1. Outpatient lumbar discectomy in surgery centers. Outpatient lumbar discectomy is a safe and effective treatment method, according to a study published in the Journal of Spinal Disorders & Techniques. Researchers collected data on 645 consecutive patients undergoing anterior discectomy and fusion for either stenosis or herniated nucleus pulposus involving one level. Two of the patients developed epidural hematomas, acute complications, within 48 hours of surgery. Six percent of the patients required unplanned admissions to hospitals, and more than 80 percent of those admissions were secondary to pain or nausea.
The study’s authors recommended a four-hour observation period after surgery. They also advised that the rate of unplanned admissions can be decreased by more than one-third if autogenous iliac crest bone graft is not harvested.
2. Lumbar discectomies for professional football players. National Football League linemen return-to-play after lumbar discectomy 85.7 percent of the time, according to a study published in The American Journal of Sports Medicine. The study examined 66 linemen (36 offensive and 30 defensive) who were diagnosed with lumbar disc herniation and 52 who were treated surgically. The players who underwent a discectomy had superior outcomes to those treated non-operatively.
Of the players treated surgically, 80.8 percent successfully returned to play, and 63.5 percent became starters after treatment. Among these players, 13.5 percent required revision decompression and 85.7 percent successfully returned to play. Only 2.86 percent of the players who received non-operative intervention returned to play.
3. Comorbidities when deciding whether to perform discectomy for disc herniation. The Spine Patient Outcomes Research Trial compared surgical and nonsurgical outcomes for three common lumbar spine diagnoses, such as disc herniation. The trial included patients who experienced radicular symptoms for at least six weeks, had neurological findings on a physical exam and demonstrated a disc herniation consistent with their symptoms on an imaging report. Patients with intervertebral disc herniation who met specific criteria did significantly better with surgery than with non-surgical treatment, according to a report of the trial’s findings in AAOS Now.
For the study, researchers followed 1,192 patients, 788 of which underwent discectomy for disc herniation. The treatment effect was substantially different between subgroups. It was found that patients who didn’t have joint problems and those who were married improved more than others. There were some subgroups in the nonsurgical group that reported particularly poor outcomes. Patients with depression, obesity or other comorbidities such as smoking, and those taking narcotics, did worse with surgery. However, their treatment effect was similar to patients without the comorbidities who underwent a discectomy.
4. Cervical discectomy and fusion using PEEK cage. Patients with cervical spondylosis and sympathetic symptoms can be effectively treated with anterior cervical discectomy and fusion using PEEK cages, according to a study published in the Journal of Spinal Disorders & Techniques. For the study, researchers conducted retrospective analysis of 39 patients diagnosed with cervical spondylosis with sympathetic symptoms who underwent ACDF with PEEK cages. Each patient reported results after at least one year.
Cervical spine radiographs after at least one year showed a solid fusion, with no signs of pseudoarthrosis in 36 cases. Two patients experienced delayed union, and bony fusions were achieved at nine and 11 months. The sympathetic symptoms improved in all patients after surgery.
5. Risk factors associated with microsurgical or microendoscopic discectomy. Non-contained-type or migrated herniated nucleus pulposus may be the most important risk factors for motor deficit in lumbar disc herniation. However, the severe motor deficit and non-contained-type seem to be more associated with delayed recovery. For a study published in the Journal of Spinal Disorders & Techniques, researchers examined 76 patients who underwent microsurgical or microendoscopic discectomy for LDH at the L4/L5 level.
Of the 76 patients examined, 56.6 percent suffered from motor deficit before surgery and 93 percent of those patients completely recovered within a mean duration of four months. The multivariate logistic regression analysis showed that non-contained-type and migrated herniated nucleus pulposus were important risk factors for motor deficit.
