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Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation
Murat Ulutaş1, Kadir ÇInar, Mehmet Seçer
1Sanko University Konukoglu hospital, Department of Neurosurgery Gaziantep, Turkey Dr Ersin Arslan Research and Training Hospital Department of Neurosurgery, Gaziantep, Turkey.
Abstract:
Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH.Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy.The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period.The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to the absence of early radicular pain.
Insights
A combined surgical approach effectively reduces postoperative radicular pain in multifocal disc herniation (MFDH). Transforaminal lumbar interbody fusion (TLIF) with unilateral stabilization also significantly alleviates pain, offering alternatives for MFDH treatment.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Postoperative radicular pain is a significant challenge following surgery for multifocal disc herniation (MFDH).
- Evaluating treatment efficacy for MFDH is crucial for improving patient outcomes.
Purpose of the Study:
- To compare a combined surgical approach (translaminar and far lateral) with unilateral stabilization for managing early postoperative radicular pain in MFDH patients.
- To assess the long-term effectiveness of these surgical techniques on radicular pain.
Main Methods:
- Retrospective review of 20 MFDH cases, analyzing visual analogue scale (VAS) pain scores.
- Group 1: 13 patients treated with a combined approach.
- Group 2: 7 patients treated with transforaminal lumbar interbody fusion (TLIF) and unilateral stabilization after facetectomy.
Main Results:
- The combined approach showed VAS score improvements of 50.4% (early) and 72% (late).
- TLIF with unilateral stabilization demonstrated VAS score improvements of 75% (early) and 83.3% (late).
- Both methods significantly reduced radicular pain, with TLIF/unilateral stabilization showing slightly greater improvement.
Conclusions:
- The combined approach is an effective treatment option for MFDH.
- TLIF and unilateral segmental stabilization offer substantial decompression and pain relief.
- Minimizing chemical mediators in the dorsal root ganglion may contribute to reduced early radicular pain.
