Surgical Outcomes and Recurrence Rates in Far Lateral Lumbar Disc Herniations: A Retrospective Analysis of 91 Cases
Öz
Objective: Far lateral lumbar disc herniations are distinct from intracanal herniations in clinical, radiological, and surgical aspects. This study aimed to assess surgical outcomes and recurrence risk factors for far lateral disc herniations treated with trans pars microsurgery. Methods: Retrospective analysis included patients diagnosed with far lateral disc herniation who underwent Microscopic Transpars Discectomy at our university hospital between 2017 and 2022. Data encompassed demographics, pain characteristics, neurological status, radiological findings, surgical duration, pre/postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, and late postoperative satisfaction rates. Results: Of 91 patients (58.2% men, 41.8% women; mean age 57.42 ± 10.47 years), 76.92% had excellent outcomes, 16.48% good, and 6.5% fair; recurrence occurred in 5.5%. No significant differences were found between recurrent and non-recurrent cases in sex, age, herniation side, operation time, or levels (p > 0.05). Similarly, there were no significant differences in recurrent cases for pre/postoperative VAS (p > 0.05) or ODI scores (p > 0.05). Conclusion: Microdiscectomy performed via transpars intervention is a safe and effective technique for the surgical treatment of far lateral disc herniation; age, sex, herniation level, herniation side, and VAS and ODI scores were not identified as recurrence risk factors.
Anahtar Kelimeler
Far lateral lumbar disc herniaton disc hernia fusion microdiscectomy recurrent herniation
Kaynakça
- Porchet F, Chollet-Bornand A, de Tribolet N. Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg.1999;90(1Suppl):59-66. doi:10.3171/spi.1999.90.1.0059
- Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg. 1995;83(4):648-656. doi:10.3171/jns.1995.83.4.0648
- Mariscal G, Torres E, Barrios C. Incidence of recurrent lumbar disc herniation: A narrative review. J Craniovertebr Junction Spine. 2022;13(2):110-113. doi:10.4103/jcvjs.jcvjs_38_22
- De Bonis P, Mongardi L, Pompucci A, et al. Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc: A Clinical, Radiological, Two-center Study. Spine (Phila Pa 1976). 2017;42(6):E371-E378. doi:10.1097/BRS.0000000000001839
- Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE. Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg.1990;72(3):378-382. doi:10.3171/jns.1990.72.3.0378
- Dogu H, Ozdemir NG, Yilmaz H, Atci IB. Long-term follow-up results of surgically treated patients with foraminal and far lateral disc herniations. Br J Neurosurg.2023;37(1):49-52. doi:10.1080/02688697.2021.1874293
- Monticelli M, Gelmi CAE, Scerrati A, Cavallo MA, De Bonis P. Recurrent or junctional lumbar foraminal herniated disc in patients operated with trans pars microscopic approach [published correction appears in Neurosurg Rev. 2023 Sep 19;46(1):250]. Neurosurg Rev. 2023;46(1):211. Published 2023 Aug 29. doi:10.1007/s10143-023-02109-x
- Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271-273.
- Singh V, Malik M, Kaur J, Kulandaivelan S, Punia S. A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc. Int J Health Sci (Qassim). 2021;15(2):49-57.
- Lübbers T, Abuamona R, Elsharkawy AE. Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level. Acta Neurochir (Wien). 2012;154(10):1789-1795. doi:10.1007/s00701-012-1432-z
- Chang SB, Lee SH, Ahn Y, Kim JM. Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine (Phila Pa 1976)2006;31(10):1163-1167. doi:10.1097/01.brs.0000216431.69359.91
- Park CH, Park ES, Lee SH, et al. Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression. Pain Physician. 2019;22(2):E133-E138.
- Alhashash M, Gendy H, Shousha M. Extra-laminar microscopic-assisted percutaneous nucleotomy (EL-MAPN) for the treatment of foraminal lumbar disc prolapse, a modified minimally invasive approach. Arch Orthop Trauma Surg. 2022;142(10):2405-2411. doi:10.1007/s00402-021-03846-8
- Sasani M, Ozer AF, Oktenoglu T, Canbulat N, Sarioglu AC. Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg. 2007;50(2):91-97. doi:10.1055/s-2007-984383
Far Lateral Lomber Disk Herniasyonlarının Cerrahi Tedavi Sonuçları ve Nüks Oranları: 91 Vakanın Retrospektif Analizi
Öz
Amaç: Far lateral lomber disk herniasyonları klinik, radyolojik ve cerrahi yönlerden kanal içi herniasyonlardan farklılık gösterir. Bu çalışmanın amacı, trans pars mikrodiskektomi tekniği ile cerrahi tedavi uygulanan far lateral disk herniasyonlarının cerrahi sonuçlarını ve nüks risk faktörlerini değerlendirmektir. Yöntem: 2017 ve 2022 yılları arasında üniversite hastanemizde far lateral disk herniasyonu tanısı ve trans pars mikrodiskektomi tekniği ile cerrahi tedavi uygulanan hastalar retrospektif olarak değerlendirilmek üzere çalışmaya dahil edildi. Değerlendirilen veriler; demografik ve ağrı özellikleri, nörolojik durum, radyolojik bulgular, cerrahi süre, ameliyat öncesi/sonrası vizüel analog skala (VAS) ve Oswestry Özürlülük İndeksi (ODI) skorları ve geç dönem postoperatif memnuniyet oranlarını kapsıyordu. Bulgular: 91 hastanın (%58.2 erkek, %41.8 kadın; ortalama yaş 57.42 ± 10.47 yıl), %76.92'si mükemmel, %16.48'i iyi ve %6.5'i orta sonuçlar aldı; nüks %5.5 oranında gözlendi. Nüks eden ve etmeyen vakalar arasında cinsiyet, yaş, taraf, ameliyat süresi veya seviyeler açısından anlamlı farklılık bulunmadı (p > 0.05). Benzer şekilde, ameliyat öncesi/sonrası VAS (p > 0.05) veya ODI skorlarında (p > 0.05) nüks vakaları arasında anlamlı farklılık bulunmadı. Sonuç: Transpars yaklaşım ile mikrodiskektomi, far lateral disk herniasyonun cerrahi tedavisinde güvenli ve etkili bir tekniktir; yaş, cinsiyet, herniasyon seviyesi, herniasyon tarafı ve VAS ile ODI skorları, nüks risk faktörleri olarak tanımlanmadı.
Anahtar Kelimeler
Kaynakça
- Porchet F, Chollet-Bornand A, de Tribolet N. Long-term follow up of patients surgically treated by the far-lateral approach for foraminal and extraforaminal lumbar disc herniations. J Neurosurg.1999;90(1Suppl):59-66. doi:10.3171/spi.1999.90.1.0059
- Epstein NE. Evaluation of varied surgical approaches used in the management of 170 far-lateral lumbar disc herniations: indications and results. J Neurosurg. 1995;83(4):648-656. doi:10.3171/jns.1995.83.4.0648
- Mariscal G, Torres E, Barrios C. Incidence of recurrent lumbar disc herniation: A narrative review. J Craniovertebr Junction Spine. 2022;13(2):110-113. doi:10.4103/jcvjs.jcvjs_38_22
- De Bonis P, Mongardi L, Pompucci A, et al. Transpars Microscopic Approach for the Treatment of Purely Foraminal Herniated Lumbar Disc: A Clinical, Radiological, Two-center Study. Spine (Phila Pa 1976). 2017;42(6):E371-E378. doi:10.1097/BRS.0000000000001839
- Maroon JC, Kopitnik TA, Schulhof LA, Abla A, Wilberger JE. Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine. J Neurosurg.1990;72(3):378-382. doi:10.3171/jns.1990.72.3.0378
- Dogu H, Ozdemir NG, Yilmaz H, Atci IB. Long-term follow-up results of surgically treated patients with foraminal and far lateral disc herniations. Br J Neurosurg.2023;37(1):49-52. doi:10.1080/02688697.2021.1874293
- Monticelli M, Gelmi CAE, Scerrati A, Cavallo MA, De Bonis P. Recurrent or junctional lumbar foraminal herniated disc in patients operated with trans pars microscopic approach [published correction appears in Neurosurg Rev. 2023 Sep 19;46(1):250]. Neurosurg Rev. 2023;46(1):211. Published 2023 Aug 29. doi:10.1007/s10143-023-02109-x
- Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271-273.
- Singh V, Malik M, Kaur J, Kulandaivelan S, Punia S. A systematic review and meta-analysis on the efficacy of physiotherapy intervention in management of lumbar prolapsed intervertebral disc. Int J Health Sci (Qassim). 2021;15(2):49-57.
- Lübbers T, Abuamona R, Elsharkawy AE. Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level. Acta Neurochir (Wien). 2012;154(10):1789-1795. doi:10.1007/s00701-012-1432-z
- Chang SB, Lee SH, Ahn Y, Kim JM. Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine (Phila Pa 1976)2006;31(10):1163-1167. doi:10.1097/01.brs.0000216431.69359.91
- Park CH, Park ES, Lee SH, et al. Risk Factors for Early Recurrence After Transforaminal Endoscopic Lumbar Disc Decompression. Pain Physician. 2019;22(2):E133-E138.
- Alhashash M, Gendy H, Shousha M. Extra-laminar microscopic-assisted percutaneous nucleotomy (EL-MAPN) for the treatment of foraminal lumbar disc prolapse, a modified minimally invasive approach. Arch Orthop Trauma Surg. 2022;142(10):2405-2411. doi:10.1007/s00402-021-03846-8
- Sasani M, Ozer AF, Oktenoglu T, Canbulat N, Sarioglu AC. Percutaneous endoscopic discectomy for far lateral lumbar disc herniations: prospective study and outcome of 66 patients. Minim Invasive Neurosurg. 2007;50(2):91-97. doi:10.1055/s-2007-984383
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Bilişimi ve Bilişim Sistemleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Mart 2024 |
| Gönderilme Tarihi | 14 Ocak 2024 |
| Kabul Tarihi | 22 Mart 2024 |
| Yayımlandığı Sayı | Yıl 2024 |