Multiple disc herniations in spondyloepiphyseal dysplasia tarda. A case report.
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Spondyloepiphyseal dysplasia (SED) tarda is a group of inherited dysplasias in which the spine and the epiphyses of long bones are affected from late childhood. A 19-year-old male was diagnosed as SED tarda. He had a thoracic and then lumbar disc herniations which were separated by a 4-year interval. Surgical excision was performed for each disc herniation. This is the first case report of multiple disc herniations in SED. (+info)
Ten- to 15-year outcome of surgery for lumbar disc herniation: radiographic instability and clinical findings.
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The most appropriate treatment for radiculopathy associated with disc pathology is still controversial. Since 1934, surgical treatment has consisted of hemilaminectomy and removal of the herniated material. Many authors believe that these procedures may cause degenerative spondylosis and vertebral instability. Several surgical methods have been proposed, but the long-term effects are still being debated. In addition there appear to be few well-designed outcome studies on the management of this disease. In the present study, 150 patients were selected for surgery with strict criteria and all treated with the standard technique. The series was evaluated by subjective analyses (Roland questionnaire; 120 patients), objective examinations (68 patients - 56.6%) and radiographic studies including dynamic views (analyzed by the Taillard and Boxall methods) to establish the presence of vertebral instability (50 patients - 41.6%). The subjective and objective analyses showed a high rate of good results. Radiographic studies showed vertebral instability in 30 cases, but only 9 were symptomatic. Recurrences were not observed and only a few patients suffered from leg pain. The standard procedure for lumbar disc herniation showed good results at 10- and 15-year follow-up. (+info)
Prognostic criteria for work resumption after standard lumbar discectomy.
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The purpose of this study was to determine prognostic criteria for return to work 9-12 years after standard nucleotomy for herniated nucleus pulposus confirmed by CT. From 1985 until 1988, 182 patients (102 male, 80 female, mean age 45 years) with a single-level herniated nucleus pulposus were operated on for the first time. In summer 1997, an average of 10.2 years after the operation, 101 of 182 patients (55.5%) returned a standardised questionnaire. Eighteen patients (9.8%) had died during the intervening years, while 63 patients (34.6%) were lost to follow-up because of moving to other cities. Two groups could then be distinguished: group I worked full time in their usual job; group II did not. The influence of the degree of the paresis, time elapsed since the occurrence, intraoperative findings, age, sex, weight, type of work and re-operations were analysed statistically. Group I consisted of 44 patients who still worked full time in their usual job. Group II contained 57 patients, of whom 18 worked only part of the time, 9 had changed to a lighter full-time job, 23 had taken early retirement, and 7 were receiving a pension. Patients in group I were significantly younger (38 vs. 51 years), had a smaller proportion of patients with more than 20% overweight (27% vs. 44%), had a smaller proportion of severe, grade 0 and 1, motor dysfunction (0% vs. 16.3%), had been operated sooner (within 3 days: 52.3% vs. 19.3%), had undergone fewer re-operations for recurrence of the herniation (4.5% vs. 21.1%), and had worked less frequently in physically demanding jobs (6.7% vs. 22.8%). We concluded that when there is a relative indication for herniated nucleus pulposus surgery, it should be limited to patients aged below 40 years, with slight motor dysfunction, who work in physically undemanding jobs, so as to make a satisfactory long-term result more likely. (+info)
Is there a rational basis for post-surgical lifting restrictions? 1. Current understanding.
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Lifting restrictions postoperatively are quite common, but there appears to be little scientific basis for them. Lifting restrictions are inhibitory in terms of return to work and may be a factor in chronicity. The mean functional spinal motion unit stiffness changes with in vitro or computer-simulated discectomies, facetectomies and laminectomies were reviewed from the literature. We modified the NIOSH lifting equation to include another multiplier related to stiffness change post surgery. The new recommended lifts were computed for different lifting conditions seen in industry. The reduction of rotational stiffness ranged from 21% to 41% for a discectomy, 1% to 59% for a facetectomy and 4% to 16% for a partial laminectomy. The recommended lifts based on our modified equation were adjusted accordingly. There is no rational basis for current lifting restrictions. The risk to the spine is a function of many other variables as well as weight (i.e., distance of weight from body). The adjusted NIOSH guidelines provide a reasonable way to estimate weight restrictions and accommodations such as lifting aids. Such restrictions should be as liberal as possible so as to facilitate, not prevent, return to work. Patients need more advice regarding lifting activities and clinicians should be more knowledgeable about the working conditions and constraints of a given workplace to effectively match the solution to the patient's condition. (+info)
Is there a rational basis for post-surgical lifting restrictions? 2. Possible scientific approach.
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Lifting restrictions postoperatively are quite common but there appears to be little scientific basis for them. Lifting restricitions are inhibitory in terms of return to work and may be a factor in chronicity. The mean changes in functional spinal motion unit (FSU) stiffness with in vitro or computer-simulated discectomies, facetectomies and laminectomies were reviewed from the literature. We modified the NIOSH lifting equation to include another multiplier related to stiffness change post surgery. The new recommended lifts were computed for different lifting conditions seen in industry. The reduction of rotational stiffness ranged from 21% to 41% for a discectomy, 1% to 59% for a facetectomy and 4% to 16% for a partial laminectomy. The recommended lifts based on our modified equation were adjusted accordingly. There is no rational basis for current lifting resctrictions. The risk to the spine is a function of many other variables as well as weight (i.e., distance of weight from body). The adjusted NIOSH guidelines provide a reasonable way to estimate weight restrictions and accomodations such as lifting aids. Such resitrictions should be as liberal as possible so as to facilitate, not prevent, return to work. Patients need more advice regarding lifting activities and clinicians should be more knowledgeable about the working conditions and constraints of a given workplace to effectively match the solution to the patient's condition. (+info)
Predictors for work incapacity continuing after disc surgery.
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OBJECTIVES: This study was carried out to provide information on and identify factors about the fitness for work 12 months after disc herniation surgery. In addition a predictive tool for this outcome was developed. METHODS: A selected patient population (N = 177) operated on for lumbar disc herniation from September 1995 until May 1996 was evaluated by medical advisers of a sickness fund. The patients were submitted to a standardized interview about their personal, social, medical, professional, and psychological status. To assess the functional status of the lumbar spine, a standardized clinical examination was used. RESULTS: Eighty-five percent of the patients were employed 1 year after surgery. The most important predictors at 6 weeks after intervention were the estimation of pain according to a visual analogue scale, the patient's prediction of his possibilities to resume work, the Oswestry disability index score, and the Zung depression score. Of the clinical factors, nonorganic signs and sensory disturbances after surgery were negative prognosticators for long-lasting disability. Using the Oswestry score, the Zung score, the patient's own prediction, the score on the Social Readjustment Rating Scale, and the score on the Modified Somatic Perception Questionnaire, 86% of the poor outcomes could be correctly classified. CONCLUSIONS: The Oswestry disability scale and the Zung depression scale should be included in the routine postoperative assessment after disc surgery and the patient's own prediction of his possibility for fitness for work should be taken seriously. If a poor outcome is predicted, the patient is in need of rehabilitation and should be guided more intensely. (+info)
When does the patient with a disc herniation undergo lumbosacral discectomy?
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OBJECTIVES: To design a model that could accurately predict eventual lumbar disc surgery in the patient initially presenting with clinical findings of nerve root compression. METHODS: Prospective study in 183 patients with nerve root compression sampled from a primary care population. All patients underwent a standardised history, physical examination, and MRI. Surgery carried out in the next 6 months was recorded. Models were constructed to predict whether patients eventually received surgery. RESULTS: Two models were constructed. Reduced model A was based on baseline findings, only, and contained six variables. Model B incorporated change over time as well and contained 10 variables. The area under the curve (in a receiver operating characteristic) for these models was 0.86 and 0.92, respectively. It was shown that at a probability cut off of 0.60, model B predicted eventual surgery with a sensitivity of 57% and a specificity of 100%. CONCLUSIONS: Given the requirement of a high specificity, eventual operation could be adequately predicted in a sample of 183 patients with clinical nerve root compression. The application of the model in patients with nerve root compression might lead to earlier operation in a subset of patients resulting in a reduction of duration of illness and associated indirect costs. An important prerequisite for future application would be the validation of the prediction rule in another population. (+info)
The relation between expectations and outcomes in surgery for sciatica.
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OBJECTIVE: To describe the expectations that patients and their physicians have for outcomes after surgical treatment for sciatica and to examine the associations between expectations and outcomes. DESIGN: Prospective cohort study. SETTING/PATIENTS: We recruited 273 patients, from the offices of orthopedic surgeons, neurosurgeons, and occupational medicine physicians in Maine, who had diskectomy for sciatica. MEASUREMENTS AND MAIN RESULTS: Patients' and physicians' expectations were measured before surgery. Satisfaction with care and changes in symptoms and functional status were measured 12 months after surgery. More patients who expected a shorter recovery tJgie after surgery were "delighted," "pleased," or "mostly satisfied" with their outcomes 12 months after surgery than patients who expected a longer recovery tJgie (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1, 4.4). Also, more patients who preferred surgery after learning that sciatica could get better without surgery had good symptom scores 12 months after surgery than patients who did not prefer surgery (OR 2.9; 95% CI 1.2, 7.0). When physicians predicted a "great deal of Jgiprovement" after surgery, 39% of patients were not satisfied with their outcomes and 25% said their symptoms had not Jgiproved. CONCLUSIONS: More patients with favorable expectations about surgery had good outcomes than patients with unfavorable expectations. Physicians' expectations were overly optJgiistic. Patient expectations appear to be Jgiportant predictors of outcomes, and eliciting them may help physicians identify patients more likely to benefit from diskectomy for sciatica. (+info)