• Title/Summary/Keyword: Microdiscectomy

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Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

  • Park, Beom-Seok;Kwon, Young-Joon;Won, Yu-Sam;Shin, Hyun-Chul
    • Journal of Korean Neurosurgical Society
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    • v.48 no.3
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    • pp.225-229
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    • 2010
  • Objective : The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. Methods : Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). Results : The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. Conclusion : Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain.

Small Bowel Injury as a Complication of Lumbar Microdiscectomy : Case Report and Literature Review

  • Kim, Duk-Sung;Lee, Jung-Kil;Moon, Kyung-Sub;Ju, Jae-Kyun;Kim, Soo-Han
    • Journal of Korean Neurosurgical Society
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    • v.47 no.3
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    • pp.224-227
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    • 2010
  • Small bowel injury resulting from unforeseen penetration of the anterior annulus fibrosus and longitudinal ligament is a rare complication of lumbar microdiscectomy. The patient complained of abdominal tenderness and distention immediately after microdiscectomy for L4-5 and L5-S1 disc herniation. Using abdominal computed tomography, we found several foci of air overlying the anterior aspect of the vertebral body at the L5-S1 level. Segmental resection of the small bowel including small tears and primary anastomosis of the jejunum were performed. Here, we present a case of intestinal perforation after lumbar microdiscectomy and discuss technical methods to prevent this complication with a review of literature.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

  • Baek, Geum-Seong;Kim, Yeon-Seong;Lee, Min-Cheol;Song, Jae-Wook;Kim, Sang-Kyu;Kim, In-Hwan
    • Journal of Korean Neurosurgical Society
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    • v.52 no.3
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    • pp.210-214
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    • 2012
  • Objective : This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). Methods : Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. Results : Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. Conclusion : If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

Preliminary Study on Effectiveness of Dexamethasone-Soaked Gelatin Sponges for Reducing Pain after Lumbar Microdiscectomy : A Randomized Controlled Trial

  • Shin, Dong-Ah;Gong, Tae-Sik;Shin, Dong-Gyu;Kwon, Chang-Young;Kim, Hyoung-Ihl
    • Journal of Korean Neurosurgical Society
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    • v.39 no.1
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    • pp.11-15
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    • 2006
  • Objective : A prospective, randomized, controlled clinical study is performed to verify the effectiveness of epidural dexamethasone-soaked gelatin sponges to reduce postoperative pain following lumbar microdiscectomy. Methods : Twenty-three patients (10 men and 13 women) undergoing lumbar microdiscectomy were included. Five pieces of gelatin sponge measuring $1{\times}1cm$ [Gelfoam; Pharmacia & Upjohn. Kalamazoo, MI, USA], soaked with either 5mg dexamethasone or an equal amount [2mL] of saline, were left on the decompressed nerve root after unilateral hemilami-nectomy, flavectomy and discectomy. Results : Subjective visual analog scale[VAS] scores of leg pain in the dexamethasone group on the first, third and first postoperative days [2.5, 2.5, 1.7, respectively] were significantly lower than in the control group [5.0, 4.8, 3.6][P<0.05]. No side effects related to the dexamethasone-soaked gelatin sponges were observed. Conclusion : The intraoperative application of dexamethasone-soaked gelatin sponges during lumber microdiscetomy can provide effective-postoperative analgesia without complications.

Implementation and Outcomes of a Critical Pathway for Lumbar Laminectomy or Microdiscectomy

  • Chung, Sang-Bong;Lee, Sun-Ho;Kim, Eun-Sang;Eoh, Whan
    • Journal of Korean Neurosurgical Society
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    • v.51 no.6
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    • pp.338-342
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    • 2012
  • Objective : The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. Methods : From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. Results : The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference ($p{\leq}0.000$). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). Conclusion : Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.

Analysis of Readmission Patients after Lumbar Microdiscectomy (요추간판 미세 현미경 수술 후 재입원 환자의 분석)

  • Chi, Yong-Chul;Son, Byung-Gil;Choi, Eun-Seok;Lee, Si-Ou;Shin, Jong-Hyun;Cha, Young-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.29 no.6
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    • pp.772-777
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    • 2000
  • Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

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Surgical Tips to Preserve the Facet Joint during Microdiscectomy

  • Park, Man-Kyu;Kim, Kyoung-Tae;Cho, Dae-Chul;Sung, Joo-Kyung
    • Journal of Korean Neurosurgical Society
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    • v.54 no.4
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    • pp.366-369
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    • 2013
  • Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.

Cervical Disc Herniation Producing Acute Brown-Sequard Syndrome

  • Kim, Jong-Tae;Bong, Ho-Jin;Chung, Dong-Sup;Park, Young-Sup
    • Journal of Korean Neurosurgical Society
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    • v.45 no.5
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    • pp.312-314
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    • 2009
  • Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature.

Study on the effect of Post Open laser Lumbar Micro-discectomy on the Cross Section Area of Deep Muscles in Patients (요추부 미세 현미경 레이져 디스크 수술(OLM)이 환자의 심부근육 단면적 크기에 미치는 영향)

  • Kong, Bong-Jun;Kim, Jin-Sang;Min, Dong-Ki
    • PNF and Movement
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    • v.10 no.2
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    • pp.25-31
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    • 2012
  • Purpose : The purpose of this study is to figure out the effects of Open Laser Microdiscectomy(OLM) on deep muscles by comparing multifidus and longissimus muscle size (cross section area; CSA) of pre and post operation. Methods : The subjects consisted of forty patients who had OLM. The data were analyzed with paired t-test comparing left and right deep muscle CSA of pre and post-operation, and both the deep muscle CSA of pre and post-operation, using SPSS ver. 15.0 program. Results : The results of this study showed a significant difference in deep muscle size (CSA) between pre and post operation (p<.05). Although there was not a meaningful difference between right and left deep muscle size (CSA) in pre operation (p>.05), there was a significant difference between both of them in post operation (p<.05). Conclusion : Therefore we made the conclusion that the operation causes decrease of muscle tone in deep muscles and muscle imbalance by causing muscle atrophy in the lumbar deep muscle after the operation.

Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Recurrent Disc Herniation

  • Lee, Dong-Yeob;Shim, Chan-Shik;Ahn, Yong;Choi, Young-Geun;Kim, Ho-Jin;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.46 no.6
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    • pp.515-521
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    • 2009
  • Objective : The purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for recurrent disc herniation. Methods : Fifty-four patients, who underwent surgery, either PELD (25 patients) or repeated OLM (29 patients), due to recurrent disc herniation at L4-5 level, were divided into two groups according to the surgical methods. Excluded were patients with sequestrated disc, calcified disc, severe neurological deficit, or instability. Clinical outcomes were assessed using Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). Radiological variables were assessed using plain radiography and/or magnetic resonance imaging. Results : Mean operating time and hospital stay were significantly shorter in PELD group (45.8 minutes and 0.9 day, respectively) than OLM group (73.8 minutes and 3.8 days, respectively) (p < 0.001). Complications occurred in 4% in PELD group and 10.3% in OLM group in the perioperative period. At a mean follow-up duration of 34.2 months, the mean improvements of back pain, leg pain, and functional improvement were 4.0, 5.5, and 40.9% for PELD group and 2.3, 5.1, and 45.0% for OLM group, respectively. Second recurrence occurred in 4% after PELD and 10.3% after OLM. Disc height did not change after PELD, but significantly decreased after OLM (p = 0.0001). Neither sagittal rotation angle nor volume of multifidus muscle changed significantly in both groups. Conclusion : Both PELD and repeated OLM showed favorable outcomes for recurrent disc herniation, but PELD had advantages in terms of shorter operating time, hospital stay, and disc height preservation.