Keywords
Microdiscectomy (MD)
Lumbar Disc Herniation (LDH)
How to Cite
Abstract
Unsatisfactory results from lumbar disc herniation (LDH) conservative treatment suggest referral of patients for neurosurgical treatment. The time required for such a decision is about 4-6 weeks. In most cases, surgery quickly relieves pain symptoms and restores patient functions. We consider two discectomy methods quite effective in our hospital: standard open discectomy (SD) and microdiscectomy (MD). Many retrospective studies have demonstrated the superiority of one of these techniques. Most studies describe microdiscectomy as a golden standard for surgical treatment of symptomatic disc herniation.
METHODOLOGY
An interventional study was conducted at Akbar Niazi Teaching Hospital ANTH for 2 years. The total Sample Size was 120 by random sampling, Patients were divided into two groups. All required information, including past medical history, was collected through a questionnaire. For clinical diagnosis and assessment, an MRI was done. In Group A, 60 patients underwent surgery by standard laminectomy (SD) and 60 patients were treated by microdiscectomy surgery (MD). The chi-square test was applied to determine statistical findings, and a p-value less than 0.05 was taken as significant.
RESULTS
Analyses of the parameters mean VAS values of lumbar and leg pain postoperatively, and within one month after surgery demonstrated statistically significant differences between standard and microdiscectomy (p<0.05). LDH surgical techniques have become more and more sophisticated over the last 40 years, but without substantial improvement in the functional and clinical results. Appropriate patient selection is a crucial factor for the postoperative outcome. Neurosurgeons should fully master the chosen technique for satisfactory postoperative results.
Keywords: Laminectomy, Minimally Invasive Surgical Procedures, Radicular Pain, Postoperative Pain, Treatment Outcome, Recurrence, Visual Analog Scale
References
Ammerman J, Watters WC, Inzana JA, Carragee G, Groff MW. Closing the treatment gap for lumbar disc herniation patients with large annular defects: a systematic review of techniques and outcomes in this high-risk population. Cureus. 2019 May 7;11(5). https://doi.org/10.7759/cureus.4613
Di Cello A, Borelli M, Marra ML, Franzon M, D’Alessandro P, Di Carlo C, Venturella R, Zullo F. A more accurate method to interpret lactate dehydrogenase (LDH) isoenzymes’ results in patients with uterine masses. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2019 May 1;236:143-7. https://doi.org/10.1016/j.ejogrb.2019.03.017
Muthu S, Ramakrishnan E, Chellamuthu G. Is endoscopic discectomy the next gold standard in the management of lumbar disc disease? Systematic review and superiority analysis. Global spine journal. 2021 Sep;11(7):1104-20. https://doi.org/10.1177/2192568220948814
Molteni G, Nocini R, Ghirelli M, Molinari G, Fior A, Veneri A, Nocini PF, Marchioni D. Free flap head and neck microsurgery with VITOMⓇ 3D: Surgical outcomes and surgeon's perspective. Auris Nasus Larynx. 2021 Jun 1;48(3):464-70. https://doi.org/10.1016/j.anl.2020.09.010
Pinto D, Marques A, Pereira JF, Palma PJ, Santos JM. Long-term prognosis of endodontic microsurgery—a systematic review and meta-analysis. Medicina. 2020 Sep 3;56(9):447. https://doi.org/10.3390/medicina56090447
Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK. A review of lumbar spinal stenosis with intermittent neurogenic claudication: disease and diagnosis. Pain medicine. 2019 Dec 1;20(Supplement_2):S32-44. https://doi.org/10.1093/pm/pnz161
Angelini E, Baranto A, Brisby H, Wijk H. Healthcare practitioners’ experiences of postoperative pain management in lumbar spine surgery care—a qualitative study. Journal of clinical nursing. 2020 May;29(9-10):1662-72. https://doi.org/10.1111/jocn.15230
Ebrahimkhani M, Arjmand N, Shirazi-Adl A. Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine. Scientific reports. 2021 Sep 9;11(1):17892. https://doi.org/10.1038/s41598-021-97288-2
Zahra N, Sheha EA, Elsayed H. Low back pain, disability and quality of life among health care workers. IJPRPM. 2020 Apr 1;9(2):34-44. https://doi.org/10.1002/1348-9585.12378
Hines K, Mouchtouris N, Knightly JJ, Harrop J. A brief history of quality improvement in health care and spinal surgery. Global Spine Journal. 2020 Jan;10(1_suppl):5S-9S. https://doi.org/10.1111/jocn.15230
Angelini E, Baranto A, Brisby H, Wijk H. Healthcare practitioners’ experiences of postoperative pain management in lumbar spine surgery care—a qualitative study. Journal of clinical nursing. 2020 May;29(9-10):1662-72. https://doi.org/10.1111/jocn.15230
Frost BA, Camarero-Espinosa S, Foster EJ. Materials for the spine: anatomy, problems, and solutions. Materials. 2019 Jan 14;12(2):253. https://doi.org/10.3390/ma12020253
Rawal N. Epidural analgesia for postoperative pain: improving outcomes or adding risks?. Best Practice & Research Clinical Anaesthesiology. 2021 May 1;35(1):53-65. Rawal N. Epidural analgesia for postoperative pain: improving outcomes or adding risks?. Best Practice & Research Clinical Anaesthesiology. 2021 May 1;35(1):53-65. https://doi.org/10.1016/j.bpa.2020.12.001
Aprilia A, Aminatun D. INVESTIGATING MEMORY LOSS: HOW DEPRESSION AFFECTS STUDENTS’MEMORY ENDURANCE. Journal of English Language Teaching and Learning. 2022 Jul 1;3(1):1-1. https://doi.org/10.33365/jeltl.v3i1.1719
Kose G, Tastan S, Temiz NC, Sari M, Izci Y. The effect of low back pain on daily activities and sleep quality in patients with lumbar disc herniation: a pilot study. Journal of Neuroscience Nursing. 2019 Aug 1;51(4):184-9. https://doi.org/10.1097/jnn.0000000000000446
Fuhrman JD, Gorre N, Hu Q, Li H, El Naqa I, Giger ML. A review of explainable and interpretable AI with applications in COVID‐19 imaging. Medical Physics. 2022 Jan;49(1):1-4. https://doi.org/10.1002/mp.15359
Yadav RI, Long L, Yanming C. Comparison of the effectiveness and outcome of microendoscopic and open discectomy in patients suffering from lumbar disc herniation. Medicine. 2019 Dec;98(50). https://doi.org/10.1097/md.0000000000016627
Yang MM, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ open. 2019 Apr 1;9(4):e025091. https://doi.org/10.1136/bmjopen-2018-025091
Bombieri FF, Shafafy R, Elsayed S. Complications associated with lumbar discectomy surgical techniques: a systematic review. Journal of Spine Surgery. 2022 Sep;8(3):377. https://doi.org/10.21037/jss-21-59
Almeida JP, Tabasinejad R, Kalyvas A, Takami H, Mohan N, O'Halloran PJ, Sanchez MM, Velasquez C, Zadeh G, Gentili F. The importance of long term follow up after endoscopic pituitary surgery: durability of results and tumor recurrence. Neurology India. 2020 Jun 1;68(7):92. https://doi.org/10.4103/0028-3886.287675
Chowdhury MZ, Turin TC. Variable selection strategies and their importance in clinical prediction modelling. Family medicine and community health. 2020;8(1). https://doi.org/10.1136/fmch-2019-000262
Morales-Arráez D, Ventura-Cots M, Altamirano J, Abraldes JG, Cruz-Lemini M, Thursz MR, Atkinson SR, Sarin SK, Kim W, Chavez-Araujo R, Higuera-de La Tijera MF. The MELD score is superior to the Maddrey discriminant function score to predict short-term mortality in alcohol-associated hepatitis: a global study. Official journal of the American College of Gastroenterology| ACG. 2022 Feb 1;117(2):301-10. https://doi.org/10.14309/ajg.0000000000001596
Piarulli A, Chiariello GA, Bruno P, Cammertoni F, Rabini A, Pavone N, Pasquini A, Ferraro F, Mazza A, Nesta M, Francesco M. Psychological effects of skin incision size in minimally invasive valve surgery patients. Innovations. 2020 Nov;15(6):532-40. https://doi.org/10.1177/1556984520956980
Hamawandi SA, Sulaiman II, Abdulhameed AM. Effect of duration of symptoms on the clinical and functional outcomes of lumbar microdiscectomy: a randomized controlled trial. Orthopaedic Surgery. 2022 Jan;14(1):157-68. https://doi.org/10.1111/os.13114
Kasir R, Zakko P, Hasan S, Aleem I, Park D, Nerenz D, Abdulhak M, Perez-Cruz M, Schwalb J, Saleh ES, Easton R. The Duration of Symptoms Influences Outcomes After Lumbar Microdiscectomies: A Michigan Spine Surgery Improvement Collaborative. Global spine journal. 2023 Nov 2:21925682231210469. https://doi.org/10.1177/21925682231210469
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