Undiagnosed Peripheral Nerve Disease in Patients with Failed Lumbar Disc Surgery

Abstract

Study DesignRetrospective study (level of evidence=3).PurposeWe examine the relationship between residual symptoms after discectomy for lumbar disc herniation and peripheral nerve (PN) neuropathy.Overview of LiteraturePatients may report persistent or recurrent symptoms after lumbar disc herniation surgery; others fail to respond to a variety of treatments. Some PN neuropathies elicit symptoms similar to those of lumbar spine disease.MethodsWe retrospectively analyzed data for 13 patients treated for persistent (n=2) or recurrent (n=11) low back pain (LBP) and/or leg pain after primary lumbar discectomy.ResultsLumbar re-operation was required for four patients (three with recurrent lumbar disc herniation and one with lumbar canal stenosis). Superior cluneal nerve (SCN) entrapment neuropathy (EN) was noted in 12 patients; SCN block improved the symptoms for eight of these patients. In total, nine patients underwent PN surgery (SCN-EN, n=4; peroneal nerve EN, n=3; tarsal tunnel syndrome, n=1). Their symptoms improved significantly.Conclusions Concomitant PN disease should be considered for patients with failed back surgery syndrome manifesting as persistent or recurrent LBP.

Treatment of Coexisting Paralumbar Spine Diseases in Patients with Lumbar Disc Herniation

“…Elsewhere, 8) we reported that LDH patients with FBSS benefited from treatment of their peripheral nerve disease; their persistent or recurrent LBP and leg pain improved. These findings suggest that block treatment for coexisting PLSD may be effective in patients with LDH.…”

“…LDH patients with cauda equina syndrome and severe or progressive neurological symptoms are also surgical candidates. 8) …”

“… 7) In some patients with FBSS, treatment for PLSD improves some symptoms. 1 , 8) We report the effective block treatment of coexisting PLSD in patients with LDH.…”

Effectiveness of Gelatin‐Thrombin Matrix Sealants (Floseal®) on Postoperative Spinal Epidural Hematoma during Single‐Level Lumbar Decompression Using Biportal Endoscopic Spine Surgery: Clinical and Magnetic Resonance Image Study

“…Therefore, bleeding control is one of the factors affecting successful clinical outcomes after spine surgery. Owing to recent developments in the techniques of minimally invasive spine surgery and advancements in endoscope-related optical technology, BESS was introduced, and numerous results have been reported [8][9][10][11][12][13]. Because it has surgical indications similar to those in conventional open surgery, BESS is gaining interest recently as a minimally invasive spine surgery technique with favorable outcomes similar to those of microscopic decompression in spinal stenosis [8].…”

“…Recently, the use of an endoscope has gained interest in the field of minimally invasive surgery. For the treatment of spinal stenosis, biportal endoscopic spine surgery (BESS) was introduced as an alternative method for microscopic unilateral laminotomy for bilateral decompression (ULBD) [8][9][10][11][12][13]. The basic concept of the BESS is similar to those of arthroscopic and laparoscopic surgeries, in which an endoscope is inserted through a viewing portal, and surgical instruments are inserted into a separate working portal.…”