Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A Retrospective Review of 156 Patients
Volume 2 | Issue 1 | April-September 2021 | page: 06-11 | Hitesh N. Modi, Alkesh Rathod, Utsab Shrestha
Authors: Hitesh N. Modi [1], Alkesh Rathod [1], Utsab Shrestha [1]
[1] Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Hitesh N. Modi,
Senior Consultant, Department of Spine Surgery, Zydus Hospital and Healthcare Research Pvt Ltd., SG Highway, Thaltej, Ahmedabad, Gujarat, India 380054.
E-mail: drmodihitesh@gmail.com
Abstract
Introduction: Lumbar disc herniation (LDH) is one of the most common causes for low back pain and related disabilities. Surgery is indicated in patients who do not respond to the conservative measures for at least 6 weeks or symptoms are worsened. Microendoscopic discectomy (MED) is a well-accepted minimally invasive surgical technique with similar results compared to open surgery. The purpose of this study was to evaluate the clinical outcome, functional improvement and analyze complications during MED.
Methods: A retrospective analysis was conducted in 156 patients who were operated for single or double level LDH using MED between 2016 and 2018. All patients were evaluated for pain and disability using visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Modified MabNab’s criteria used to evaluate overall outcome of surgery. Operation time, estimated blood loss (EBL), hospital stay and time to return back to previous activities were evaluated. Complications and revisions were noted during follow-up to analyze clinical results. Paired t-test was used to evaluate statistical difference in VAS and ODI score during follow-up.
Results: All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and yearly thereafter postoperatively. Average follow-up was 25.5±9.7 months and average age was 45.0±12.7 years. Average VAS scores improved significantly from preoperative 8.7±0.8 to 2.0±1.1 postoperatively (p<0.0001). Average preoperative ODI improved significantly from 53.8±6.1 to 22.6±5.1 postoperatively (p<0.0001). Both score were maintained at the final follow-up. The average time to return to previous activity level was 35.7±14.3 days. Average operation time, EBL and hospital stay were 57.6±14.6 minutes, 36.7±13.1 mL and 2.4±0.7 days, respectively. There were total 19 (12.2%) complications and 12 (7.7%) revisions in the series. Overall clinical outcome was excellent, good, fair and poor in 73.1%, 20.5%, 5.1% and 1.3% of cases using modified MacNab’s criteria.
Conclusion: Study of 156 patients operated for single or double level LDH using MED has shown encouraging clinical results and functional outcome with similar complications reported in literature. However, less intraoperative blood loss, shorter hospital stay and early return to work are some of the advantages which favours its wide spread acceptability.
Keywords: Lumbar disc herniation; Microendoscopic discectomy; clinical outcome; Complications.
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| How to Cite this Article: Modi HN, Rathod A, Shrestha U | Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A Retrospective Review of 156 Patients | Back Bone: The Spine Journal | April-September 2021; 2(1): 06-11. |
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Incorporation of MISS in Routine Spine Practice
Volume 2 | Issue 1 | April-September 2021 | page: 01-05 | Amit C. Jhala
Authors: Amit C. Jhala [1]
[1] Department of Spine Surgery, Chirayu Hospital, Vishwakunj Cross Roads, Paldi, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Amit C. Jhala,
Consultant Spine Surgeon, Chirayu Hospital, Vishwakunj Cross Roads, Paldi, Ahmedabad, Gujarat, India.
E-mail: acjhala@gmail.com
Abstract
Traditional open spine surgery is the gold standard procedure in spine practice. Minimally invasive spine surgery (MISS) since last two decades have tremendously improved in technique and technology improving the clinical and functional outcomes of the surgery and patients. But still MISS has steep learning curve, many challenges and hurdles to inculcate it in the routine spine practice of the surgeon who may be either a novice or even an established in spine practice. The author has tried to identify the hurdles in incorporating MISS in routine spine practice and suggested methods to overcome these hurdles to incorporate MISS in routine clinical practice.
Keywords: Minimally Invasive Spine Surgery (MISS); Spine practice; Spine Surgeon.
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| How to Cite this Article: Jhala AC | Incorporation of MISS in Routine Spine Practice | Back Bone: The Spine Journal | April-September 2021; 2(1): 01-05. |
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Recurrent Lumbar Disc Herniation: A Narrative Review
Volume 1 | Issue 1 | October 2020-March 2021 | page: 37-45 | Ghanshyam Kakadiya, Viraj Gandbhir, Kshitij Chaudhary
Authors: Ghanshyam Kakadiya [1] , Viraj Gandbhir [1] , Kshitij Chaudhary [1][2]
[1] Department of Orthopaedics, Topiwala National Medical College & BYL Nair Hospital, Mumbai, Maharashtra, India
[2] Department of Orthopaedics and Spine Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
Address of Correspondence
Dr. Kshitij Chaudhary,
Department of Orthopaedics and Spine Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
E-mail: chaudhary.kc@gmail.com
Abstract
This narrative review aimed to identify various risk factors of recurrent lumbar disc herniation (rLDH) post-discectomy and its management. The rLDH has remained a challenging problem for spine surgeons. The incidence of rLDH is reported widely from 1% to 21%. Many possible patient-related, disc-related, and surgery-related risk factors may predispose the patient to rLDH. Moreover, the clinical and radiological diagnosis of rLDH can be challenging. Once the diagnosis is confirmed, and alternative diagnoses for leg pain have been ruled out, a course of initial non-operative treatment can be attempted. Compared to primary LDH, non-operative treatment is less likely to succeed in rLDH, possibly due to the associated epidural fibrosis and scarring. Various surgical options can be considered, including revision discectomy and fusion. Revision discectomy is usually the primary choice of surgery for the first recurrence. A fusion procedure can be chosen for those who have repeated reherniations or significant associated back pain. Precise patient selection is a must to achieve excellent surgical outcomes.
Keywords: Lumbar disc herniation, recurrent herniation, discectomy, risk factor, Epidural fibrosis, narrative review.
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| How to Cite this Article: Kakadiya G, Gandbhir V, Chaudhary K| Recurrent Lumbar Disc Herniation: A Narrative Review | Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 37-45. |
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Improving Spinal Cord Stimulators’ Outcomes: A literature Review
Volume 1 | Issue 1 | October 2020-March 2021 | page: 33-36 | Gina Kelly-Vasquez
Authors: Gina Kelly-Vasquez [1]
[1] University of North Florida, 1 UNF Drive, Jacksonville, FL 32224
Address of Correspondence
Dr. Gina Kelly-Vasquez,
University of North Florida,1 UNF Drive, Jacksonville, FL 32224
E-mail: Animig@gmail.com
Abstract
Spinal pain is debilitating, inhibits the quality of life, requires many interventions that include non-pharmacological, pharmacological therapies that are costly to both patients and insurance companies. With the advent of updated chronic pain treatment technology, it is essential to accurately assess risks versus benefits and many varying contributing factors in treatment candidacy.
The purpose of the exploratory research is to describe current pain neuromodulation technology that includes spinal cord stimulators (SCS) and dorsal root ganglion (DRG) technology. The employed research methods are secondary research analysis comprised quantitative and qualitative data.
The research revealed that when individuals undergoing the SCS trial period, if they experienced 4.6 out of ten pains, there is a 50% probability of permanent implantation success with a sensitivity of 97.14 and specificity of 44.44%. An individual who underwent DRG implantation within 1-year, complex regional pain, and failed back syndrome was reduced by −56.7%, back pain was −46.71%, and foot pain −72.97%. In one reviewed study conducted from 1997 to 2014, 73% of permanent devices were removed due to inadequate pain control. In another reviewed research conducted from 2013 to 2017, 22% reported complications causing a need for device removal.
It is concluded that although there is a trial period for the candidacy of permanent placement of SCS or DRG, there is a high incidence of permanent device explanation. There is a need for more exploratory research on causative variables that result in permanent neuromodulation device removal. Thorough documenting of baseline pain, along with thorough psychological clearance, can aid in providing enhanced outcomes after permanent implantation.
Keywords: Spinal cord stimulators, implants, generators, explantation, revisions.
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| How to Cite this Article: Vasquez GK| Improving Spinal Cord Stimulators’ Outcomes: A literature Review| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 33-36. |
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Primary Ewing’s Sarcoma of Lumbar Spine Treated with Neoadjuvant Chemotherapy and Surgery – A Case Report
Volume 1 | Issue 1 | October 2020-March 2021 | page: 28-32 | Rohit A Thaker, Himanshu Dodiya, Shrikant Dhanani, Ankur Patel
Authors: Rohit A Thaker [1][2], Himanshu Dodiya [2], Shrikant Dhanani [2], Ankur Patel [3]
[1] Orthoplus Hospital, Spine Care Associates, Ahmedabad, Gujarat, India.
[2] Spine Care Associates, Ahmedabad, Gujarat, India.
[3] Sparsh Spine Hospital, Himmatnagar, Gujarat, India.
Address of Correspondence
Dr. Rohit A Thaker,
Consultat Spine Surgeon, Orthoplus Hospital, Spine Care Associates, Ahmedabad, Gujrat, India.
E-mail: thakerrohit1@gmail.com
Abstract
Primary involvement of mobile spine compared to non-mobile spine is very less in case of Ewing’s sarcoma (ES). There are no fixed guidelines for these types of tumors because of their low incidence. These tumors usually have very high sensitivity to chemotherapy and radiotherapy. Goal for the management of ES of the spine is adequate local control through complete removal of tumor by doing aggressive resection along with restoration of spinal stability and preservation of neurology. En bloc spondylectomy or extralesional resection with wide disease-free margin provides good oncological results with a longer survival. Whenever it is possible to give neoadjuvant chemotherapy, it is always better because it helps to shrink tumor, treat micrometastasis, and make surgical excision easier with wide margin resection. However, in some case of spinal ES, it may not be possible because of neurological compromise and they might have to be addressed first by surgery and neurological decompression. We report here one such cases of primary ES of mobile lumbar spine treated with neoadjuvant chemotherapy and then with en bloc excision of tumor. The clinical picture and imaging characteristics of patient were analyzed as well as the management modalities and outcome has been discussed.
Keywords: Ewing’s sarcoma, spine surgery, neoadjuvant chemotherapy, lumbar spine.
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| How to Cite this Article: Thaker RA, Dodiya H, Dhanani S, Patel A| Primary Ewing’s Sarcoma of Lumbar Spine Treated with Neoadjuvant Chemotherapy and Surgery – A Case Report| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 28-32. |
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Imaging in Thoracic Disc Prolapse – A Study of 25 Patients and Review of the Literature
Volume 1 | Issue 1 | October 2020-March 2021 | page: 23-27 | Devanand Degulmadi, Bharat R Dave, Ajay Krishnan, Shivanand Mayi, Ravi Ranjan Rai
Authors: Devanand Degulmadi [1], Bharat R Dave [1], Ajay Krishnan [1], Shivanand Mayi [1], Ravi Ranjan Rai [1]
[1] Stavya Spine Hospital and Research Institute, Near Nagari Eye Hospital, Mithakhali, Ellisbrige, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Devanand Degulmadi,
Stavya Spine Hospital and Research Institute, Mithakali, Ellisbrige, Ahmedabad, Gujarat, India.
E-mail: drdanand@yahoo.co.in
Abstract
Purpose: Unlike cervical and lumbar disc, thoracic disc prolapse (TDP) has limited literature. Many studies have focused on surgical technique of TDP. The aim of this study is to highlight the radiological features of TDP that would help surgeons in understanding the peculiar features of such uncommon entity and also planning the surgery.
Materials and Methods: All the patients surgically treated for TDP between May 2010 and June 2018 were included in the study. A retrospective collection of all the radiographs, CT and MR images were done.
Results: A total of 25 subjects, two patients had double level disc prolapse; hence, a total of 27 discs were analyzed. On radiographs, end-plate was concave (n = 9), straight (n = 12), cupid bow shaped (n = 6), calcification in disc space (n = 5), and calcification within the canal (n = 14). EP junction failures were type IA (n = 10), type IB (n = 6), type ID (n = 2), and type II (n = 9). On MRI, central disc prolapse (n = 10), right paracentral (n = 12), and left paracentral (n = 5). According to Pfirmann grading, three discs were Grade 2; five discs as Grade 3; 14 as Grade 4; and five as Grade 5. Fourteen discs had >40% canal occupancy. Schmorl nodes were noted (n = 17).
Conclusion: Lower thoracic spine has a higher incidence of TDP. Calcification is commonly seen in cases of TDP, either in the disc space or within the canal. Most of the cases present with >40% of canal occupancy. End plate defect, a variant of schmorl node, may be a possible contributor to disc prolapse.
Keywords: Thoracic disc prolapse, radiology, calcification.
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| How to Cite this Article: Degulmadi D, Dave BR, Krishnan A, Mayi S, Rai RR Imaging | in Thoracic Disc Prolapse: A Study of 25 Patients and Review of Literature| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 23-27. |
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