Types of herniated discs and outcomes of lumbar microsurgical discectomy with extended foraminotomy among young Turkish army personnel

Yıl 2018, Cilt: 5 Sayı: 11, 374 - 379, 30.11.2018

Ahmet Eroğlu , Ahmet Günaydın Selçuk Göçmen Serhat Pusat Cem Atabey

https://doi.org/10.17546/msd.476244

https://izlik.org/JA62FB82WK

Öz

Objective: The present study is conducted to evaluate the findings of lumbar disc disease among the young adults who are under hard physical conditions in military service. Materials and Methods: Data of 454 lumbar disc hernia patients who underwent microsurgical discectomy have been analyzed retrospectively. Patients’ age, predisposing factors, duration of symptoms, levels of disc hernia, intraoperative findings, Visual Analog Scores (VAS), and Oswestry Low Back Pain Disability Questionnaire (ODI) data were reviewed from hospital records. Results: All patients had severe radiculopathy. The 78% of the patients were smokers. Nevertheless, all recurrent disc patients (100%, n = 14) were heavy smokers. Majority of the patients (n = 424, 95%) had problem in just one vertebral point and the most common affected vertebral section was L4-L5 (n = 287, 59%). Disc herniation was centrolaterally placed in 94% (n = 425) patients. The mean VAS and ODI scores at final follow-up were 1.52 and 13.25 points with a reduction from a mean preoperative 7.08 and 60.45 points, (P < 0.001). Conclusion: Posterior longitudinal ligaments were intact and mostly centrolateral and subligamentous disc herniation were shown in young adult army personals. The comparable effect of smoking on microvascular circulation at the operation site may be effective on recurrence.

Anahtar Kelimeler

Foraminotomy , lumbar disc herniation , microsurgery

Kaynakça

• 1. Freemont AJ, Watkins A, Le Maitre C, Jeziorska M, Hoyland JA. Current understanding of cellular and molecular events in intervertebral disc degeneration: implications for therapy. J Pathol 2002; 196: 374–379.
• 2. Ameli N, Abbassioun K, Saleh H, Eslamdoost A. Aneurysmal bone cysts of the spine, report of 17 cases. J Neurosurg 1985; 63: 685–690.
• 3. Varlotta GP, Brown MD, Kelsey JL, Golden AL. Familial predisposition for the herniation of a lumbar disc in patients who are less than twenty-one years old. J Bone Joint Surg Am 1991; 73: 124–128.
• 4. Dewing CB, Provencher MT, Riffenburgh RH, Kerr S, Manos RE. The Outcomes of Lumbar Microdiscectomy in a Young, Active Population. Spine 2008; 33: 33–38.
• 5. Smorgick Y, Floman Y, Millgram MA, Anekstein Y, Pekarsky I, Mirovsky Y. Mid- to long-term outcome of disc excision in adolescent disc herniation. Spine 2006; 6: 380–384.
• 6. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 2009; 64: 338-344.
• 7. Kutlay M, Colak A, Simsek H, Yildiz S, Topuz K, Kaya S et al. Antibiotic and hyperbaric oxygen therapy in the management of post-operative discitis. Undersea Hyperb Med 2008; 35: 427-440.
• 8. Postacchini F. Management of herniation of the lumbar disc. J Bone Joint Surg Br 1999; 81: 567–576.
• 9. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study. Spine 2005; 30: 927–935.
• 10. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 2003; 85: 102–108.
• 11. Findlay GF, Hall BI, Musa BS, Oliveira MD, Fear SC. A 10-year follow-up of the outcome of lumbar microdiscectomy. Spine 1998; 23: 1168–1171.
• 12. Loupasis GA, Stamos K, Katonis PG, Sapkas G, Korres DS, Hartofilakidis G. Seven- to 20-year outcome of lumbar discectomy. Spine 1999; 24: 2313–2317.
• 13. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood EA, Abdu WA et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA 2006; 296: 2451–2459.
• 14. Varlotta GP, Brown MD, Kelsey JL, Golden AL. Familial predisposition for the herniation of a lumbar disc in patients who are less than twenty-one years old. J Bone Joint Surg Am 1991; 73: 124-128.
• 15. Matsui H, Kanamori M, Ishihara H, Yudoh K, Naruse Y, Tsuji H. Familial predisposition and clustering for juvenile lumbar disc herniation. Spine 1992; 17: 1323–1328.
• 16. Nemoto Y, Matsuzaki H, Tokuhasi Y, Okawa A, Uematu Y, Nishimura T et al. Histological changes in intervertebral discs after smoking and cessation: experimental study using a rat passive smoking model. J Orthop Sci 2006; 11: 191-197.
• 17. Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine 2002; 27: 313–319.
• 18. Battie MC, Videman T, Gill K, Moneta GB, Nyman R, Kaprio J et al. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine 1991; 16: 1015–1021.
• 19. Leboeuf-Yde C, Kyvik KO, Bruun NH. Low back pain and lifestyle. Part I: Smoking. Information from a population-based sample of 29,424 twins. Spine 1998; 23: 2207-2213.
• 20. Akmal M, Kesani A, Anand B, Singh, A, Wiseman M, Goodship A. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine 2004; 29: 568-575.
• 21. Oda H, Matsuzaki H, Tokuhashi Y, Wakabayashi K, Uematsu Y, Iwahashi M. Degeneration of intervertebral discs due to smoking: experimental assessment in a rat-smoking model. Orthop Sci 2004; 9: 135-141.
• 22. Kurihara A, Kataoka O. Lumbar disc herniation in children and adolescents. A review of 70 operated cases and their minimum 5-year follow-up studies. Spine 1980; 5: 443–451.
• 23. Takeshima T, Kambara K, Miyata S, Ueda Y, Tamai S. Clinical and radiographic evaluation of disc excision for lumbar disc herniation with and without posterolateral fusion. Spine 2000; 25: 450–456.
• 24. Brown E, Matthes JC, Bazan C 3rd, Jinkins JR. Prevalence of incidental intraspinal lipoma of the lumbosacral spine as determined by MRI. Spine 1994; 19: 833–836.
• 25. Fraser RD, Sandhu A, Gogan WJ. Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation. Spine 1995; 20: 710–714.
• 26. Haijiao W, Koti M, Smith FW, Wardlaw D. Diagnosis of lumbosacral nerve root anomalies by magnetic resonance imaging. J Spinal Disord Tech 2001; 14: 143–149.
• 27. Prestar FJ. Anomalies and malformations of lumbar spinal nerve roots. Minim Invas Neurosurg 1996; 39: 133–137.
• 28. Ito T, Takano Y, Yuasa N. Types of lumbar herniated disc and clinical course. Spine 2001; 26: 648–651.
• 29. Scapinelli R. The meningovertebral ligaments as a barrier to side-to-side migration of extruded lumbar disc herniations. Acta Orthop Belg 1992; 58: 436-441.
• 30. Martinez Quinones JV, Aso J, Consolini F, Arregui R. Long-term outcomes of lumbar microdiscectomy in a working class sample. Neurocirugia (Astur) 2011; 22: 235-244.