Pre-operative Disc Volume Measurement as a Predictor for Sufficient Intra-operative Excision in Lumbar Open Fenestration Discectomies

Lawand Ahmed  Sharif; Areewan MS  Saeed; Shwan Fikrat  Raoof

doi:10.56056/amj.2024.305

Authors

Lawand Ahmed Sharif MBChB Orthopedic Surgery, KHCMS trainee, Department of Orthopedic Surgery, Shar Teaching Hospital, Sulaimaniyah, Republic of Iraq
Areewan MS Saeed MBChB FICMS (Orthopedic), Consultant Orthopedic Surgeon, Assistant Professor at Department of Surgery, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq
Shwan Fikrat Raoof MBChB H.D (Radiologist), Department of Radiology, Shar Hospital, Sulaymaniyah, the Republic of Iraq.

DOI:

https://doi.org/10.56056/amj.2024.305

Keywords:

Intraoperative lumbar disc volume, Preoperative lumbar disc volume

Abstract

Background and objectives: A study was implemented by assessing pre-operative disc volume and compare it to resected disc volume intra-operatively to minimize complications. The purpose of this study is to determine whether preoperative measurement of disc volume by magnetic resonance imaging could estimate the amount of disc need to be removed intraoperatively.

Methods: This prospective cross-sectional study was conducted between 2021 and 2023, in which 44 patients were involved, the volume of the herniated disc. The height, width, and length of prolapsed disc were multiplied together and by 0.523, measured on magnetic resonance imaging machine, intraoperatively the resected disc was placed in the sterile syringe for measurement.

Results: Out of 44 patients, 23 of them were males, and 21 were females. The mean age was 41.4 years. The most common level of involvement was the L4-L5 levels. The size of the herniated disc preoperatively ranged from 0.70 cc to 3.70, among them 72.7% of patients had a measurement between 1.0 cc and 2.0. Intraoperatively, the size of resected disc ranged from 1.0 cc to 4.2, 63.6% of them had volume exceeding 2.0 cc. Our data showed that neither the volume of the herniated disc nor the volume of the resected disc has any correlation to the age, gender and the level of disc involved.

Conclusion: Preoperative measurement of lumbar disc herniation with a magnetic resonance image do not predict the disc volume that needs to be removed during surgery.

Downloads

Download data is not yet available.

References

Kreiner DS, Hwang SW, Easa JE, Resnick D, Baisden J, Bess S et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 2014; 14:180–91.

Fardon DF, Williams AL, Dohring EJ, Murtagh FR, Gabriel Rothman SL, Sze GK. Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014 1;14(11):2525-45.

Fjeld OR, Grøvle L, Helgeland J, Småstuen MC, Solberg TK, Zwart JA, et al. Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation. Bone Joint J. 2019;101-B (4):470-7.

Jegede KA, Ndu A, Grauer JN. Contemporary management of symptomatic lumbar disc herniations. Orthop Clin North Am. 2010; 41:217-24.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine (Phila Pa 1976). 2009 34(10):1078-93.

Shwaluk P. Clinical Anatomy and Management of Low Back Pain. Australas Chiropr Osteopathy. 1997; 6(1):24.

Garfin SR, Rydevik B, Lind B, Massie J. Spinal nerve root compression. Spine (Phila Pa 1976). 1995;20(16):1810-20.

Takahashi H, Wada A, Iida Y, Yokoyama Y, Katori S, Hasegawa K, et al, antimicrobial prophylaxis for spinal surgery. J Orthop Sci. 2009;14(1):40-4.

Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. J Neurol Neurosurg Psychiatry. 2002; 72(5):630-4.

Vucetic N, Svensson O. Physical signs in lumbar disc hernia. Clin Orthop Relat Res. 1996;(333):192-201. PMID: 8981896.

Jordan J, Konstantinou K, O'Dowd J. Herniated lumbar disc. BMJ Clin Evid. 2009; 26; 2009:1118.

Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002; 1;137(7):586-97.

Kim KY, Kim YT, Lee CS, Kang JS, Kim YJ. Magnetic resonance imaging in the evaluation of the lumbar herniated intervertebral disc. Int Orthop. 1993;17(4):241-4.

Pooni JS, Hukins DW, Harris PF, Hilton RC, Davies KE. Comparison of the structure of human intervertebral discs in the cervical, thoracic and lumbar regions of the spine. Surg Radiol Anat. 1986;8(3):175-82.

Kreyszig E. Advanced Engineering Mathematics (3rd ed.), New York: Wiley, ISBN 0-471-50728-8. 1972

Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine (Phila Pa 1976) 1993; 18:1433–8.

Heo JH, Kim CH, Chung CK, Choi Y, Seo YG, Kim DH, et al. Quantity of Disc Removal and Radiological Outcomes of Percutaneous Endoscopic Lumbar Discectomy. Pain Physician. 2017; 20(5): E737-E746.

Unicode Consortium. The Unicode Standard 12.0 – CJK Compatibility Range: 3300—33FF (PDF). Unicode.org. 2019.

Neubert A, Fripp J, Engstrom C, Gal Y, Crozier S, Kingsley MI. Validity and reliability of computerized measurement of lumbar intervertebral disc height and volume from magnetic resonance images. Spine J. 2014 1;14(11):2773-81.

Pfirrmann CW, Metzdorf A, Elfering A, Hodler J, Boos N. Effect of aging and degeneration on disc volume and shape: A quantitative study in asymptomatic volunteers. J Orthop Res. 2006; 24(5):1086-94.

Dammers R, Koehler PJ. Lumbar disc herniation: level increases with age. Surg Neurol. 2002;58(3-4):209-12.

Ali A, Khan SA, Aurangzeb A, Ahmed E, Ali G, Muhammad G, et al. Lumbar disc herniation in patients with chronic backache. J Ayub Med Coll Abbottabad. 2013;25(3-4):68-70.

Junaid M, Rashid MU, Afsheen A, Bukhari SS, Kalsoom A. Analysis of 1058 Lumbar Prolapsed Intervertebral Disc Cases in Two Tertiary Care Hospitals of Pakistan. J Ayub Med Coll Abbottabad. 2016;28(2):281-4.

Strömqvist F, Strömqvist B, Jönsson B, Karlsson MK. Gender differences in patients scheduled for lumbar disc herniation surgery: a National Register Study including 15,631 operations. Eur Spine J. 2016;25(1):162-7.

Ma D, Liang Y, Wang D, Liu Z, Zhang W, Ma T, et al. Trend of the incidence of lumbar disc herniation: decreasing with aging in the elderly. Clin Interv Aging. 2013; 8:1047-50.

Elshiekh H, Inas M. Sweed Pre-operative assessment of the size of the herniated lumbar disc on mri as apredict, surgical outcome. BMFJ 2021;38(1): 368-79.

Negro A, Paolucci A, Russo C, Di Stasi M, Guerriero P, Arrigoni F, et al. Predictive factors of volumetric reduction in lumbar disc herniation treated by O2-O3 chemiodiscolysis. Acta Biomed. 2020; 13;91(8-S):89-97.

Seo JY, Roh YH, Kim YH, Ha KY. Three-dimensional analysis of volumetric changes in herniated discs of the lumbar spine: does spontaneous resorption of herniated discs always occur Eur Spine J. 2016;25(5):1393-402.

Fountas KN, Kapsalaki EZ, Feltes CH, Smisson HF 3rd, Johnston KW, Vogel RL, et al. Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome. Spine (Phila Pa 1976). 2004 15;29(22):2521-4.