Predictors of reoperation in hispanic-americans with recurrent lumbosacral disc herniation following primary hemilaminectomy and discectomy surgery

Lastra-Power, Jorge; Nieves-Ríos, Christian; Baralt-Nazario, Francisco; Alessandra, G. Costello-Serrano; Ashlie, M. Maldonado-Pérez; Olivella, Gerardo; Pérez-Rosado, Juan; Ramírez, Norman

doi:10.1016/j.wnsx.2023.100172

Cited by 2 publications

(2 citation statements)

References 36 publications

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“…As in all observational studies, we are unable to infer causality from our findings. Between-cohort differences in unmeasured confounding variables may have influenced results, such as socioeconomic variables (e.g., unemployment [ 57 ]), patient-reported outcome measures of pain, disability or quality of life [ 31 ], length of preoperative symptoms before the primary discectomy [ 58 ], type of disc herniation (e.g., extrusion, sequestration; [ 38 ]), presence of adjacent segment degeneration [ 24 ], and lumbar spine range of motion [ 38 ], which were largely unavailable in the TriNetX dataset. It is also possible that variation in geographic region, surgeon specialty, or surgeon experience would influence the likelihood of reoperation [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a real-world study, patients in both cohorts used several types of pharmacologic and/or non-pharmacologic interventions prior to the index date of meeting our selection criteria, yet we were unable to examine their response to these forms of care. While it remains possible that the type of response to previous interventions influenced patients’ likelihood of reoperation, available evidence regarding this is limited [ 31 , 57 ]. It is possible that cohorts had differential follow-up completeness, however, our required follow-up encounter, lengthy follow-up duration, and capacity for TriNetX to link patients’ encounters across included healthcare organizations minimized this potential variation.…”

Section: Discussionmentioning

confidence: 99%

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Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

Trager,

Gliedt,

Labak

et al. 2024

BMC Musculoskelet Disord

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Background Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up. Methods We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits. Results Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35–0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6). Conclusions This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture. Registration Open Science Framework (https://osf.io/vgrwz).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

Trager,

Gliedt,

Labak

et al. 2024

BMC Musculoskelet Disord

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A Cross-Sectional Study of Dorso-Lumbar Discs Laminectomy Complications

Jasim Al-Mohammed

2024

JSRP

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Background: Epidural Fibrosis (EF) is a risk factor for Failed-Back Syndrome (FBS) and inadequate symptom alleviation following lumbar disc surgery. There is an increase in arachnoiditis and dural tears after reoperation due to the unfavourable consequences, which compromise the result and make the nerve roots vulnerable to electrical field harm. It is possible that Suction Drains (SD) used to remove collections from the surgical site significantly contribute to the prevention of EF. Aim: This research looked at the results and risks of dorso-lumbar disc laminectomy for herniated discs. Methods: One hundred patients with symptomatic unilateral or bilateral single-level (L4-5 or L5-S1) lumbar disc herniation were recruited at the Department of Neurosurgery for disc surgeries. Of these patients, 65 were males and 35 were women. Researchers used a cross-sectional design. When the SD and barrier were not implanted, the results were compared to those without. Using single-level midline surgery, which was limited to the L4, L5 or L5-S1 levels, all surgeries were performed in a prone posture. In order to expose the nerve root and dural sac, techniques such as discectomy, decompression inter-laminar laminectomy, micro-, hemi- or formal laminectomy were used. A further 24-36 hours after the procedure, the SD persisted. During the appointment, the patient had a neurological evaluation and clinical evaluation with an emphasis on the patient’s strength, reflexes, sensibility and pain levels in relation to the operated level. It also covered range of motion, discomfort in the low back and radicles, pain associated with physical activity and the results of Straight Leg Raise (SLR) tests, which included flexion (normal 60°), extension (normal 25°) and lateral flexion (normal 25°). We also measured the length of pain alleviation and the degree of the pain. As part of the follow-up after one year, an MRI was performed. Results: When comparing the groups according to neurological tests, the frequency and severity of adverse events and wound healing features, no statistically significant differences were found. Fifty patients underwent surgery at the L4-5 level and fifty more were operated on at the L5-S1 level. No new neurological impairments or problems were noted. The average amount of time spent in the hospital was five days. In comparison to the results in the beginning, more patients reported feeling better (Table 1,2). A decrease in pain alleviation of more than 50% was seen in both groups. A total of 97% of patients in the therapy group reported substantial improvement in their pain levels at the 3-month, 6-month and 1- to 3-year post-operative follow-up evaluations. All members of the study group had their values compared to their baseline levels before surgery and again after the procedure. At the one-year point, there was a tendency towards better results in the therapy group. Lots of people in the therapy group had long-term relief, along with better pain and functional status, according to the criteria that says short-term relief is less than six months and long-term relief is more than six months. Conclusion: Patients benefited greatly from suction drainage in terms of both immediate and delayed pain relief, functional improvements and SLR performance, regardless of whether it was administered alone or in combination with other therapies. Using MRI, we found that the ejection percentage was significantly lower when we used combination techniques. There was a robust clinical association between results and the degree of EF as measured by the MRI grading system. Keywords: Dorso-Lumbar Discs Laminectomy; Disc Herniation; Epidural Fibrosis; Failed-Back Syndrome; Suction Drains

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Predictors of reoperation in hispanic-americans with recurrent lumbosacral disc herniation following primary hemilaminectomy and discectomy surgery

Cited by 2 publications

References 36 publications

Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

A Cross-Sectional Study of Dorso-Lumbar Discs Laminectomy Complications

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