Microsurgical Treatment of Lumbar Disc Herniation: A Retrospective Review of 282 Cases

Abstract

Objective: Lumbar disc herniation is an important disease that causes symptoms of back pain, leg pain, and imbalances in muscle strength in patients, causing socio-economic problems due to loss of workforce in the society. In this study, which was conducted from April 2015 to April 2017, we retrospectively evaluated the patients with lumbar disc herniation, who underwent microsurgery. Materials and Methods: Microsurgery with maximum resection principle was performed on 282 patients. Of these patients, 125 were men and 157 were women. The mean age of the patients was 44 (19-80) years. Operations were planned by using lumbar X-ray and lumbar magnetic resonance imaging techniques. Computed tomography of the lumbar spine and electromyography were used to support the diagnoses when necessary. A retrospective evaluation of the patients was performed considering their gender, age, physical examination and radiological findings, disc distances, preoperative and postoperative findings, complications, recurrences, and patient satisfaction. Results: Of the included patients, 125 were men (44.33%) and 157 were women (55.67%). The mean age was 44 (19-80) years. Among the study patients, pathological findings were found at the intervertebral disc between the L1 and L2 levels in three (1.06%) patients, the L2 and L3 levels in eight (2.84%) patients, the L3 and L4 levels in 32 (11.35%) patients, the L4 and L5 levels in 103 (36.52%) patients, and the L5 and S1 levels in 61 (21.63%) patients. Pathological findings were present in two levels in 61 (21.63%) patients, in three levels in 13 (4.61%) patients, and in four levels in one (0.35%) patient. The dural injury was identified in nine (3.19%) patients, subcutaneous cerebrospinal fluid collection was present in one (0.35%) patient, and a mislabeled laminotomy was found in one (0.35%) patient. Spondylodiscitis developed in one (0.35%) patient, superficial skin infections developed in two (0.71%) patients, and postoperative spondylolisthesis occurred in one (0.35%) patient to whom stabilization was applied. Recurrences developed in eight (2.84%) patients and these patients underwent repeat surgery. According to the Prolo follow-up scale, the results of the surgery were excellent in 137 (48.58%) patients, good in 124 (43.97%) patients, moderate in 20 (7.09%) patients, and poor in one (0.35%) patient. Conclusion:Our study results demonstrate that the microsurgical technique and maximal disc resection in selected cases of surgery are effective and reliable methods in the surgical treatment of lumbar disc herniation.

Transpedicular Fixation for the Alleviation of Neurogenic Claudication and Backache in the Management of Spondylolisthesis

“…18 Transpedicular fixation has been found to have a better segmental stabilization effect than laminar hook-rod or wire-rod techniques and leads to the improvisation in symptoms of backache and neurogenic claudication. 19 This study was carried out to find out the effects of transpedicular fixation in the alleviation of symptoms like neurogenic claudication and back pain in patients with spondylolisthesis.…”