Is fusion the most suitable treatment option for recurrent lumbar disc herniation? A systematic review
| Autor: | Zarina Brady, Shahswar Arif, Yavor Enchev, Nikolay Peev |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation 0301 basic medicine medicine.medical_specialty medicine.medical_treatment Operative Time Pain Intervertebral Disc Degeneration 03 medical and health sciences 0302 clinical medicine Discectomy Humans Severe pain Medicine Lumbar Vertebrae business.industry food and beverages Treatment options General Medicine Middle Aged Surgery Endoscopic discectomy Spinal Fusion 030104 developmental biology Neurology Female Neurology (clinical) Lumbar disc herniation business Intervertebral Disc Displacement 030217 neurology & neurosurgery Diskectomy |
| Zdroj: | Neurological Research. 42:1034-1042 |
| ISSN: | 1743-1328 0161-6412 |
| Popis: | Recurrent lumbar disc herniation (rLDH) is a common issue after primary discectomy and can cause severe pain, morbidity, and reoperation. The purpose of this systematic review was to evaluate the surgical management of recurrent lumbar disc herniation.A systematic literature search was conducted using Pubmed and Embase databases on 18Sixteen studies, (comprising of seven prospective and nine retrospective) met the inclusion criteria. Ten studies evaluated discectomy only; four analysed fusion, and two analysed both discectomy only and fusion approaches. Fusion approaches recorded a superior success rate (8.3 % higher, p0.05); postoperative VAS back score improvement (5 % higher, p0.05) than discectomy alone. However, discectomy alone approaches recorded a more favourable postoperative VAS leg score improvement (4.2 % higher p0.05), and complication rate (3.2% lower, p0.05) than fusion techniques.There is significant heterogeneity in clinical outcomes reported for studies after surgical intervention in rLDH patients. Neither discectomy nor fusion's superiority was statistically significant. Despite fusion yielding longer operative times, and length of stay (adding to the expense), it is superior in minimising mechanical instability and recurrence. Finally, we conclude that both approaches are equally efficacious in rLDH cases, and choice should be based on a case by case basis. |
| Databáze: | OpenAIRE |
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