International Journal of Spine Surgery最新文献

{"title":"Incidental Finding of Breast Tumor After Scoliosis Surgery: A Case Report.","authors":"Yen-Chun Chiu, Shih-Chieh Yang, Yu-Hsien Kao, Chao-Ming Hung, Yuan-Kun Tu","doi":"10.14444/8647","DOIUrl":"https://doi.org/10.14444/8647","url":null,"abstract":"<p><strong>Introduction: </strong>Breast asymmetry (BA) is a common condition in patients with adolescent idiopathic scoliosis (AIS). Physicians may misdiagnose a patient with a unilateral breast tumor as a normal condition related to scoliosis. The present report describes the case of a patient with a breast tumor that was detected incidentally after surgical correction of scoliosis.</p><p><strong>Patient presentation and outcomes: </strong>A 21-year-old woman was diagnosed as having AIS and reported to our institute for management. Thoracic third to lumbar second vertebra instrumented spine de-rotation and associated fusion surgery were performed to correct the deformity. After the operation, enlargement of left breast volume and obvious BA were noted. Breast sonography was performed, and a large tumor was found. Finally, the biopsy revealed a fibroadenoma of the left breast.</p><p><strong>Conclusions: </strong>In managing patients with scoliosis and BA, comprehensive consideration of other possible etiologies is crucial to prevent misdiagnosis. This article reminds physicians that breast tumors can be concealed by BA related to AIS.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline Neck Disability Index and Patient-Reported Outcomes Measurement Information System Physical Function Predict Postoperative Return to Normal in Cervical Spine Surgery.","authors":"Gregory S Kazarian, Michael E Steinhaus, Sravisht Iyer, Drake LeBrun, Robert Cecere, Takashi Hirase, Francis Lovecchio, Todd J Albert, Darren Lebl, Darren Huang, Harvinder Sandhu, Bernard Rawlins, Frank Schwab, Virginie Lafage, Han Jo Kim","doi":"10.14444/8653","DOIUrl":"https://doi.org/10.14444/8653","url":null,"abstract":"<p><strong>Background: </strong>Recent studies assessing the importance of various preoperative factors on postoperative outcomes following spine surgery have uncovered several important variables that influence subjective and objective outcomes following cervical spine surgery, but it is still unclear which patients are most likely to benefit from operative management.</p><p><strong>Purpose: </strong>The objective of this study was to assess whether preoperative patient-reported outcome measures (PROMs) can be used to predict which patients achieve \"normal\" levels of pain and function after surgery.</p><p><strong>Study design: </strong>This was a prospective cohort study.</p><p><strong>Patient sample: </strong>This study included all adult patients undergoing cervical spine surgery by 1 of 7 senior spine surgeons at our institution between 2016 and 2018. Of the 164 patients who were eligible for 6-month follow-up at the time that study data were collected, 139 had available follow-up data and were included in our analysis.</p><p><strong>Outcomes measures: </strong>Patients completed the Neck Disability Index (NDI) as well as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference computer adaptive tests preoperatively and at 6 months postoperatively.</p><p><strong>Methods: </strong>Patients who achieved postoperative patient-acceptable symptom state (PASS) for NDI (≤17) and the normative mean (50) for PROMIS were identified. The relationship between preoperative PROMs and the probability of achieving PASS and the normative mean was assessed.</p><p><strong>Results: </strong>One hundred thirty-nine patients met inclusion criteria with diagnoses of myelopathy (<i>n</i> = 36), radiculopathy (<i>n</i> = 48), and myeloradiculopathy (<i>n</i> = 49). For NDI, a 1-point worsening in the preoperative score resulted in an OR of achieving PASS of 0.96 (<i>P</i> < 0.001) in the overall population. This association held true for patients with radiculopathy (OR 0.96; <i>P</i> = 0.022) but not myelopathy (OR 0.98; <i>P</i> = 0.35). For PROMIS PF, a 1-point improvement in the preoperative score resulted in an OR of achieving the normative mean of 1.10 (<i>P</i> < 0.001). This association held true for patients with radiculopathy (OR 1.14; <i>P</i> = 0.033) but did not reach statistical significance for patients with myelopathy (OR 1.03; <i>P</i> = 0.515).</p><p><strong>Conclusions: </strong>Preoperative PROMs can predict postoperative benefit for patients undergoing cervical spine surgery, with worse baseline function associated with a lower likelihood of attaining PASS for NDI and the normative mean for PROMIS PF, especially for patients with radiculopathy.</p><p><strong>Clinical relevance: </strong>Baseline symptoms and function, including myelopathy or radiculopathy-dominant symptoms and preoperative PROMs, may predict postoperative outcomes.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Postoperative Epidural Hematoma Formation Between Biportal Endoscopic Spine Surgery and Conventional Microscopic Surgery: A Randomized Controlled Trial.","authors":"Dae-Woong Ham, Jeuk Lee, Byung-Taek Kwon, Yisack Yoo, Sang-Min Park, Kwang-Sup Song","doi":"10.14444/8578","DOIUrl":"https://doi.org/10.14444/8578","url":null,"abstract":"<p><strong>Background: </strong>Biportal endoscopic spine surgery (BESS) has become widely recognized as a minimally invasive method for spinal decompression and discectomy. However, postoperative epidural hematoma (POEH) presents a significant risk in spinal surgery due to its potential to compress neural elements and lead to neurological deficits. This study compares the clinical and radiological outcomes of BESS with those of conventional microscopic surgery.</p><p><strong>Methods: </strong>In this single-center, single-blinded, actively controlled randomized clinical trial, 46 patients undergoing single-level posterior decompression or discectomy for spinal stenosis or herniated intervertebral discs were enrolled. Participants were randomly allocated to either the conventional microscopic surgery group or the BESS group. Experienced spine surgeons performed all procedures. Postoperative magnetic resonance imaging assessments were conducted following the removal of the drain system. Outcome measures included the cross-sectional area (CSA) of the dura sac and POEH, as well as the incidence of neurological deficits.</p><p><strong>Results: </strong>The demographic and baseline characteristics of the patients were similar across the 2 groups, with 24 in the conventional group and 22 in the BESS group. There were no significant differences in the preoperative and postoperative CSA of the dura sac between the groups. However, the BESS group exhibited a significantly larger CSA of POEH (0.36 ± 0.34 cm²) compared with the conventional group (0.17 ± 0.15 cm², <i>P</i> = 0.033). Despite this higher incidence of POEH, there was no corresponding increase in neurological deficits or revision surgeries.</p><p><strong>Conclusion: </strong>The findings indicate that while BESS achieves decompression comparable to that of conventional microscopic surgery, it is associated with a higher incidence of epidural hematomas. Importantly, these hematomas did not result in an increased rate of neurological deterioration or the need for surgical interventions. Further studies with larger sample sizes and extended follow-up are required to confirm these results and further refine the BESS technique.</p><p><strong>Clinical relevance: </strong>Despite a higher incidence of epidural hematomas, BESS offers comparable decompression to microscopic surgery without increased neurological risks, making it a viable, less invasive option for patient care.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Biportal Endoscopic Decompressive Laminectomy in Octogenarians With Severe Lumbar Spinal Stenosis.","authors":"Sang-Min Park, John I Shin, Jin-Ho Park, Jonghun Jung, Jiwon Park, Ho-Joong Kim, Jin S Yeom, Hyun-Jin Park","doi":"10.14444/8649","DOIUrl":"10.14444/8649","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option.</p><p><strong>Methods: </strong>This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery.</p><p><strong>Results: </strong>The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups.</p><p><strong>Conclusions: </strong>BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly.</p><p><strong>Clinical relevance: </strong>This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.","authors":"Xavier Castel, Henri d'Astorg, Mohammad Allaji, Vincent Fiere, Marc Szadkowski","doi":"10.14444/8654","DOIUrl":"https://doi.org/10.14444/8654","url":null,"abstract":"<p><strong>Objective: </strong>This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (<i>n</i> = 71), obese open surgery (<i>n</i> = 31), and nonobese endoscopic (<i>n</i> = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed.</p><p><strong>Results: </strong>No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, <i>P</i> = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes.</p><p><strong>Conclusions: </strong>FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods.</p><p><strong>Clinical relevance: </strong>FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: How to Improve Fusion Rate?","authors":"Hyun-Jin Park, John I Shin, Ki-Han You, Jason I Yang, Nathan Kim, Yong H Kim, Min-Seok Kang, Sang-Min Park","doi":"10.14444/8648","DOIUrl":"https://doi.org/10.14444/8648","url":null,"abstract":"<p><strong>Background: </strong>Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is a minimally invasive surgical technique for treating degenerative lumbar spine conditions. It offers advantages such as reduced soft tissue trauma and lower infection rates, but certain technical aspects may be challenging. The current study aims to identify strategies to enhance the fusion rate in BE-TLIF by addressing these specific challenges.</p><p><strong>Methods: </strong>A literature review was conducted on techniques to improve fusion rates in BE-TLIF.</p><p><strong>Results: </strong>The review suggests that lateral-based portals supplemented with medial portals allowed for safe insertion of interbody cages with large footprint. Direct visualization of the disc space with a 30° endoscope assisted with better disc space preparation. Facetectomies performed with osteotomes, rather than burrs, ensured maximum retrieval of autologous bone graft. Utilizing bone morphogenetic proteins with sustained release carriers such as hydroxyapatite can be useful to increase fusion rates of BE-TLIF.</p><p><strong>Conclusions: </strong>To our knowledge, the current literature is the first comprehensive review of strategies to enhance fusion rates in BE-TLIF. The proposed techniques and biological adjuncts are effective means to address key challenges associated with the procedure, and such strategies would potentially shorten the learning curve and improve clinical outcomes. Further clinical studies are required to validate these findings and establish standardized protocols.</p><p><strong>Clinical relevance: </strong>These findings provide practical solutions to overcome common challenges in BE-TLIF. The suggested techniques would reduce the incidence of pseudarthrosis, improve patient outcomes, and ultimately offer a safer and more reliable option for lumbar interbody fusion patients.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of 1027 Adverse Events Reports for Interspinous Process Devices From the US Food and Drug Administration Manufacturer and User Facility Device Experience Database.","authors":"Gregory S Kazarian, Yusef J Jordan, Mitchell Johnson, Satyaj Bhargava, Robert Cecere, Takashi Hirase, Sheeraz Qureshi, James Dowdell, Evan Sheha, Francis Lovecchio, Sravisht Iyer","doi":"10.14444/8652","DOIUrl":"https://doi.org/10.14444/8652","url":null,"abstract":"<p><strong>Background: </strong>Interspinous process devices (IPDs) introduce a new class of complications to surgical decompression without fusion: hardware-related complications. The purpose of this study was to describe the adverse events associated with IPDs.</p><p><strong>Study design: </strong>This was a retrospective review of the Food and Drug Administration Manufacturer and User Facility Device Experience database.</p><p><strong>Methods: </strong>The database was queried from its inception to November 2022 for reports associated with \"Prosthesis, Spinous Process Spacer/Plate.\" Entries were categorized by event type, patient impact, and interventions.</p><p><strong>Results: </strong>A total of 943 surgery-related adverse events were identified. The most common intraoperative events were implant malfunctions (39.7%, <i>n</i> = 374) and fractures (2.2%, <i>n</i> = 21). The most common postoperative events were persistent pain (26.6%, <i>n</i> = 251), implant migration (19.1%, <i>n</i> = 180), and fracture (6.8%, <i>n</i> = 64). The most common resultant outcome of an adverse event was the need for revision surgery (48.8%, <i>n</i> = 460). The need for revision surgery was common in patients who experienced fracture (47.1%), implant migration (84.5%), infection (76.7%), and neurological complications (76.9%). Implant migration, fracture, and implant malfunction, 3 complications that are unique to decompression with an IPD as compared with traditional laminectomy, accounted for 45.9% of revisions (211/460), and revision was required in 33.0% of cases where 1 of these complications was reported (211/640). Implant malfunction made up 21.2% of Coflex complications, 47.3% of Superion complications, and 5.2% of X-Stop complications.</p><p><strong>Conclusions: </strong>The most common adverse events were implant malfunction, inadequate efficacy, implant migration, and fracture. Concerningly, these complications require revision surgery in one-third of cases when they occur. Implant-specific assessments demonstrate a high prevalence of implant malfunctions for the Coflex and Superion implants.</p><p><strong>Clinical relevance: </strong>Interspinous process devices introduce a new class of complications to isolated spinal decompression surgery: implant-related complications. These complications occur both intraoperatively and postoperatively, and they frequently necessitate revision surgery.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are the Umbilicus and Iliac Crests Truly at the Level of L4 to L5? A Computed Tomography-Based Study of Surface Anatomy of the Anterior Lumbar Spine.","authors":"David Shin, Kai Nguyen, Easton Small, Trevor Case, Mikayla Kricfalusi, Alexander Bouterse, Andrew Cabrera, Ethan Purnell, Wheddy Laguerre, Jacob Razzouk, Omar Ramos, Olumide Danisa, Wayne Cheng","doi":"10.14444/8651","DOIUrl":"https://doi.org/10.14444/8651","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine whether the iliac crests are truly at the level of L4 to L5, accounting for patient demographic and anthropometric characteristics.</p><p><strong>Methods: </strong>We measured the umbilicus and iliac crests relative to the lumbar spine using computed tomography of patients without spinal pathology, accounting for the influences of patient height, weight, body mass index (BMI), sex, race, and ethnicity.</p><p><strong>Results: </strong>A total of 834 patients (391 men and 443 women) were reviewed. The location of the umbilicus relative to the lumbar spine demonstrated a unimodal distribution pattern clustered at L4, while the iliac crests were most frequently located from L4 to L5. Iliac crests were located above the L4 to L5 disc space 26.5% of the time. Iliac crests were located at the L4 to L5 disc space 29.8% of the time. No correlations were observed between the umbilicus and iliac crests with patient height, weight, or BMI. There was no difference in the location of the umbilicus with respect to patient sex, race, and ethnicity. The locations of the iliac crests were cephalad in women compared with men and in Hispanics compared with African American, Caucasian, and Asian patients.</p><p><strong>Conclusions: </strong>The iliac crests were located above the level of the L4 to L5 disc space approximately 26% of the time. The umbilicus is most frequently at the level of the L4 vertebral body. Patient height, weight, and BMI do not influence the location of the umbilicus or the iliac crests relative to the lumbar spine. Patient sex and ethnicity influence the location of the iliac crests but not the umbilicus relative to the lumbar spine.</p><p><strong>Clinical relevance: </strong>Modern neurosurgical techniques require clearance of the iliac crests during anterior and anterolateral approaches. Understanding the level of the iliac crests is crucial in planning for transpsoas fusion approaches.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation.","authors":"Gregory I Sacks, Vincent Destefano, Susan M Fiore, Raphael P Davis, Samuel Ahknoukh, Harry M Mushlin","doi":"10.14444/8650","DOIUrl":"https://doi.org/10.14444/8650","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) is a common cause of radicular pain with an annual incidence between 5 and 20 cases per 1000 adults. LDH is typically treated by microdiscectomy, of which more than 300,000 are performed in the United States each year. Despite this frequency, 25% to 33% of patients report poor surgical outcomes. This study sought to present a retrospective analysis of patients who underwent microdiscectomy surgery for the treatment of LDH with the aim of identifying demographic, historical, and surgical factors that may contribute to inadequate surgical results.</p><p><strong>Methods: </strong>A retrospective study of 241 patients at Stony Brook Medicine from 2017 to 2022 was performed, 123 of whom had follow-up of 90 days or more and were included for final analysis. Data collection included demographics, medical/surgical history, and surgical methodology. Good outcomes were defined as meeting the absolute point change threshold (ACT)-3.5pt reduction in pain reported by the Numerical Rating System (NRS) or the resolution of either radicular pain or neurological symptoms.</p><p><strong>Results: </strong>Univariate analysis revealed that 100% of patients with prior fusion surgery (<i>P</i> = 0.039) and 73.2% who underwent preoperative physical therapy (PT; <i>P</i> = 0.032) failed to meet the ACT. Additionally, 79.1% (<i>P</i> = 0.021) and 82.8% (<i>P</i> = 0.026) of patients who had PT had residual radicular pain and neurological symptoms, respectively. Multivariate logistic regression confirmed correlations between preoperative PT and failure to meet the ACT (<i>P</i> = 0.030, OR = 0.252) and resolution of radicular (<i>P</i> = 0.006, OR = 0.196) and neurological (<i>P</i> = 0.030, OR = 0.177) complaints. ACT directly correlated with higher preoperative NRS scores in univariate (<i>P</i> = 0.0002) and multivariate (<i>P</i> = 0.002, OR = 1.554) analyses.</p><p><strong>Conclusion: </strong>Our results show that higher preoperative NRS scores, PT, and prior fusion surgery are associated with poorer outcomes. While PT is considered a viable nonoperative treatment for LDH, our findings suggest detrimental effects when preceding surgery, indicating the need for additional research into the effects of PT on patients with high grade LDH.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Transforaminal Percutaneous Endoscopic Discectomy in Treatment of Patients Suffering From Discogenic Low Back Pain in Kenya.","authors":"Shirazahmed Munshi, Abdullah Kaki, Osama AlAhdal, Seema Yadav","doi":"10.14444/8628","DOIUrl":"10.14444/8628","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a globally prevalent condition, often attributed to lumbar disc herniation (LDH). Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive surgical approach for LDH, offering distinct advantages. This study aimed to assess the progression of pain in patients who underwent TPED in Kenya, with a focus on the impact of pre-existing factors.</p><p><strong>Methods: </strong>This retrospective study included 610 patients from the Mediheal Group of Hospitals who underwent TPED between January 2018 and December 2022. Data were collected from medical records, direct patient interactions, and telephone interviews. Statistical analyses, including repeated measures analysis of variance, correlation coefficients, and <i>t</i> tests, were used to examine pain progression and factors influencing outcomes.</p><p><strong>Results: </strong>Among the 610 included patients, all reported LBP and 87.9% reported leg pain. TPED resulted in significant pain reduction (<i>P</i> < 0.001) for both LBP and leg pain, with sustained improvement over 1 year. Factors such as age, body mass index, and duration of pain correlated with pain outcomes. No significant impact of comorbidities on pre- or postoperative pain was observed. Its retrospective design and the absence of a control group limit the strength of causal inferences.</p><p><strong>Conclusions: </strong>TPED is an effective treatment for LBP and leg pain in Kenyan patients with LDH. Pain improvement was sustained over 1 year after performing TPED, and pre-existing factors influenced outcomes. This study provides valuable insights into TPED outcomes, contributing to the understanding of LDH management in diverse populations.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}