Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome

Halldin, Klas; Lind, Bengt; Rönnberg, Katarina; Göthlin, Jan; Gadeholt-Göthlin, G.; Zoëga, Björn; Brisby, Helena

doi:10.1007/s00264-008-0519-x

Cited by 21 publications

(21 citation statements)

References 7 publications

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“…Experimentally, it is generally agreed that the structural damage due to nucleotomy significantly destabilizes the motion segment [4]. In vivo, however, there is a lack of consensus whether, and to which extent, segmental stability is affected and might thus contribute to failed back surgery syndrome, reoperations and, finally, the need for fusion [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Increase or decrease in stability after nucleotomy? Conflicting in vitro and in vivo results in the sheep model

Reitmaier

Volkheimer

Berger-Roscher

et al. 2014

J. R. Soc. Interface.

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Nucleotomy is a common surgical procedure to treat disc herniations. The potential occurrence of segmental instability after surgery, however, is suspected to necessitate re-operation and fusion. Although in vitro studies support the theory of destabilization after nucleotomy, a prior, in-house animal study contrarily revealed an increase in stability after surgery. To identify which structural compartment of the motion segment is decisive for increased stability after nucleotomy in vivo, the flexibilities of ovine motion segments were measured after different stepwise reductions at the anterior and posterior spinal column. Different test groups were used in which nucleotomy had been performed during surgery in vivo and under isolated in vitro conditions, respectively. In accordance with expectations, in vitro nucleotomy on ovine motion segments significantly increased flexibility. By contrast, nucleotomy significantly decreased flexibility 12 weeks after surgery. After removal of the posterior structures, however, the differences in flexibility diminished. The present results thus suggest that it might not exclusively be the trauma to the intervertebral disc during surgery which is decisive for post-operative stability, but rather adaptive mechanisms in the posterior structures. Therefore, care should be taken to minimize the damage to the posterior structures in the course of the surgical approach, which more likely compromises stability.

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Section: Introductionmentioning

confidence: 99%

Increase or decrease in stability after nucleotomy? Conflicting in vitro and in vivo results in the sheep model

Reitmaier

Volkheimer

Berger-Roscher

et al. 2014

J. R. Soc. Interface.

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“…The lower back pain caused by lumbar disc herniation and other cause is a common clinical condition [24][25][26]. Many surgical treatments focus on the lateral zones of LIF.…”

Section: Discussionmentioning

confidence: 99%

Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina

Yuan

Wen

Zhang

et al. 2015

International Orthopaedics (SICOT)

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Nerves and blood vessels are fixed and protected by transforaminal ligaments and/or corporotransverse ligaments. It is necessary to distinguish the ligaments from nerves using transforaminal endoscopy so that the ligaments can be cut without damaging nerves. Care needs to be taken in intrusive operations because of the veins running through Kambin's triangle. We recommend injecting into the lamina of the vertebral arch and the midpoint between the adjacent roots of the transverse processus when administering nerve root block. Blind percutaneous incision and acupotomology lysis is dangerous in the lateral zones of the LIF, as they are filled with nerves and blood vessels.

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“…47 In contrast, the degree of spinal stenosis defined before an operation does correlate positively with outcomes. 48 Unexpectedly, those with less preoperative stenosis had ''unsatisfactory outcomes.''…”

Section: Magnetic Resonance Imagingmentioning

confidence: 92%

The Diagnosis of the Origins of Spinal Pain: Implications for the Spinal Surgeon

Seres

2009

Neurosurgery Quarterly

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Surgery for common spinal disorders has changed dramatically in the last several decades. The failed surgical back syndrome patients populate a vast number of chronic pain clinics and rehabilitation facilities. New surgical procedures promise better outcomes. Yet documented improvement in imaging studies and the original promise of newer technologies have not consistently resulted in better clinical outcomes. More important than the technical success is the improved state of the patient. The search for the ''properly selected patient'' is a commonly used euphemism to explain away less ideal outcomes. Yet the phrase continues without clear specificity. The study is a review of some of the problems in planning the surgical care for the spinal patient. Spinal surgeons generally do not follow their patients after surgery long enough to fully comprehend the results and the impacts of their procedures, especially as viewed by the patient. We present an alternative approach that reduces the role of the spinal surgeon by encouraging more input from those who are likely to follow the patient who might not fare well. Experience in the treatment of surgical failures educates these practitioners to provide an evidence-based approach to surgical indications not as readily available to the spinal surgeon in many modern surgical practices.

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Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome

Cited by 21 publications

References 7 publications

Increase or decrease in stability after nucleotomy? Conflicting in vitro and in vivo results in the sheep model

Increase or decrease in stability after nucleotomy? Conflicting in vitro and in vivo results in the sheep model

Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina

The Diagnosis of the Origins of Spinal Pain: Implications for the Spinal Surgeon

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