Preoperative retrolisthesis as a risk factor of postdecompression lumbar disc herniation

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>In this study, the authors aimed to identify specific risk factors for postdecompression lumbar disc herniation (PDLDH) in patients who have not undergone discectomy and/or fusion.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Between 2007 and 2012, 493 patients with lumbar spinal stenosis underwent bilateral partial laminectomy without discectomy and/or fusion in a single hospital. Eighteen patients (herniation group [H group]: 15 men, 3 women; mean age 65.1 years) developed acute sciatica as a result of PDLDH within 2 years after surgery. Ninety patients who did not develop postoperative acute sciatica were selected as a control group (C group: 75 men, 15 women; mean age 65.4 years). Patients in the C group were age and sex matched with those in the H group. The patients in the groups were also matched for decompression level, number of decompression levels, and surgery date. The radiographic variables measured included percentage of slippage, intervertebral angle, range of motion, lumbar lordosis, disc height, facet angle, extent of facet removal, facet degeneration, disc degeneration, and vertebral endplate degeneration. The threshold for PDLDH risk factors was evaluated using a continuous numerical variable and receiver operating characteristic curve analysis. The area under the curve was used to determine the diagnostic performance, and values greater than 0.75 were considered to represent good performance.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Multivariate analysis revealed that preoperative retrolisthesis during extension was the sole significant independent risk factor for PDLDH. The area under the curve for preoperative retrolisthesis during extension was 0.849; the cutoff value was estimated to be a retrolisthesis of 7.2% during extension.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors observed that bilateral partial laminectomy, performed along with the removal of the posterior support ligament, may not be suitable for lumbar spinal stenosis patients with preoperative retrolisthesis greater than 7.2% during extension.</jats:p></jats:sec>

The Outcome of Lumber Microdiscectomy

“…All patients with poor outcomes were re-evaluated with an MRI and eight of them underwent revision surgery. The result of the study done by Virk et al [14] is closely near to this study in which 98% of the patients had excellent and good outcome while one (2%) had just fair clinically outcome. In the assessment of patients post-operatively for improvement of signs and symptoms, back pain, sciatica and paresthesia were reported with good mean improvement (90%), (86.7%) and (87.5%), respectively.…”

Expression and Mechanism of Interleukin 1 (IL-1), Interleukin 2 (IL-2), Interleukin 8 (IL-8), BMP, Fibroblast Growth Factor 1 (FGF1), and Insulin-Like Growth Factor (IGF-1) in Lumbar Disc Herniation

“…Insulin-like growth factor 1 (IGF-1) has an important role in promoting cell proliferation and apoptosis inhibition. However, previous studies in this area have mostly focused on malignant tumors [3,6,8,10,16], and there have been few studies on lumbar disc herniation. Relevant investigations proved that activation of the IGF-1 factor can activate the PI3K/AKT signal pathway [5,7–9].…”

“…Intervertebral disc herniation is a very common disease in clinical practice [1–6]. Most of the symptoms can be relieved or cured by non-operative therapy.…”

Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis

“…They claimed that patients with motion at spondylolisthesis >1.25mm, disc height >6.5mm, and facet angle >50° were more likely to experience instability. Takenaka et al24) investigated factors related to the development of post decompression lumbar disc herniation after bilateral partial laminectomy in LSS. They revealed that preoperative retrolisthesis was the sole significant risk factor.…”