Lumbar disc herniation surgery with microdiscectomy plus interspinous stabilization: Good clinical results, but failure to lower the incidence of re-operation. (May 2018)

• Record Type: Journal Article
• Authors: Segura-Trepichio, Manuel; Martin-Benlloch, Antonio; Manuel Montoza-Nuñez, Jose; Candela-Zaplana, David; Nolasco, Andreu
• Is Part Of: Journal of clinical neuroscience. Volume 51(2018)
• Page Start: 29
• Page End: 34
• Publication Date: 2018-05
• Subjects: IDSS interspinous dynamic stabilization system -- LOS length of stay -- CI confidence interval -- ICD-10-CM international classification of diseases, tenth revision, clinical modification -- ICD-9-CM international classification of diseases, ninth revision, clinical modification -- BMI body mass index -- CCI Charlson comorbidity index -- CT computed tomography -- ANOVA analysis of variance; Lumbar disc herniation -- Discectomy -- Microdiscectomy -- Patient related outcomes -- Length of stay -- In-hospital costs -- Surgical safety -- Readmission -- Re-operation; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.02.010
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Associate an interspinous system to prevent pain and re-operation is proposed. Clinical outcomes improved, although it seems to be due to microdiscectomy. IDSS implant related complications were frequent. The addition of IDSS did not protect against re-operation. Abstract: Background: Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system (IDSS) in association with disc excision to prevent pain and re-operation, remains controversial. Methods: Patients (age 18–50 years) presenting with lumbago/sciatica (ICD-10-CM M54.3, M54.4) due to voluminous lumbar disc herniation were eligible for participation. Patients underwent microdiscectomy plus IDSS. The primary outcome measure was the clinical efficacy using Owestry disability index(ODI) and visual analogue pain scale (VAS). We also evaluated several other outcome parameters including: length of stay and costs during hospital admission, 90-day complication rate, and 1-year re-operation rate. This prospective observational study was carried out from January 2015 to August 2016. Results: A total of 30 patients whose mean age was 38.6(±9.2) years were included. ODI score dropped from 62.93(±16.45) to 13.50(±16.67), representing 78.54% (95% C.I 68.07–88.66%) improvement of the baseline score after one year (p < 0.001). Patients had 90 day re-admission and 1 year re-operation rates of 4/30(13.3%) and 3/30(10%) respectively. Length of stay was 2.1 ± 1.2 days. In-Hospital cost was 1069.8 ± 288.4 € (not including 1500€ of the implant). Implant related complications were common 12/30(40%), although they did not have any clinical consequences. Conclusion: Our short-term experience indicates that microdiscectomy plus interspinous device is safe and it shows good clinical results, although the clinical improvement seems to be due to microdiscectomy, without the implant adding any extra benefit. The addition of IDSS did not protect against re-operation, and it increased the surgical expenses.