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Ahmed Bahaa Al Din AlShazli,Ashraf Yassin Amer,Ahmed Maher Sultan,Ahmed Samir Barakat,Wael Koptan,Yasser ElMiligui,Hesham Shaker 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.2
Study Design: This was a prospective case series of 30 patients with post-discectomy syndrome with an average of 18 months of follow-up (level IV). Purpose: The efficacy of post-discectomy syndrome managed by minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) was evaluated. Overview of Literature: In post-discectomy syndrome wherein conservative treatment had failed, the best surgical treatment modality still remains controversial. Methods: Patients were functionally assessed using the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain (LP) and Oswestry Disability Index (ODI). Radiological fusion was confirmed with plain X-rays and when indicated with computed tomography scan at 12 months postoperatively. A total of 30 patients with 37 operated at lumbar levels with failed discectomy surgery who met our inclusion criteria were treated with MIS-TLIF. Results: The ODI of all patients showed significant improvement from a mean of 73.78% preoperatively to 16.67% at 1 month and 14.13% at 12 months postoperatively. The preoperative LBP VAS score (mean, 4.37) showed a significant decrease (p<0.001) to 1.90 at 1 month and 1.10 at 12 months. Preoperative LP VAS score of limb pain averaged 7.53 and showed a significant (p<0.001) decrease to 3.47 at 1 month and 1.10 at 12 months. All patients attained radiological fusion at 12 months. Conclusions: MIS-TILF constitutes a valid and effective treatment option for patients with post-discectomy syndrome.
Mosaad Mohamed,Khozamy Ali,Barakat Ahmed Samir,Emran Ihab,Elmeligy Yasser,Abulhamd Alaa 대한척추외과학회 2023 Asian Spine Journal Vol.17 No.5
Study Design: randomized, prospective, and level I clinical study.Purpose: To compare the clinical outcomes and radiological findings of revision discectomy alone versus revision discectomy with fusion as surgical treatment for recurrent lumbar disc herniation (RDH).Overview of Literature: RDH is a common complication following a primary discectomy. The optimal surgical procedure for RDH is still debated.Methods: Sixty patients with RDH were randomly divided into two equal groups: the first group underwent revision discectomy alone and the second underwent revision discectomy with fusion. The primary outcomes evaluated were Visual Analog Scale (VAS) for low back and limb pains, Oswestry Disability Index (ODI), disc height indexes, foraminal height index, and disc height subsidence. Secondary outcomes included operative time, blood loss, postoperative hospital stay, and complications.Results: Revision discectomy with fusion showed superior pain relief and improved functional outcomes, including better VAS scores for both back and leg pain and ODI at 24-month follow-up. Additionally, it restored the stability of the spine better with lower disc height subsidence without significant complications. However, these advantages came at the cost of increased blood loss and longer operative time and hospital stays.Conclusions: Revision discectomy with fusion is recommended for RDH; however, the choice of the procedure should be made caseby- case basis, considering many factors related to the patient and surgical facilities.