike in overwhelming numbers.…”

Section: Introductionmentioning

confidence: 99%

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

Gudavalli

Olding²,

Joachim

et al. 2016

Journal of Chiropractic Medicine

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Purpose: The purpose of this case series is to report on changes in pain levels experienced by 69 postsurgical continued pain patients who received Cox Technic Flexion Distraction (CTFD). Methods: Fifteen doctors of chiropractic collected retrospective data from the records of the postsurgical continued pain patients seen in their clinic from February to July 2012 who were treated with CTFD, which is a type of chiropractic distraction spinal manipulation. Informed consent was obtained from all patients who met the inclusion criteria for this study. Data recorded included subjective patient pain levels at the end of the treatments provided and at 24 months following the last treatment. Results: Fifty-four (81%) of the patients showed greater than 50% reduction in pain levels at the end of the last treatment, and 13 (19%) showed less than 50% improvement of pain levels at the end of active care (mean, 49 days and 11 treatments). At 24-month follow-up, of 56 patients available, 44 (78.6%) had continued pain relief of greater than 50% and 10 (18%) reported 50% or less relief. The mean percentage of relief at the end of active care was 71.6 (SD, 23.2) and at 24 months was 70 (SD, 25). At 24 months after active care, 24 patients (43%) had not sought further care, and 32 required further treatment consisting of chiropractic manipulation for 17 (53%), physical therapy, exercise, injections, and medication for 9 (28%), and further surgery for 5 (16%). Conclusion: Greater than 50% pain relief following CTFD chiropractic distraction spinal manipulation was seen in 81% of postsurgical patients receiving a mean of 11 visits over a 49-day period of active care.

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Section: Introductionmentioning

confidence: 99%

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

Gudavalli

Olding²,

Joachim

et al. 2016

Journal of Chiropractic Medicine

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“…Since it was first described in 1933 [7], lumbar discectomy has become a widely accepted intervention for radiculopathy caused by acute herniation of the lumbar intervertebral disc [2,7,12,15,18]. Although over time numerous technical iterations have been introduced, including microscope-assisted discectomy, use of minimally invasive tubular retractors, and endoscopic techniques, the underlying principle of the procedure remains unchanged from that proposed by Mixter and Barr [7]: removal of compressive and irritant disc material from the vicinity of the affected nerve root [15].…”

Section: Introductionmentioning

confidence: 99%

“…Although over time numerous technical iterations have been introduced, including microscope-assisted discectomy, use of minimally invasive tubular retractors, and endoscopic techniques, the underlying principle of the procedure remains unchanged from that proposed by Mixter and Barr [7]: removal of compressive and irritant disc material from the vicinity of the affected nerve root [15]. The advantages of surgical intervention in this setting, and its effectiveness as compared with nonoperative management, have been highlighted in several high-quality publications, including the prospective Maine Lumbar Spine Study [2] and the Spine Patient Outcomes Research Trial (SPORT) [18].…”

Section: Introductionmentioning

confidence: 99%

Does Surgical Timing Influence Functional Recovery After Lumbar Discectomy? A Systematic Review

Schoenfeld

Bono

2015

Clinical Orthopaedics &Amp; Related Research

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Background The impact of the duration of preoperative symptoms on outcomes after lumbar discectomy has not been sufficiently answered in a single study but is a potentially important clinical variable. Questions/purposes A systematic review was performed to answer two questions: (1) Does symptomatic duration before surgery influence functional recovery after lumbar discectomy? (2) What is the time point for intervention beyond which the extent of postoperative recovery might be compromised? Methods The systematic review began with a query of PubMed using a structured algorithm comprised of medical subject heading terms. This was supplemented by a keyword search in PubMed along with queries of Embase, Scopus, and Web of Science and searches of reference lists as well as the tables of contents of relevant journals. Eligible studies were those that evaluated aspects of recovery after elective discectomy and stratified duration of symptoms before surgery. Included papers were abstracted by two authors and determinations regarding the period of symptom duration and its impact on outcome were recorded. Eleven studies met all inclusion criteria. No prospectively randomized trials addressed our study questions.

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“…However, in the long-term, major problems develop due to painful disc degeneration of the treated segment as well as re-herniation [24]. Thus, as a possible strategy against developing disc degeneration, the administration of UVL HA hydrogel matrix during primary surgery was analyzed in an established porcine nucleotomy model with aged discs and biomechanical properties close to the human situation [20].…”

Section: Discussionmentioning

confidence: 99%

Injection of a polymerized hyaluronic acid/collagen hydrogel matrix in an in vivo porcine disc degeneration model

et al. 2012

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Introduction Disc degeneration and re-herniation after nucleotomy procedures are common problems. Simultaneous application of hyaluronic acid (HA)-based matrix has been proposed to limit disc degeneration. This, however, is hampered by loss of the substituted matrix out of the disc. Hence, in situ polymerization of the injected matrix with ultraviolet light (UVL) directly used after injection may be useful. Therefore, this study evaluates a new HA/collagen hydrogel matrix with in situ polymerization after implantation in an established porcine nucleotomy model. Materials and methods 12 mature minipigs were used. A total of 60 lumbar discs were analyzed. 36 discs underwent partial nucleotomy with a 16G biopsy needle. Of those, 24 discs received matrix (porcine nucleus pulposus collagenous scaffold component and chemically modified HA) which was in situ polymerized using UVL immediately after transplantation. 12 nucleotomized discs and 24 non-nucleotomized discs served as controls. After 24 weeks, animals were killed. X-rays, MRIs, histology, and gene expression analysis were done. Results Disc height was reduced equally after sole nucleotomy and nucleotomy with HA treatment and in MRIs signal intensity decreased. For both nucleotomy groups, the nucleus histo-degeneration score showed a significant increase compared to controls. In histology, HA treatment resulted in more scarring and inflammation in the annulus. Gene expression of catabolic MMPs was up-regulated, whereas IFN-gamma, IL-6, and IL-1b were unchanged. Conclusion Although nucleotomy and administration of the implant material did not cause generalized inflammation of the disc, localized annular damage with annulus inflammation and scarring resulted in detrimental degenerative disc changes. As a result, therapeutic strategies should strongly focus on the prevention of annular damage or techniques for annular repair to remain disc integrity.

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Long-Term Outcomes of Surgical and Nonsurgical Management of Sciatica Secondary to a Lumbar Disc Herniation: 10 Year Results from the Maine Lumbar Spine Study

Cited by 490 publications

References 33 publications

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series

Does Surgical Timing Influence Functional Recovery After Lumbar Discectomy? A Systematic Review

Injection of a polymerized hyaluronic acid/collagen hydrogel matrix in an in vivo porcine disc degeneration model

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