1. The effectiveness of non-surgical treatments, re-discectomy and minimally invasive transforaminal lumbar interbody fusion in post-discectomy pain syndrome
- Author
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Mehmet Aydogan, Halil Yener Erken, and Mehmet Nuri Erdem
- Subjects
Sciatica ,Pain syndrome ,medicine.medical_specialty ,Visual analogue scale ,business.industry ,medicine.medical_treatment ,Low back pain ,Surgery ,Oswestry Disability Index ,03 medical and health sciences ,0302 clinical medicine ,Lumbar interbody fusion ,Discectomy ,Etiology ,medicine ,Original Study ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background: There have been many studies that reported various treatment options about recurrent disc herniation, recurrent sciatica, and low back pain following discectomy. However, evaluation and treatment algorithm of post-discectomy pain syndrome (PDPS) could not be standardized. The purpose of this study was to report the results of patients with PDPS who were treated with various treatment options with a minimum 2-year follow-up. Methods: We retrospectively evaluated 54 of 75 patients with PDPS who had no response to 12 weeks of conservative treatment between 2009 and 2014. Fifteen of 21 patients with re-herniation who did not respond to non-surgical treatments benefited from re-discectomy. Twenty-seven patients eventually underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery and 12 patients, who had no need for surgery, responded well to the non-surgical treatments. All patients were evaluated using the 10-point visual analog scale (VAS) and Oswestry Disability Index (ODI) preoperatively and at the post-treatment or postoperative follow-ups. Results: Pre-treatment mean VAS score of the patients who benefited from non-surgical treatments was 7.9. The mean VAS score decreased to 2.1 at the final follow-up. The mean pre-treatment ODI was 46%, which decreased to 25.9% at the final follow-up. Preoperative mean VAS score of the patients who were treated with MIS-TLIF surgery was 8.1. The average VAS score decreased to 1.8 at the final follow-up. The mean preoperative ODI was 48%, which decreased to 24.2% at the final follow-up. Conclusions: Twelve of 54 patients with PDPS regardless of underlying etiology benefited from non-surgical treatments. Fifteen of 21 patients with re-herniation benefited from re-discectomy. MIS-TLIF is found as a highly effective procedure for the relief of post-discectomy pain that is resistant to non-surgical treatment options and for patients who had a second re-herniation.
- Published
- 2018
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