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Eugene K Wai - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of preoperative predictors for postoperative clinical outcomes following Lumbar Discectomy
The Spine Journal, 2016Co-Authors: Courtney A Wilson, Darren M Roffey, Donald Chow, Fahad Alkherayf, Eugene K WaiAbstract:Abstract Background Context Sciatica is often caused by a herniated Lumbar intervertebral disc. When conservative treatment fails, a Lumbar Discectomy can be performed. Surgical treatment via Lumbar Discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. Purpose This review aimed to determine preoperative predictors that are associated with postsurgical clinical outcomes in patients undergoing Lumbar Discectomy. Study Design This is a systematic review. Methods This systematic review of the scientific literature followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE and PubMed were systematically searched through June 2014. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. No financial support was provided for this study. No potential conflict of interest-associated biases were present from any of the authors. Results The search strategy yielded 1,147 studies, of which a total of 40 high-quality studies were included. There were 17 positive predictors, 20 negative predictors, 43 non-significant predictors, and 15 conflicting predictors determined. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical outcomes. Conclusions It may be possible for certain preoperative factors to be targeted for clinical evaluation by spine surgeons to assess the suitability of patients for Lumbar Discectomy surgery, the hope being to thereby improve postoperative clinical outcomes. Prospective cohort studies are required to increase the level of evidence with regard to significant predictive factors.
Zeki Sekerci - One of the best experts on this subject based on the ideXlab platform.
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Postoperative seizure following transforaminal percutaneous endoscopic Lumbar Discectomy.
Asian journal of neurosurgery, 2016Co-Authors: Hayri Kertmen, Bora Gürer, Erdal Yilmaz, Zeki SekerciAbstract:Endoscopic surgery for Lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic Lumbar Discectomy is a well-known, safe, and effective method used for the treatment of the Lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic Lumbar Discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic Lumbar Discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic Lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic Lumbar Discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac.
Sang-ho Lee - One of the best experts on this subject based on the ideXlab platform.
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Open Lumbar MicroDiscectomy and Posterolateral Endoscopic Lumbar Discectomy for Antero- and Retrospondylolisthesis.
Pain physician, 2020Co-Authors: Dong-ju Yun, Sang-joon Park, Sang-ho LeeAbstract:Background Posterolateral endoscopic Lumbar Discectomy (PLELD) or percutaneous endoscopic Lumbar Discectomy has been reported to be effective as treatment for herniated Lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open Lumbar microDiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. Objectives We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. Study design This study used a retrospective design. Setting Research was conducted in a hospital and outpatient surgical center. Methods This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data. Results Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD. Limitations The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection. Conclusions In patients with spondylolisthesis who have a herniated Lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011. Key words Anterospondylolisthesis, disc degeneration, endplate, herniated Lumbar disc, open Lumbar Discectomy, percutaneous endoscopic Lumbar Discectomy, posterolateral endoscopic Lumbar Discectomy, retrospondylolisthesis, slippage.
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MASSIVE RETROPERITONEAL HEMATOMA AFTER TRANSFORAMINAL PERCUTANEOUS ENDOSCOPIC Lumbar Discectomy : REPORT OF TWO CASES
2008Co-Authors: Yong Ahn, Jin Uk Kim, Byung Hoi Lee, Jong-dae Park, Sang-ho Lee, Dong Hyun HongAbstract:STUDY DESIGN Case reports of hemorrhagic complication of transforaminal percutaneous endoscopic Lumbar Discectomy (PELD). OBJECTIVE To evaluate the cause of retroperitoneal hematoma after transforaminal PELD and to discuss how to prevent the unintended hemorrhagic complication. of Background Data. PELD is an alternative to the open Lumbar Discectomy for radiculopathy resulting from soft Lumbar disc herniation. It has been considered a safe surgical procedure with several benefits, including less risk of intraoperative vascular injury, less paraspinal muscle damage, early functional recovery, and no need for long hospitalization. METHODS Massive retroperitoneal hematoma after transforaminal PELD occurred in two cases. Both patients suffered from intractable radicular leg pain caused by soft Lumbar disc herniation. Of the two, one patient had underlying liver cirrhosis with coagulopathy. The other patient was admitted due to a recurrent disc herniation. RESULTS After detection of retroperitoneal hematoma, the patients underwent exploration for evacuation of the hematoma performed by general surgeons. The patients were completely recovered without any neurological deficit or vascular sequelae. CONCLUSION Although transforaminal percutaneous endoscopic Lumbar Discectomy is a minimal invasive and safe procedure, the possibility of retroperitoneal hematoma should be kept in mind, as happened in our cases. Adequate technical and anatomical considerations are important to avoid this unusual hemorrhagic complication, especially for the patient with underlying medical problems or previous operative scarring.
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Clinical Outcomes of Percutaneous Endoscopic Laser Lumbar Discectomy
The Korean Journal of Pain, 2005Co-Authors: Won Sok Chang, Sang-ho LeeAbstract:Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional Discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic Lumbar Discectomy in herniated Lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the Lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic Lumbar Discectomy was applied to the patients, and clinical responses evaluated using MacNab’s criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic Lumbar Discectomy is a safe, noninvasive and effective treatment modality for herniated Lumbar intervertebral disc disease.
Fahad Alkherayf - One of the best experts on this subject based on the ideXlab platform.
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a systematic review of preoperative predictors for postoperative clinical outcomes following Lumbar Discectomy
The Spine Journal, 2016Co-Authors: Courtney A Wilson, Darren M Roffey, Donald Chow, Fahad Alkherayf, Eugene K WaiAbstract:Abstract Background Context Sciatica is often caused by a herniated Lumbar intervertebral disc. When conservative treatment fails, a Lumbar Discectomy can be performed. Surgical treatment via Lumbar Discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. Purpose This review aimed to determine preoperative predictors that are associated with postsurgical clinical outcomes in patients undergoing Lumbar Discectomy. Study Design This is a systematic review. Methods This systematic review of the scientific literature followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE and PubMed were systematically searched through June 2014. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. No financial support was provided for this study. No potential conflict of interest-associated biases were present from any of the authors. Results The search strategy yielded 1,147 studies, of which a total of 40 high-quality studies were included. There were 17 positive predictors, 20 negative predictors, 43 non-significant predictors, and 15 conflicting predictors determined. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical outcomes. Conclusions It may be possible for certain preoperative factors to be targeted for clinical evaluation by spine surgeons to assess the suitability of patients for Lumbar Discectomy surgery, the hope being to thereby improve postoperative clinical outcomes. Prospective cohort studies are required to increase the level of evidence with regard to significant predictive factors.
Hayri Kertmen - One of the best experts on this subject based on the ideXlab platform.
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Postoperative seizure following transforaminal percutaneous endoscopic Lumbar Discectomy.
Asian journal of neurosurgery, 2016Co-Authors: Hayri Kertmen, Bora Gürer, Erdal Yilmaz, Zeki SekerciAbstract:Endoscopic surgery for Lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic Lumbar Discectomy is a well-known, safe, and effective method used for the treatment of the Lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic Lumbar Discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic Lumbar Discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic Lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic Lumbar Discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac.
