Our Summary

This study examined the factors that might increase the risk of a patient experiencing a recurrence after undergoing a specific type of back surgery (percutaneous endoscopic lumbar discectomy or PELD) for a common back problem (lumbar disc herniation or LDH). The researchers looked at data from eight different studies and considered several potential risk factors, including the patient’s sex, whether they had changes in their vertebrae (Modic changes), if they had type 2 diabetes, if they smoked, their age, their body mass index (BMI), and the range of motion in their spine.

The results showed that patients were more likely to have a recurrence of their back problem after surgery if they had more Modic changes, were smokers, had type 2 diabetes, were older, had a higher BMI, and had a larger range of motion in their spine. This suggests that these factors may be useful to consider when planning this type of surgery and predicting a patient’s post-surgery outcome. The results were reliable and not significantly affected by bias.

FAQs

  1. What factors increase the risk of recurrence after a percutaneous endoscopic lumbar discectomy (PELD)?
  2. How do Modic changes and type 2 diabetes affect the outcome of a PELD surgery?
  3. How can the patient’s lifestyle habits like smoking and their body mass index affect the results of a PELD surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about discectomy is to quit smoking before undergoing the surgery. Smoking can increase the risk of complications and recurrence after surgery, so quitting can improve the chances of a successful outcome. Additionally, maintaining a healthy weight, managing diabetes effectively, and discussing any changes in the spine with your doctor can also help reduce the risk of recurrence after discectomy.

Suitable For

Patients who are typically recommended for discectomy are those who have tried conservative treatments such as physical therapy, medication, and injections without success, and continue to experience severe pain, weakness, or numbness in the lower back or legs due to a herniated disc pressing on a nerve. Patients with a clear diagnosis of lumbar disc herniation supported by imaging studies such as MRI or CT scans are also good candidates for discectomy. Additionally, patients who are in good overall health and do not have significant medical comorbidities that would increase their surgical risk are typically recommended for discectomy.

Timeline

Before discectomy:

  1. Patient experiences symptoms of lumbar disc herniation, such as lower back pain, leg pain, numbness, and weakness.
  2. Patient undergoes imaging tests, such as MRI or CT scans, to confirm the diagnosis of lumbar disc herniation.
  3. Patient may undergo conservative treatments, such as physical therapy, medications, and epidural steroid injections, to manage symptoms.
  4. If conservative treatments fail to provide relief, patient and their healthcare provider may decide to proceed with discectomy surgery.

After discectomy:

  1. Patient undergoes discectomy surgery to remove the herniated disc material that is compressing the spinal nerves.
  2. Patient may experience some pain and discomfort immediately after surgery, which is typically managed with pain medications.
  3. Patient begins a course of physical therapy and rehabilitation to improve strength, flexibility, and range of motion in the spine.
  4. Patient gradually resumes daily activities and work, with guidance from their healthcare provider.
  5. Patient experiences relief from symptoms of lumbar disc herniation, such as reduced pain, numbness, and weakness in the lower back and legs.
  6. Patient follows up with their healthcare provider for regular check-ups and monitoring of their recovery progress.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a discectomy procedure?
  2. How long is the recovery process after a discectomy surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. What are the success rates of discectomy surgery for treating my specific condition?
  5. Are there any alternative treatments or procedures that I should consider before opting for a discectomy?
  6. How long do the effects of a discectomy typically last before a recurrence may occur?
  7. Are there any lifestyle changes or precautions I should take to reduce the risk of recurrence after surgery?
  8. What is the likelihood of needing additional surgeries in the future after a discectomy?
  9. How soon after the surgery can I return to work or resume normal activities?
  10. Are there any long-term effects or considerations I should be aware of following a discectomy surgery?

Reference

Authors: Jiang L, Xie X, He R, Da J. Journal: J Orthop Surg Res. 2023 Dec 7;18(1):935. doi: 10.1186/s13018-023-04378-0. PMID: 38057884