Acute disc herniation following surgical decompression of lumbar spinal stenosis: a retrospective comparison of mini-open and minimally invasive techniques.

BACKGROUND: Disc herniation following decompression of lumbar spinal stenosis is a less familiar surgical complication. Previous studies suggested that open lumbar decompression techniques, associated with relative segmental instability especially in the presence of degenerated disc in older patients, are more likely to result in disc herniation compared to minimally invasive techniques. The current study compares the incidence of acute disc herniation following mini-open and minimally invasive decompression of lumbar spinal stenosis. METHODS: This was a retrospective study reviewing 563 patients who underwent spinal decompression for symptomatic lumbar stenosis by mini-open bilateral partial laminectomy technique or minimally invasive laminotomy utilizing a tubular system. Demographic and clinical data were collected and compared between the groups. RESULTS: Postoperative disc herniation rate was significantly lower in the minimally invasive group with 2 of 237 cases (0.8%) versus 19 of 326 cases (5.8%) in the mini-open group (p = 0.002). This finding was more noticeable following multi-level procedures with no case of postdecompression disc herniation in the minimally invasive group compared to 8 of 39 cases (20.5%) in the mini-open group (p = 0.003). CONCLUSION: The incidence of postoperative disc herniation following spinal decompression for symptomatic lumbar stenosis was 5.8% following mini-open bilateral partial laminectomy compared to only 0.8% after minimally invasive laminotomy (p = 0.002). These findings highlight the more extensive nature of mini-open surgery associated with relative segmental instability that poses a greater risk for postoperative disc herniation.

[Lumbar nucleoplasty].

Low back pain (LBP) is one of the common reasons for people to seek treatment from a physician. A familiar cause of LBP and radicular pain is disc bulge or protrusion. The treatment for this indication is diverse and suited to the type pathology and its severity. The treatment can be conservative ranging from a diversity of minimal invasive surgical methods to an open discectomy. The classification of disc herniation is based on the severity of the bulge, whereby the lowest degree is protrusion/ prolapse, then extrusion and the most severe level is sequestered disc. This classification is important when considering the treatment options. One of the known possible treatments for disc protrusion is Nucleoplasty or disc Coblation. This percutaneous surgical method is used to treat discogenic back pain and radicular pain. This method is based on reducing disc volume by using radio frequency energy. During the last decade, many medical centers worldwide used this procedure. In recent years, this method is rising in popuLarity due to its percutaneous approach, low complication rate, good results at the post surgical stage reflecting improvement in symptoms and facilitating rapid return to normal life. The accepted indications for Nucleoplastia are discogenic radicular pain, contained disc herniation according to an MRI scan with intact annulus fibrosus, insufficient response to conservative treatment and absence of a medical emergency as in the case of Cauda Equina syndrome. Patient selection according to those parameters is very important. Today this surgical method is still controversial. In recent years many studies regarding Nucleoplasty have been published, although more research is necessary in order to evaluate long term results and tailor it to the appropriate patient and pathology.

[Sport activity after hip and knee arthroplasty].

Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.