Recurrence Rate of Lumbar Disc Herniation After Open Discectomy in Active Young Men

Kim, Min Seok; Park, Kunwoo; Hwang, Changju; Lee, Youngkyun; Koo, Ki Hyoung; Chang, Bong‐Soon; Lee, Choon-Ki; Lee, Dong‐Ho

doi:10.1097/brs.0b013e31818f9116

Cited by 63 publications

(52 citation statements)

References 31 publications

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“…Varying results of reoperative microdiscectomy have been reported, 6,11,23,25,26,28,29 and, overall, there is a 25.1% cumulative risk of further spinal surgery in the first 10 years after surgery. 22 The prognosis of repeated back surgery is considered poor in terms of pain-free recovery and return to work.…”

Section: Discussionmentioning

confidence: 99%

Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain

Lequin¹,

Verbaan²,

Bouma³

2014

SPI

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Object. Patients with recurrent sciatica due to repeated reherniation of the intervertebral disc carry a poor prognosis for recovery and create a large burden on society. There is no consensus about the best treatment for this patient group. The goal of this study was to evaluate the 12-month results of the placement of stand-alone Trabecular Metal cages in these patients.Methods. The authors performed a retrospective analysis of 26 patients with recurrent disc herniations treated with stand-alone posterior lumbar interbody fusion (PLIF) with Trabecular Metal cages. At 1 year patients were evaluated using the Roland Morris Disability Questionnaire (RMDQ) and a visual analog scale (VAS) for back and leg pain. Furthermore, Likert scores of perceived recovery and satisfaction with the treatment were recorded. Lumbar spine radiographs after 1 year were compared with postoperative radiographs to measure subsidence. Stability of the operated segment was assessed using dynamic radiography.Results. The patient group consisted of 26 patients (62% male) with a mean age of 45.7 ± 11.4 years (± SD). Patients had a history of 1 (31%), 2 (42%), or more (27%) discectomies at the same level. The mean follow-up period was 15.3 ± 7.3 months. At follow-up the mean VAS score for pain in the affected leg was 36.7 ± 27.9. The mean VAS score for back pain was 42.5 ± 30.2. The mean RMDQ score at follow-up was 9.8 ± 6.2. Twelve (46%) of the 26 patients had a global perceived good recovery. With respect to treatment satisfaction, 18 patients (69%) were content or very content with the operation and would recommend it. Disc height was increased immediately postoperatively, and at the 1-year follow-up it was still significantly higher compared with the preoperative height (mean 41% ± 38.7%, range -25.7 to 126.8, paired t-test, both p < 0.001), although a mean of 7.52% ± 11.6% subsidence occurred (median 2.0% [interquartile range 0.0%-10.9%], p < 0.003). No significant correlation between subsidence and postoperative back pain was found (Spearman's rho -0.2, p = 0.459). Flexion-extension radiographs showed instability in 1 patient.Conclusions. Although only 46% of patients reported a good recovery with significant reductions in back and leg pain, 85% of patients reported at least some benefit from the operation, and a marked improvement in working status at follow-up was noted. In view of previously published poor results of instrumented lumbar fusion for patients with failed back surgery syndrome, the present data indicate that Trabecular Metal interbody fusion cages can be used in a stand-alone fashion and should not always need supplemental posterior fixation in patients with recurrent disc herniation without spinal instability, although a long-term follow-up study is warranted.

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Section: Discussionmentioning

confidence: 99%

Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain

Lequin¹,

Verbaan²,

Bouma³

2014

SPI

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“…However, the use of simple percentages without considering the effect of the time course or the follow-up losses has a potential drawback that cannot reflect a true reoperation rate. On the contrary, survivorship analysis is considered to be a more appropriate method to provide accurate assessment of the true reoperation rate [6,14]. We therefore performed the current study to determine the survivorship of the DIAM TM implantation for primary lumbar spinal stenosis and disc herniation as well as risk factors for reoperation.…”

Section: Introductionmentioning

confidence: 99%

Survivorship analysis of 150 consecutive patients with DIAM™ implantation for surgery of lumbar spinal stenosis and disc herniation

2010

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Recently, the Device for Intervertebral Assisted Motion (DIAM TM ) has been introduced for surgery of degenerative lumbar disc diseases. The authors performed the current study to determine the survivorship of DIAM TM implantation for degenerative lumbar disc diseases and risk factors for reoperation. One hundred and fifty consecutive patients underwent laminectomy or discectomy with DIAM TM implantation for primary lumbar spinal stenosis or disc herniation. The characteristics of the 150 patients included the following: 84 males and 66 females; mean age at the time of surgery, 46.5 years; median value of followup, 23 months (range 1-48 months); 96 spinal stenosis and 54 disc herniations; and 146 one-level (115, L4-5; 31, L5-6) and 4 two-level (L4-5 and L5-6). In the current study, due to lumbosacral transitional vertebra (LSTV) L6 meant lumbarization of S1 and this had a prominent spinous process so that the DIAM TM was implanted at L5-6. Reoperations due to any reasons of the DIAM TM implantation level or adjacent levels were defined as a failure and used as the end point for determining survivorship. The cumulative reoperation rate and survival time were determined via Kaplan-Meier analysis. The log-rank test and Cox regression model were used to evaluate the effect of age, gender, diagnosis, location, and level of DIAM TM implantation on the reoperation rate. During a 4-year follow-up, seven patients (two males and five female) underwent reoperation at the DIAM TM implantation level, giving a reoperation rate of 4.7%. However, no patients underwent reoperation for adjacent level complications. The causes of reoperation were recurrent spinal stenosis (n = 3), recurrent disc herniation (n = 2), post-laminectomy spondylolisthesis (n = 1), and delayed deep wound infection (n = 1). The mean time between primary operation and reoperation was 13.4 months (range 2-29 months). Kaplan-Meier analysis predicted an 8% cumulative reoperation rate 4 years post-operatively. Survival time was predicted to be 45.6 ± 0.9 months (mean ± standard deviation). Based on the log-rank test, the reoperation rate was higher at L5-6 (p = 0.002) and two-level (p = 0.01) DIAM TM implantation compared with L4-5 and one-level DIAM TM implantation. However, gender (p = 0.16), age (p = 0.41), and diagnosis (p = 0.67) did not significantly affect the reoperation rate of DIAM TM implantation. Based on a Cox regression model, L5-6 [hazard ratio (HR), 10.3; 95% CI, 1.7-63.0; p = 0.01] and two-level (HR, 10.4; 95% CI, 1.2-90.2; p = 0.04) DIAM TM implantation were also significant variables associated with a higher reoperation rate. Survival time was significantly lower in L5-6 (47 vs. 22 months, p = 0.002) and two-level DIAM TM implantation (46 vs. 18 months, p = 0.01) compared with L4-5 and one-level DIAM TM implantation. The current results suggest that 8% of the patients who have a DIAM TM implantation for primary lumbar spinal stenosis or disc herniation are expected to undergo reoperation at the same level within 4 years after surger...

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“…Ka lev ski Sve to slav, 1 Ha ri to nov Di mi ter, 1 Pe ev Ni ko lay, 1 Ka lev ska Ev ge nia Ci lje vi: Svr ha ove re tro spek tiv ne stu di je je da skre ne pa `nju na simp to mat ski lum bal ni bol kod adole scent nih pa ci je na ta, u ci lju pod sti ca nja ra ni je di jagno ze i hi rur {kog le ~e nja. Stu di ja je oce ni la ra di o lo {ke, kli ni~ ke i hi rur {ke is ho de kod 13 ova kvih pa ci je na ta.…”

Section: Sa `E Takunclassified

“…De ge n e r a ti ve chan ges in the in ter ver te bral disc be gin at the la te te ens, af ter the com ple tion of the physi cal growth and de ve l op ment, du r ing which po s te ri or her ni a tion of the nu c le us pul po sus can ca u se sci a t i ca be ca u se of ner ve ro ot com pres sion (1). Symp to m a tic low back pain and mo no ra di cu lar leg pain are ra re in pa ti ents un der age of 20 years (2,3,4).…”

Section: Introductionmentioning

confidence: 99%

Surgical management of symptomatic low back pain and monoradicular leg pain in adolescent and young adult patients

Kalevski¹,

Haritonov²,

Peev³

et al. 2014

SANAMED

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Ab stract: Ob jec ti ves:The pur po se of the pre s ent re t ro spec ti ve study is to draw at ten tion to symp to m a tic low back pain in ad o le s cent pa ti ents, in or der to en co ur a ge ear li er di ag no sis and sur gi cal tre at ment. The study as ses sed the ra di o lo g i cal, cli n i cal fe a tu res and sur gi cal out co mes of 13of this kind of pa ti ent. Ma te ri als and Met h ods:Out of a se ri es of 983 con se c u ti ve ca ses (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) of lum bar disc ex ci sions from our ne u ro sur gi cal in sti tu tion, 13-1,32% of the pa ti ents we re be t we en the ages of 15 and 20 mean 17,84. Fif teen op e r a ti ons, in clu d ing two re o pe ra ti ons, we re per for med on this pa ti ent gro up, by a con ven ti onal mic ro sur gi cal pro ce du re. The in di ca ti ons for surgery we re fa i l u re of con ser va ti ve tre at ment, in trac ta ble pain and/or pro gres si ve ne u ro lo g i cal im pa ir ment.Re sults: Low back pain and mo no ra di cu lar sci a t ica we re the main com pla ints in 77%, but fin d ings of ne u ro lo g i cal de f i cits we re ra re -1 ca se. The sur gi cal fin d ings re ve a led a pro tru d ing disc in ele ven ca ses, one la t e ral re cess ste no sis and one lum bar syno vial cyst. Ini ti ally, all pa ti ents we re tre a ted con ser va ti vely by the ir phy si ci ans mo re than 3 months wit h o ut suc cess. On the day of dis char ge, Kir kaldy-Wil lis cri te ria results we re ex cel lent or good in 92% of pa ti ents. The fol low-up pe riod ran ged from 6 months to 2 years with an av e r a ge of 1 year and 2 months. The re sults we re excel lent in 10 pa ti ents and good in 3 pa ti ents.Di s cus sion: We de m on stra te that the ca u se of low back pain and mo no ra di cu lar leg pain in ad o le s cent pati ents may not only be a ca u se of her ni a ted lum bar disc or la t e ral re cess nar ro w ing. Very ra rely the se symptoms may be ca u sed by lum bar syno vial cysts.Con clu sion: Sur gi cal tre at ment of ad o le s cent pati ents is able to re li e ve the cli n i cal symp toms qu ickly.Cli n i cal symp toms such as low back pain and leg pain and the ne u ro lo gic de f i cit di s ap pe ar wit hin 3 months af ter sur gery.Key words: ad o le s cent, disk, her ni a tion, sur gery, tre at ment. IN TRO DUC TIONDe ge n e r a ti ve chan ges in the in ter ver te bral disc be gin at the la te te ens, af ter the com ple tion of the physi cal growth and de ve l op ment, du r ing which po s te ri or her ni a tion of the nu c le us pul po sus can ca u se sci a t i ca be ca u se of ner ve ro ot com pres sion (1). Symp to m a tic low back pain and mo no ra di cu lar leg pain are ra re in pa ti ents un der age of 20 years (2,3,4). The re are a num ber of dif fe r en tial di ag no ses to be con si d e red in pa ti ents with the men ti o ned com pla ints (5). Most of ten they are due to lum bar disc her ni a tion (LDH). An ot her ca u se of ra di cu lo pathy in ad o le s cents co uld be spi nal tu mors (5, 6). They are al s...

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Recurrence Rate of Lumbar Disc Herniation After Open Discectomy in Active Young Men

Abstract: Survival analysis provides a more accurate estimation of true recurrence rate. Protruded discs are more likely to show recurrence than other types.

Cited by 63 publications

References 31 publications

Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain

Posterior lumbar interbody fusion with stand-alone Trabecular Metal cages for repeatedly recurrent lumbar disc herniation and back pain

Survivorship analysis of 150 consecutive patients with DIAM™ implantation for surgery of lumbar spinal stenosis and disc herniation

Surgical management of symptomatic low back pain and monoradicular leg pain in adolescent and young adult patients

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