The effect of psychological disturbance on symptoms, self-reported disability and surgical outcome in carpal tunnel syndrome

In a prospective study, we have evaluated the impact of psychological disturbance on symptoms, self-reported disability and the surgical outcome in a series of 110 patients with carpal tunnel syndrome. Self-reported severity of symptoms and disability were assessed using the patient evaluation measure and the Boston carpal tunnel questionnaire. Psychological distress was assessed using the hospital anxiety and depression scale. There was a significant association between psychological disturbance and the pre-operative symptoms and disability. However, there was no significant association between pre-operative psychological disturbance and the outcome of surgery at six months. We concluded that patients with carpal tunnel syndrome should not be denied surgery because of pre-operative psychological disturbance since it does not adversely affect the surgical outcome.     

Does the MMPI predict chemonucleolysis outcome?

Ninety-one patients with lumbar disc herniation were treated by chemonucleolysis with intradiscal chymopapain injection and evaluated at least 1 year after surgery (average, 18 months). There were 54 good, 10 fair, and 27 poor results after chemonucleolysis. Good versus fair/poor outcome groups differed preoperatively on the Minnesota Multiphasic Personality Inventory (MMPI) Hypochondriasis (Hs), Hysteria (Hy), Psychopathic Deviate (Pd), Paranoia (Pa), Hypomania (Ma), and Social Introversion (Si) scales. Presence of compensation issues at the time of surgery was significantly related to outcome, and the MMPI scales provided additional predictive power. Nineteen patients who did not show improvement with chemonucleolysis subsequently underwent lumbar laminectomy and discectomy, and the ultimate outcome for the entire series including these laminectomy patients was 66 good, 10 fair, and 15 poor results. Good versus fair/poor ultimate outcome patients differed significantly on preoperative MMPI Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia, Hypomania, and Social Introversion scales. After controlling for the effects of compensation issues, MMPI scales added significantly to the ability to predict ultimate surgical outcome. However, the MMPI could not be used with confidence to predict the outcome for a given patient and should serve only to alert the surgeon to the presence of psychological risk factors and the possible need for referral for psychological evaluation and treatment.     

Psychological Profile and Outcome in Patients Undergoing Gastroplasty for Morbid Obesity

Eighteen out of 22 consecutive patients undergoing vertical banded gastroplasty were reviewed with regard to preoperative psychological assessment and postoperative outcome. Each patient was initially evaluated by a consultant liaison psychiatrist with regard to previous or ongoing psychological disturbance, and suitability for bariatric surgery. Patients could be grouped into three broad categories: Group A (seven patients) those with no psychiatric abnormality; Group B (six patients) those with minor psychiatric disorders such as sociopathic teenage behaviour, outpatient treatment for depression; and Group C (five patients) those with a history of major psychiatric disturbance such as depressive psychosis and drug dependency. Psychiatric morbidity had no adverse effect in terms of postoperative outcome or weight loss. Mean weight loss of 26%, 30% and 33% was recorded in groups A, B and C respectively after a mean follow-up period of 33 months following gastroplasty. The occurrence of postoperative psychiatric problems correlated closely with preoperative psychological assessment, with none of seven patients in group A but four of the five patients in group C requiring psychiatric management. Our findings indicate that psychiatric illness is not associated with poor outcome following surgery for morbid obesity and such patients should not be excluded if psychiatric support is available before and after surgery.     

Psychological vulnerability as a predictor for short-term outcome in lumbar spine surgery

Summary A prospective survey of the outcome following lumbar spine surgery was carried out during a period of six months. Of a consecutive series of 144 patients 130 cases (90%) could be evaluated. Postoperative follow-up was for six months.A test of psychological vulnerability was included with the preoperative data. Outcome was determined as unsatisfactory in case of re-operation (9%) before follow-up or if pain persisted unchanged or became worse (30%).Psychological vulnerability was significantly associated with poor outcome irrespective of age, sex, pre-operative somatic health, and surgical findings. The relative risk ratio of persisting pain attributable to psychological vulnerability was 1.8.The finding support the contention that psychogenic factors independently and significantly contribute to the multiple factor interaction that determines short-term outcome.The social consequences were strongly associated with psychological vulnerability. Among patients pre-operatively on sick-leave the relative risk ratio of unemployment attributable to psychological vulnerability was 6.0.     

Does Additional Discectomy and the Degree of Dural Sac Compression Influence the Outcome of Decompressive Surgery for Lumbar Spinal Stenosis?

The discussion regarding factors that reliably predict the long-term surgical results in patients with lumbar spinal stenosis is still going on. This retrospective study analyses the relation between the dimensions of the dural sac and patients' clinical status before and after decompressive operations performed with or without additional discectomy. The type of surgery performed in 134 patients and the dural sac dimensions measured on postmyelograpic computed tomography in 100 of these patients were related to the Prolo scores before surgery and at follow-up (mean 46 months). The degree of dural sac compression correlated significantly with the patients' postoperative Prolo score and with the difference between the pre- and postoperative scores. The dural sac diameters predicted outcome after surgery more reliably than the preoperative Prolo scores. There was no statistically significant difference in the outcome when comparing patients with and without additional discectomy. The results presented suggest that the relief of symptoms after decompressive surgery for lumbar spinal stenosis correlates with the degree of the dural sac compression and that the simultaneous presence of disc herniation necessitating additional discectomy does not influence the postoperative outcome. However, these results have to be confirmed by prospective studies.     

Microdiscectomy compared with standard discectomy: an old problem revisited with new outcome measures within the framework of a spine surgical registry

Studies comparing the relative merits of microdiscectomy and standard discectomy report conflicting results, depending on the outcome measure of interest. Most trials are small, and few have employed validated, multidimensional patient-orientated outcome measures, considered essential in outcomes research. In the present study, data were collected prospectively from six surgeons participating in a surgical registry. Inclusion criteria were: lumbar/lumbosacral degenerative disease; discectomy/sequestrectomy without additional fusion/stabilisation; German or English-speaking. Before and 3 and 12 months after surgery, patients completed the Core Outcome Measures Index comprising questions on leg/buttock pain, back pain, back-related function, symptom-specific well-being, general quality-of-life, and social and work disability. At follow-up, they rated overall satisfaction, global outcome, and perceived complications. Compliance with the registry documentation was excellent: 87% for surgeons (surgery forms), 91% for patients (for 12 months follow-up). 261 patients satisfied the inclusion criteria (225 microdiscectomy, 36 standard discectomy). The standard discectomy group had significantly greater blood-loss than the microdiscectomy (P < 0.05). There were no group differences in the proportion of surgical complications or duration of hospital stay (P > 0.05). The groups did not differ in relation to any of the patient-orientated outcomes or individual outcome domains (P > 0.05). Though not equivalent to an RCT, the study included every single eligible patient in our Spine Center and allowed surgeons to use their regular procedure; it hence had extremely high external validity (relevance/generalisability). There was no clinically relevant difference in outcome after lumbar disc excision dependent on the use of the microscope. The decision to use the microscope should rest with the surgeon.     

A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery

The objective of this systematic review is to summarize scientific evidence concerning the predictive value of bio-psychosocial risk factors with regard to the outcome after lumbar disc surgery. Medical and psychological databases were used to locate potentially relevant articles, which resulted in the selection of 11 studies. Each of these studies has a prospective design that examined the predictive value of preoperative variables for the outcome of lumbar disc surgery. Results indicated that socio-demographic, clinical, work-related as well as psychological factors predict lumbar disc surgery outcome. Findings showed relatively consistently that a lower level of education, a higher level of preoperative pain, less work satisfaction, a longer duration of sick leave, higher levels of psychological complaints and more passive avoidance coping function as predictors of an unfavourable outcome in terms of pain, disability, work capacity, or a combination of these outcome measures. The results of this review provide preliminary opportunities to select patients at risk for an unfavourable outcome. However, further systematic and methodologically high quality research is required, particularly for those predictors that can be positively influenced by multidisciplinary interventions.This research was funded by a grant from the RVVZ (Reserves Voormalige Vrijwillige Ziekenfondsverzekering).     

The use of presurgical psychological screening to predict the outcome of spine surgery.

BACKGROUND CONTEXT: Several previous studies have shown that psychosocial factors can influence the outcome of elective spine surgery. PURPOSE:The purpose of the current study was to determine how well a presurgical screening instrument could predict surgical outcome. STUDY DESIGN/SETTING: The study was conducted by staff of a psychologist's office. They performed preoperative screening for spine surgery candidates and collected the follow-up data. PATIENT SAMPLE: Presurgical screening and follow-up data collection was performed on 204 patients who underwent laminectomy/discectomy (n=118) or fusion (n=86) of the lumbar spine. OUTCOME MEASURES: The outcome measures used in the study were visual analog pain scales, the Oswestry Disability Questionnaire, and medication use. METHODS: A semi-structured interview and psychometric testing were used to identify specific, quantifiable psychological, and "medical" risk factors for poor surgical outcome. A presurgical psychological screening (PPS) scorecard was completed for each patient, assessing whether the patient had a high or low level of risk on these psychological and medical dimensions. Based on the scorecard, an overall surgical prognosis of "good," "fair," or "poor" was generated. RESULTS: Results showed spine surgery led to significant overall improvements in pain, functional ability, and medication use. Medical and psychological risk levels were significantly related to outcome, with the poorest results obtained by patients having both high psychological and medical risk. Further, the accuracy of PPS surgical prognosis in predicting overall outcome was 82%. Only 9 of 53 patients predicted to have poor outcome achieved fair or good results from spine surgery. CONCLUSIONS: These findings suggest that PPS should become a more routine part of the evaluation of chronic pain patients in whom spine surgery is being considered.     

Assessing outcome in lumbar disc surgery using patient completed measures

Measuring outcome after spinal surgery is difficult. The objective of this study was to assess the use of four measures in establishing outcome in patients undergoing lumbar discectomy. Forty-six consecutive patients who had undergone two operations for lumbar disc prolapse and 54 patients who had undergone one operation for the same condition over the same period were identified. The SF-36 questionnaire was used to assess general health. The Roland-Morris questionnaire and a simple modification of the Roland-Morris questionnaire were used to assess back and leg related disability, respectively. Analogue pain scales were used to measure back pain and sciatica. The SF-36 scores revealed significantly worse health status in the two operation compared with the one operation patients and in all patients compared with the normal population. Using the Roland-Morris and the leg disability questionnaires, patients who had undergone two operations reported significantly worse disability (Roland-Morris, 53%, poor outcome) than those who had undergone one operation (Roland-Morris, 19%, poor outcome). There was significantly greater back disability than leg disability in both groups of patients and this was confirmed by the analogue pain scales. In patients who had undergone two operations, 25% classified their back pain as very bad or unbearable, and 22.5% described very bad or unbearable leg pain. For the one operation patients these figures were 9.5 and 2.4%, respectively. The results demonstrate that both generic and condition specific patient completed measures have the potential to detect differences in outcome between patients who have undergone either one or two lumbar disc operations. The study provides support for the use of these patient completed measures in assessing outcome in lumbar disc surgery.     

经皮椎间孔镜下选择性减压治疗老年性腰椎管狭窄症的疗效分析

目的：评价经皮椎间孔镜治疗老年性腰椎管狭窄症的临床效果。方法：对2006年7月至2011年7月收治的60例老年性腰椎管狭窄症患者进行回顾性分析,其中男32例,女28例;年龄72～83岁,平均（66.7±2.5）岁。根据手术方法不同分为传统手术组和椎间孔镜组,每组30例。记录比较两组患者围手术期观察指标、手术切口VAS评分（术后12、24、48、72 h）,采用Oswestry功能障碍指数（ODI评分）对两组患者术前,术后6、24个月的日常生活能力进行评定。结果：在手术时间、术中出血量、术后使用镇痛药物例数和住院时间的比较上,椎间孔镜组明显优于传统手术组（P<0.05）.术后椎间孔镜组切口疼痛程度较传统手术组明显降低（P<0.05）.60例患者均获得至少24个月的随访,两组患者于术后1、24个月时ODI评分均较术前明显改善,但椎间孔镜组患者ODI评分改善明显优于传统手术组患者（P<0.05）.结论：腰椎经皮椎间孔镜技术在手术切口、术中出血量、住院时间等方面具有微创优越性,对脊柱稳定结构破坏小,患者术后恢复快,是治疗老年性腰椎管狭窄症的一种新的有效的微创手术方式。     

Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine

STUDY DESIGN: Prospective, randomized, double-blind study. OBJECTIVE: To assess the efficacy of ketorolac and bupivacaine in reducing postoperative pain after microsurgical lumbar discectomy. SUMMARY OF BACKGROUND DATA: Microsurgical lumbar discectomy often is performed as an ambulatory procedure. Pain, nausea, and urinary retention may delay discharge. It was hypothesized that intraoperative ketorolac or bupivacaine would reduce postoperative pain as measured by morphine demand. METHODS: After Institutional Review Board (IRB) approval and informed consent, 30 patients undergoing single-level microsurgical lumbar discectomy under general anesthesia randomly received either intravenous ketorolac, intramuscular bupivacaine, or placebo before wound closure. After surgery, all patients received intravenous, MSO4, patient-controlled analgesia. MSO4 demand was compared between groups at 30 minutes and at 1, 4, 8, 16, 20, and 24 hours after surgery by one-way ANOVA. Pre- and postoperative pain was assessed by using a standard scale and was correlated to postoperative MSO4 demand by Pearson correlation. Significance was assumed at P < 0.05. RESULTS: There were no group differences in age, gender, weight, disc level, preoperative pain, or preoperative use of pain medication. Neither ketorolac nor bupivacaine decreased pain or nausea scores, MSO4 demand, or time to void and ambulation. Preoperative pain was significantly correlated to postoperative narcotic demand (r = 0.46, P < 0.01). Preoperative narcotic or NSAID use was not correlated to either preoperative pain scores or postoperative MSO4 requirement. CONCLUSIONS: Neither ketorolac nor bupivacaine decreased the postoperative narcotic requirement in patients undergoing microsurgical lumbar discectomy. Postoperative narcotic requirements are increased in patients who are in severe pain before surgery, regardless of preoperative narcotic use.     

Does minimally invasive lumbar disc surgery result in less muscle injury than conventional surgery? A randomized controlled trial

The concept of minimally invasive lumbar disc surgery comprises reduced muscle injury. The aim of this study was to evaluate creatine phosphokinase (CPK) in serum and the cross-sectional area (CSA) of the multifidus muscle on magnetic resonance imaging as indicators of muscle injury. We present the results of a double-blind randomized trial on patients with lumbar disc herniation, in which tubular discectomy and conventional microdiscectomy were compared. In 216 patients, CPK was measured before surgery and at day 1 after surgery. In 140 patients, the CSA of the multifidus muscle was measured at the affected disc level before surgery and at 1 year after surgery. The ratios (i.e. post surgery/pre surgery) of CPK and CSA were used as outcome measures. The multifidus atrophy was classified into three grades ranging from 0 (normal) to 3 (severe atrophy), and the difference between post and pre surgery was used as an outcome. Patients’ low-back pain scores on the visual analogue scale (VAS) were documented before surgery and at various moments during follow-up. Tubular discectomy compared with conventional microdiscectomy resulted in a nonsignificant difference in CPK ratio, although the CSA ratio was significantly lower in tubular discectomy. At 1 year, there was no difference in atrophy grade between both groups nor in the percentage of patients showing an increased atrophy grade (14% tubular vs. 18% conventional). The postoperative low-back pain scores on the VAS improved in both groups, although the 1-year between-group mean difference of improvement was 3.5 mm (95% CI; 1.4–5.7 mm) in favour of conventional microdiscectomy. In conclusion, tubular discectomy compared with conventional microdiscectomy did not result in reduced muscle injury. Postoperative evaluation of CPK and the multifidus muscle showed similar results in both groups, although patients who underwent tubular discectomy reported more low-back pain during the first year after surgery.     

Fitness for work after surgery for lumbar disc herniation: a retrospective study

This report retrospectively evaluates fitness for work in 3956 cases of surgery for lumbar disc herniation between 1992 and 1994. Patient records were derived from a database including all interventions of the insured population of the largest Belgian sickness fund. The datafile consisted of 126 cases of percutaneous nucleotomy (nucleotomy group), 286 cases of lumbar disc surgery with fusion (fusion group) and 3544 cases of standard lumbar disc surgery (standard group). Fitness to resume work within 12 months after intervention was obtained in about 70% of the patients in the standard and nucleotomy groups but in only 45% of the patients in the fusion group. Ten medicosocial factors were related to fitness for work as outcome measure. Incapacity for work more than 12 months after intervention was defined as a bad outcome. Logistic regression was used to test the combined relative significance of the different variables. For the standard group a long duration of work incapacity before intervention, older age, lower benefit, employment as a blue-collar worker, a long duration of hospital stay and unemployment were significantly associated with a poor outcome. Related factors for the fusion group were a long duration of work incapacity before operation, a long duration of hospital stay and unemployment. For the nucleotomy group, no factor was significantly associated with a poor outcome. For the total group, discectomy combined with fusion was significantly related to a poor outcome whereas a standard discectomy and a percutaneous nucleotomy did not differ in their impact on fitness for work. Received: 12 February 1997 Revised: 26 July 1997 Accepted: 23 August 1997     

Can exercise therapy improve the outcome of microdiscectomy?

STUDY DESIGN: A prospective randomized controlled trial of exercise therapy in patients who underwent microdiscectomy for prolapsed lumbar intervertebral disc. Results of a pilot study are presented. OBJECTIVE: To determine the effects of a postoperative exercise program on pain, disability, psychological status, and spinal function. SUMMARY OF BACKGROUND DATA: Microdiscectomy is often used successfully to treat prolapsed lumbar intervertebral disc. However, some patients do not have a good outcome and many continue to have low back pain. The reasons for this are unclear but impairment of back muscle function due to months of inactivity before surgery may be a contributing factor. A postoperative exercise program may improve outcome in such patients. METHODS: Twenty patients who underwent lumbar microdiscectomy were randomized into EXERCISE and CONTROL groups. After surgery, all patients received normal postoperative care that included advice from a physiotherapist about exercise and a return to normal activities. Six weeks after surgery, patients in the EXERCISE group undertook a 4-week exercise program that concentrated on improving strength and endurance of the back and abdominal muscles and mobility of the spine and hips. Assessments of spinal function were performed in all patients during the week before surgery and at 6, 10, 26, and 52 weeks after. The assessment included measures of posture, hip and lumbar mobility, back muscle endurance capacity and electromyographic measures of back muscle fatigue. On each occasion, patients completed questionnaires inquiring about pain, disability and psychological status. RESULTS: Surgery improved pain, disability, back muscle endurance capacity and hip and lumbar mobility in both groups of patients. After the exercise program, the EXERCISE group showed further improvements in these measures and also in electromyographic measures of back muscle fatigability. All these improvements were maintained 12 months after surgery. The only further improvement showed by the CONTROL group between 6 and 52 weeks was an increase in back muscle endurance capacity. CONCLUSION: A 4-week postoperative exercise program can improve pain, disability, and spinal function inpatients who undergo microdiscectomy. [Key words: electromyogram median frequency, exercise therapy, intervertebral disc prolapse, microdiscectomy, randomized controlled trial, spinal function.     

Recurrent lumbar disc herniation: results of operative management

STUDY DESIGN: A retrospective evaluation of 28 patients with recurrent lumbar disc herniation. OBJECTIVES: To analyze the outcome of the revisions (repeat discectomy), the risk factors of recurrent disc herniation, and the factors that influenced the outcomes of repeat discectomy. SUMMARY OF BACKGROUND DATA: Recurrent herniation following disc excision has been reported in 5-11% of patients. There have been many studies on recurrent disc herniation, but these studies have analyzed mixed patient populations. METHODS: Recurrent lumbar disc herniation was defined as disc herniation at the same level, regardless of ipsilateral or contralateral herniation, with a pain-free interval greater than 6 months. Eight women and 20 men were studied. The levels of disc herniation were L4-L5 (19 cases) and L5-S1 (9 cases). Gadolinium-enhanced magnetic resonance imaging was performed in all patients. Revision surgery was performed in all patients by using conventional open discectomy. The pain-free interval, side and degree of herniation, operation time, duration of hospital stay, and clinical improvement rate were recorded. RESULTS: The mean pain-free interval was 60.8 months. There were 21 cases of ipsilateral herniation and 7 cases of contralateral herniation. The degrees of herniation in revision were protrusion (14 cases), subligamentous extrusion (3 cases), transligamentous extrusion (8 cases), and sequestration (3 cases). The degrees of herniation in the previous discectomy were protrusion (17 cases), subligamentous extrusion (10 cases), and transligamentous extrusion (1 case). The length of surgery was significantly different (P = 0.003) between the revision surgery and the previous discectomy. There were no significant differences between revision and previous surgery in terms of hospital stay or clinical improvement rates. Age, gender, smoking, professions, traumatic events, level and degree of herniation, and pain-free interval did not affect the clinical outcomes. CONCLUSION: Conventional open discectomy as a revision surgery for recurrent lumbar disc herniation showed satisfactory results that were comparable with those of primary discectomy. Based on the results of this study, repeat discectomy can be recommended for the management of recurrent lumbar disc herniation.     

Retrospective analysis of microsurgical and standard lumbar discectomy

This report retrospectively evaluates 112 cases of microsurgical lumbar discectomy (MICRO) and 35 cases of standard discectomy (STND) performed by one neurosurgeon using data derived from a questionnaire and from chart review. The total amount of postoperative pain medication consumed and postoperative temperature curves in each group were compared to determine how postsurgical morbidity was affected by the MICRO and STND procedures. At a mean follow-up interval of 12.3 and 41 months, 97% of the MICRO respondents reported a good or excellent outcome. Patients with preoperative symptoms exceeding 6 months returned to work in 9.9 +/- 1.7 weeks; this interval decreased to 5.58 +/- 0.75 weeks, and overall outcome score improved significantly at 41 months' follow-up if symptoms were less than or equal to 6 months in duration before surgery. At 44 months' mean follow-up, 88% of the STND respondents reported a good or excellent outcome with no decrease in the return-to-work interval in patients who described symptoms of 6 months or less. Mean postoperative pain medication consumed by MICRO patients was one tenth that of STND patients, and temperature curves showed significant temperature elevations in the STND group when compared with the MICRO group, in which patients remained afebrile throughout the postoperative period. Within the limitations of a retrospective study, these data support the conclusion that a microsurgical approach to the lumbar herniated disc provides a more frequent and rapid convalescence than the STND approach.     

Predictors of return to work after anterior cervical discectomy

Return to previous level of employment after surgery is important to patients. Predictors of return to work have been well described in lumbar disc surgery. However, this information cannot be generalized to the population undergoing cervical discectomy. The authors retrospectively reviewed 67 consecutive patients who underwent anterior cervical discectomy. Strict inclusion criteria were used. Baseline demographics were recorded as well as other potential predictors of postoperative return to work such as number of levels of disease, smoking history, and disability claims. Follow-up information about work status was reviewed with each patient at office visit. Forty-five patients were found eligible for the study. At a mean follow-up of 2.8 years (SD 1.4), 38% had not returned to work by 1 year. Preoperative sick leave in this group was significantly greater than for those patients who returned to work within the year (p = 0.0014). Postoperative neck pain was more common in individuals who did not return to work after surgery (p = 0.01). Increasing age and disability claims also appeared to negatively impact the ability to return to work. Gender, type of work, smoking history, and number of levels of disc disease did not appear to have any association with postoperative return to work. The authors conclude that the duration preoperative sick leave and postoperative neck pain negatively impact postoperative work status in patients undergoing anterior cervical discectomy. Age and disability claims also influence return to work.     

显微外科微创技术与传统手术治疗腰椎间盘突出症的比较观察

目的 探讨与传统椎间盘摘除术相比,显微外科微创技术治疗腰椎间盘突出症的手术疗效和优缺点.方法 回顾性分析2008年1月至2010年1月因腰椎间盘突出症采用显微腰椎间盘摘除术(40例)和传统后路椎板开窗术(48例)病例的手术时间、术中出血、术后住院天数和手术疗效.突出间隙:L3～L4突出12例,L4～L5突出46例,L5～S1突出30例.常规术式术前腰椎JOA评分8～19分,平均12.2分.显微外科术式术前腰椎JOA评分7～19分,平均12.7分.结果 2例常规术式术中出现硬脊膜破裂,予缝合修复.所有病例经10～34个月(平均18个月)随访,无神经根损伤、马尾神经损伤及感染等并发症.常规术式术后10个月JOA评分(24.0±2.6)分,优良率为87.5%.显微外科术式术后10个月JOA评分(24.2±2.8)分,优良率为90%.结论 显微技术下单节段腰椎间盘突出症与传统后路椎板开窗手术疗效相近,具有创伤小、术后住院时间短、手术效果确切等优点,同时进一步减少了术中出血量.是一种治疗单节段腰椎间盘突出症的理想的微创术式.

Abstract：

Objective To discuss the surgical outcome of fenestration assistant by microscopy for single-level lumbar disc protrusion (LDH), compared with tradition laminotomy and discectomy. Methods From January 2008 to January 2010, forty-eight patients underwent traditional open discectomy and 40 underwent microscopy surgery. The lumbar disc protrusion involved L3- L4 level in 12 cases, L4-L5 level in 46 cases, and L5-S1 level in 30 cases; preoperative JOA score was 8-19 points (average 12.9 points) for traditional open discectomy patients and 7-19 points (average 12.7 points) for microscopy surgery patients. Results Cauda equina injury was occurred and repaired in 2 cases in traditional surgery group. The follow-up period was 10-34 months (average 18 months) for all patients. No complications such as wrong orientation, nerve root injury, and infection occurred. The JOA score 10 months after operation was (24.0 ± 2.6) for traditional surgery patients with 87.5% success rate and (24.2 ± 2.8) for microscopy surgery patients with 90% success rate. Conclusion Two methods have similar clinical outcomes, but microscopy assistant fenestration for LDH has advantages of minimal invasion, shorter operative time, shorter length of hospital stay and less intraoperative blood loss. It is one of ideal minimally invasive operations for single-level lumbar disc protrusion.     

The functional relevance of neurological recovery after lumbar discectomy: a follow-up of more than 20 years

We have studied 180 patients (128 men and 52 women) who had undergone lumbar discectomy at a mean of 25.4 years (20 to 32) after operation. Pre-operatively, most patients (70 patients; 38.9%) had abnormal reflexes and/or muscle weakness in the leg (96 patients; 53.3%). At follow-up 42 patients (60%) with abnormal reflexes pre-operatively had fully recovered and 72 (75%) with pre-operative muscle impairment had normal muscle strength. When we looked at patient-reported outcomes, we found that the Short form-36 summary scores were similar to the aged-matched normative values. No disability or minimum disability on the Oswestry disability index was reported by 136 patients (75.6%), and 162 (90%) were satisfied with their operation. The most important predictors of patients' self-reported positive outcome were male gender and higher educational level. No association was detected between muscle recovery and outcome. Most patients who had undergone lumbar discectomy had long-lasting neurological recovery. If the motor deficit persists after operation, patients can still expect a long-term satisfactory outcome, provided that they have relief from pain immediately after surgery.