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Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations

BACKGROUND: The observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both...

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Autores principales: Kaner, Tuncay, Sasani, Mehdi, Oktenoglu, Tunc, Cosar, Murat, Ozer, Ali Fahir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier, Inc. 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365639/
https://www.ncbi.nlm.nih.gov/pubmed/25802656
http://dx.doi.org/10.1016/j.esas.2010.06.001
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author Kaner, Tuncay
Sasani, Mehdi
Oktenoglu, Tunc
Cosar, Murat
Ozer, Ali Fahir
author_facet Kaner, Tuncay
Sasani, Mehdi
Oktenoglu, Tunc
Cosar, Murat
Ozer, Ali Fahir
author_sort Kaner, Tuncay
collection PubMed
description BACKGROUND: The observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher rate of recurrent disc herniation and sciatica was observed in all 3 groups in comparison to patients with type I (fragment-fissure) disc hernia. METHODS: In total, 40 single-level lumbar disc herniation cases were treated with limited posterior lumbar microdiscectomy and posterior dynamic stabilization. The mean follow-up period was 32.75 months. Cases were selected after preoperative magnetic resonance imaging and intraoperative observation. We used the Carragee classification system in this study and excluded Carragee type I (fragment-fissure) disc herniations. Clinical results were evaluated with visual analog scale scores and Oswestry scores. Patients’ reherniation rates and clinical results were evaluated and recorded at 3, 12, and 24 months postoperatively. RESULTS: The most common herniation type in our study was type III (fragment-contained), with 45% frequency. The frequency of fragment-defects was 25%, and the frequency of no fragment-contained defects was 30%. The perioperative complications observed were as follows: 1 patient had bladder retention that required catheterization, 1 patient had a superficial wound infection, and 1 patient had a malpositioned transpedicular screw. The malpositioned screw was corrected with a second operation, performed 1 month after the first. Recurrent disc herniation was not observed during the follow-up period. CONCLUSIONS: We observed that performing discectomy with posterior dynamic stabilization decreased the risk of recurrent disc herniations in Carragee type II, III, and IV groups, which had increased reherniation and persistent/continuous sciatica after limited lumbar microdiscectomy. Moreover, after 2 years’ follow-up, we obtained improved clinical results.
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spelling pubmed-43656392015-03-23 Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations Kaner, Tuncay Sasani, Mehdi Oktenoglu, Tunc Cosar, Murat Ozer, Ali Fahir SAS J Dynamic Stabilization BACKGROUND: The observed rate of recurrent disc herniation after limited posterior lumbar discectomy is highest in patients with posterior wide annular defects, according to the Carragee classification of type II (fragment-defect) disc hernia. Although the recurrent herniation rate is lower in both type III (fragment-contained) and type IV (no fragment-contained) patients, recurrent persistent sciatica is observed in both groups. A higher rate of recurrent disc herniation and sciatica was observed in all 3 groups in comparison to patients with type I (fragment-fissure) disc hernia. METHODS: In total, 40 single-level lumbar disc herniation cases were treated with limited posterior lumbar microdiscectomy and posterior dynamic stabilization. The mean follow-up period was 32.75 months. Cases were selected after preoperative magnetic resonance imaging and intraoperative observation. We used the Carragee classification system in this study and excluded Carragee type I (fragment-fissure) disc herniations. Clinical results were evaluated with visual analog scale scores and Oswestry scores. Patients’ reherniation rates and clinical results were evaluated and recorded at 3, 12, and 24 months postoperatively. RESULTS: The most common herniation type in our study was type III (fragment-contained), with 45% frequency. The frequency of fragment-defects was 25%, and the frequency of no fragment-contained defects was 30%. The perioperative complications observed were as follows: 1 patient had bladder retention that required catheterization, 1 patient had a superficial wound infection, and 1 patient had a malpositioned transpedicular screw. The malpositioned screw was corrected with a second operation, performed 1 month after the first. Recurrent disc herniation was not observed during the follow-up period. CONCLUSIONS: We observed that performing discectomy with posterior dynamic stabilization decreased the risk of recurrent disc herniations in Carragee type II, III, and IV groups, which had increased reherniation and persistent/continuous sciatica after limited lumbar microdiscectomy. Moreover, after 2 years’ follow-up, we obtained improved clinical results. Elsevier, Inc. 2010-09-01 /pmc/articles/PMC4365639/ /pubmed/25802656 http://dx.doi.org/10.1016/j.esas.2010.06.001 Text en © 2010 SAS - The International Society for the Advancement of Spine Surgery. Published by Elsevier Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Dynamic Stabilization
Kaner, Tuncay
Sasani, Mehdi
Oktenoglu, Tunc
Cosar, Murat
Ozer, Ali Fahir
Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations
title Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations
title_full Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations
title_fullStr Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations
title_full_unstemmed Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations
title_short Clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: Carragee classification system for lumbar disc herniations
title_sort clinical outcomes after posterior dynamic transpedicular stabilization with limited lumbar discectomy: carragee classification system for lumbar disc herniations
topic Dynamic Stabilization
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365639/
https://www.ncbi.nlm.nih.gov/pubmed/25802656
http://dx.doi.org/10.1016/j.esas.2010.06.001
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