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Lumbar Disc Herniation Surgery - Novel Approaches, Timing and Outcomes

Abstract
Lumbar Disc Herniation Surgery – Novel Approaches, Timing and Outcomes JOEL BECK Department of Orthopaedics, Institute of clinical sciences, Sahlgrenska academy, University of Gothenburg, Sweden, 2021 ABSTRACT BACKGROUND Full Endoscopic Lumbar Discectomy (FELD) is a minimal invasive procedure to treat lumbar disc herniation. A description of the clinical introduction in Sweden and a comparison to other surgical methods is a prerequisite before a widespread national introduction. Mental health status and proper surgical timing have been hypothesized to influence the outcomes after lumbar disc herniation surgery and was investigated in a large national cohort. AIM The purpose of the thesis was to introduce FELD to a larger audience, and to gain further knowledge about important predictors for an unsuccessful result after lumbar disc herniation surgery. STUDY POPULATION The study population contain the first 92 patients having a FELD procedure at the Sahlgrenska University Hospital, Gothenburg, Sweden. They were recruited and compared to controls from the Swedish national spine register – Swespine. Preoperative sciatic pain duration and mental health measured by the EQ-5D were examined for 6216 patient having lumbar disc herniation surgery 2013-2017 and patient reported outcomes were analysed. METHODS The introduction of the FELD procedure was described using a cohort of patients from the Sahlgrenska University Hospital. Postoperative patient reported outcomes measures were compared to matched controls. Preoperative duration of sciatica, anxiety and depression as predictive factors of postoperative residual leg pain and disability was studied in lumbar disc herniation patients. RESULTS The Swedish introduction of FELD was described and the postoperative results were compared to patients having standard surgery for lumbar disc herniation. FELD was able to achieve comparable in post-operative leg pain, satisfaction and disability. An extended duration of sciatica was associated with patients reporting inferior outcomes. A significant proportion of patients that state extreme anxiety and depression preoperatively, fail to improve after lumbar disc herniation surgery. CONCLUSION: The FELD procedure can be introduced with similar results to standard surgery for LDH. A prolonged duration of preoperative sciatica leads to a greater risk of achieving dissatisfied patients with a higher level of residual leg pain. Patients that suffer from anxiety and depression are able to reach the same level of quality of life as other lumbar disc herniation patients, but at a higher risk of not improving and expressing disability or residual leg pain. KEYWORDS FELD, Full Endoscopic Lumbar Discectomy, PELD, Percutaneous endoscopic lumbar discectomy, disc herniation, sciatica, pain duration, discectomy, time-to-surgery
Parts of work
1. Beck J, Westin O, Klingenstierna M, Baranto A. Successful Introduction of Full-Endoscopic Lumbar Interlaminar Discectomy in Sweden. Int J Spine Surg. 2020;14(4):563-570. ::doi::10.14444/7075
 
2. Joel Beck, Olof Westin, Mikael Klingenstierna, Adad Baranto. Full-Endoscopic lumbar discectomy vs standard surgery for lumbar disc herniation - a matched cohort study Submitted
 
3. Beck J, Westin O, Brisby H, Baranto A. Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients. J Neurosurg Spine. 2021;1-9. ::doi::10.3171/2020.8.SPINE20602
 
4. Joel Beck, Olof Westin, Adad Baranto. Don't back down - Lumbar disc herniation surgery for the depressed and anxious In manuscript
 
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Clinical Sciences. Department of Orthopaedics
Disputation
Fredagen den 10 december 2021, kl 9.00, Hjärtats Aula, Sahlgrenska Universitetssjukhuset, Blå Stråket 5, Göteborg
Date of defence
2021-12-10
URI
http://hdl.handle.net/2077/69328
Collections
  • Doctoral Theses / Doktorsavhandlingar Institutionen för kliniska vetenskaper
  • Doctoral Theses from Sahlgrenska Academy
  • Doctoral Theses from University of Gothenburg / Doktorsavhandlingar från Göteborgs universitet
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Thesis frame (1.460Mb)
Abstract (704.5Kb)
Cover (1.956Mb)
Date
2021-11-16
Author
Beck, Joel
Keywords
FELD
Sciatica
Discectomy
Disc Herniation
Full Endoscopic Lumbar Discectomy
PELD
Time-To-Surgery
Pain duration
Percutaneous Endoscopic Lumbar Discetomy
Publication type
Doctoral thesis
ISBN
978-91-8009-518-1 (PRINT)
978-91-8009-519-8 (PDF)
Language
eng
Metadata
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