Sciatica Presentations and Predictors of Poor Outcomes Following Surgical Decompression of Herniated Lumbar Discs: A Review Article.

Pain associated with sciatica is one of the most common indications for surgery. The annual rate of discectomy has increased over recent years, with a significant number of patients reporting a poor outcome or symptom recurrence after surgery. This study aims to evaluate the predictors of poor outcome for patients undergoing lumbar discectomy for sciatica. A comprehensive search was conducted to find relevant literature published between 1985 and 2019. All literature with a clear methodology were included. Many factors that affect postoperative recovery after lumbar discectomy have been reported. Some evidence suggests that sociodemographic factors, including female gender, smoking, increased age, low socioeconomic status, and low education level may be associated with less favorable outcomes after surgery. Symptom duration does not appear to be associated with a significant difference in long-term outcomes; however, early surgery (within one year) may result in a faster postoperative recovery with better early results. Furthermore, patients who had discectomy for predominant leg pain had better outcomes compared to those who had the surgery for back pain as the main presentation. There was no evidence to suggest a correlation between the size of the herniated disc and long-term outcomes of sciatica; however, a higher anatomical level of herniation (L1-2, L2-3) was associated with poorer outcomes compared to the lower level of herniation (L3-4, L4-5). A few studies suggested slow postoperative recovery correlates with unemployment and depression. We recommend that the predictors of postoperative outcomes should be taken into consideration when selecting or counseling patients for lumbar disc decompression.

Determination of the postoperative limb alignment following a high tibial osteotomy in patients with uni-compartmental knee osteoarthritis, review article.

OBJECTIVES: High tibial osteotomy is an established surgical procedure for treatment of mal-aligned Varus knees due to medial compartment knee osteoarthritis. Aims are to evaluate whether post-operative axial alignment achieves good long-term results. METHODS AND RESULTS: Literature search done and studies with a follow up period of 2 or more years were included. The mean postoperative mechanical axis varied widely from 3 to 16° with significant differences between the studies. CONCLUSION: The results suggested that medial knee osteoarthritis can be treated successfully with HTO. The post-operative valgus angle should be between 3 and 13° of valgus to achieve good long-term results.

Medium-term outcome of posterior surgery in the treatment of non-tuberculous bacterial spinal infection.

OBJECTIVE: to evaluate the outcome of posterior spinal stabilization surgery for the management of bacterial spinal infection. METHODS: 21 patients with bacterial infection were managed surgically with posterior stabilization. Outcome measures included neurological status. Follow-up data collected using Spine Tango COMI questionnaires and Euro Qol EQ-5D. RESULTS: The mean improvement in neurological deficits was 0.91 Frankel grade. Residual symptoms of pain had no or minor effect on the work or usual activities in 52% of subjects, with 88% reported having either no or mid problems with mobility. CONCLUSION: Posterior surgery can improve neurological outcome in approximately half of the patients.