2013, Vol.20, No.4

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03

pISSN : 2093-4378 / eISSN : 2093-4386
https://journal.kci.go.kr/krspine

Study Design: Retrospective study. Objectives: To evaluate the effectiveness of microdiscectomy under local anesthesia in comparison with general anesthesia. Summary of Literature Review: No comparative studies regarding the outcomes of microdiscectomy under local and general anesthesia could be found in the literature. Materials and Methods: Between May 2000 and June 2004, 88 patients who underwent microdiscectomy under local anesthesia (n=50,local anesthesia group) or under general anesthesia (n=38, general anesthesia group) were selected and included in this study with a follow up period more than 3 years. The operation time and duration of hospital stay were documented. The Visual Analogue Scale (VAS)and the Oswestry Disability Index (ODI) were used to evaluate the degree of symptom relief. The patient satisfaction was evaluated using the MacNab’s criteria and postoperative complications. Results: Between both groups there is no significant operation time difference. However, the average hospital stay duration in the general anesthesia group was 7.3 days, while it was 4.7 days in the local anesthesia group (P<0.05). The VAS and ODI scores were improved in both groups. Thirty-two cases (84.2%) of the general anesthesia group and 40 cases (80%) of the local anesthesia group showed satisfied results by the MacNab’s criteria with no statistically significant difference (P>0.05). Three patients in the general anesthesia group and 7 patients in the local anesthesia group needed a reoperation. Conclusions: A microdiscectomy under local anesthesia shows faster recovery period. But it shows also a relative high revision rate. In patients with old age and underlying disease, local anesthesia can be used for the microdiscectomy selectively and careful exploration of the herniated disc is required.

Study Design: Retrospective study. Objective: To compare patients who underwent spinal revision surgery of adjacent segment degeneration with above one and above two vertebral segment preceded by initial spinal fusion surgery. Summary of Literature Review: The adjacent segment disease(ASD) occurs more frequently at the more proximal segment of the spinal fusion. Also, the preexisting degenerative segments (with discs or facet joints) not included in the fusion procedure, fusion segmental sagittal angle, fixed appliances method, gender, and age, have been accepted as the causes. Materials and Methods: The patients were watched over a year after the spinal revision operation followed by initial spinal fusion of single or multiple segments; the subjects were limited to 41 patients. The average age, entity of diseases, average duration between the initial spinal fusion and the revision surgery, multiple clinical and radiographic parameters were evaluated and compared. Results: Using the UCLA grade of intervertebral disc degeneration, the average grade of 1 level upper segment was 2.2 in group A and 1.9in group B without statistical significance(p=0.426). However, the average grade of 2-level upper segment was 1.8 in group A and 2.4 in group B with significant difference(p=0.021). There was no statistical difference in other factors between the two groups. Conclusions: Patients with ASD of above two-vertebral segment after spinal fusion were more severe in disc degeneration than those with ASD of above one vertebral segment before initial spinal fusions.

Study Design: Retrospective study. Objectives: To identify the implementation of self-exercise therapy and analyze the effects of exercise therapy after lumbar discectomy Materials and Methods: Studied 47 patients who underwent partial lumbar discectomy and laminectomy from January, 2009 to December, 2009. They were instructed on 16 kinds of exercise therapy in total from postoperative 1day to postoperative 6weeks. Group A (n=25), whose frequency of outpatient clinic visit is above the average, and Group B (n=22), whose frequency of visit is relatively low;,below 5 times. We tested the visual analog scale (VAS scale) of back, Oswestry disability index and the strength of the two groups before surgery and at postoperative 3, 6, and 12 months. Results: The degree of pain was significantly different (26.6±9.4 and 53.5±18.6) between group A and group B at postoperative 6months. Function of daily life and strength test were significantly different (6.6±4.8 and 11.3±4.0 at group A, 3.6±0.9 and 3.0±1.1 at group B) between the two groups at postoperative 12 months. The characteristics of low compliance patients are low accessibility to the hospital and lack of knowledge on the importance of exercise according to the degree of pain. Conclusion: These results suggested that postoperative exercise program has significant effects on the pain, the function of daily life. It also increases flexibility and strengthens the muscle of patients with high compliance of outpatient clinic visit. The factors influencing the results are the age of patients, the willingness to exercise, and the environment in which each patient lives/resides.