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Arockia Doss, Ross Van Der Wal, Paul Bannan, and Constantine Chris Phatouros

This 78-year-old woman presented with a 5-day history of rapidly progressive loss of vision, proptosis, chemosis, complete ophthalmoplegia, and raised intraocular pressure (36 mm Hg) in the left eye. She described having mild double vision and discomfort of the left eye several weeks prior. A day prior to symptom onset she had undergone an open lumbar discectomy during which she had been placed prone with her head turned to one side and down. Her blood pressure and pulse rate were within normal limits throughout the procedure. An indirect dural

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Cesare Zoia, Daniele Bongetta, Cristiano Alicino, Marcella Chimenti, Raffaelino Pugliese, and Paolo Gaetani

F our of 5 adults are affected by low-back pain at some point in their lives, and its most common cause, if associated with severe leg pain, is the presence of intracanal prolapsed intervertebral disc material. 9 If conservative management is not successful, the most routinely performed surgical procedure is lumbar discectomy, which accounts for more than 280,000 procedures per year in the United States. 14 The outcome satisfaction rates are uniformly reported as quite high in the short-term to midterm (up to 75% at 6–8 weeks), irrespective of the many

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Khoi D. Than, Jill N. Curran, Daniel K. Resnick, Christopher I. Shaffrey, Zoher Ghogawala, and Praveen V. Mummaneni

hemilaminectomy and discectomy usually provides symptomatic relief. FIG. 1. Axial T2-weighted MR image of a symptomatic L4–5 disc herniation. The prevalence of lumbar radiculopathy is estimated at 3%–5%. 15 A more recent epidemiological study of a prospectively collected database in the United States military determined the incidence of lumbar radiculopathy to be 4.86 per 1000 person-years in this population. 12 Risk factors for the development of lumbar radiculopathy included female sex, white race, and age. In the US, approximately 300,000 lumbar discectomies

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Oluwaseun O. Akinduro, Brandon A. Miller, Diogo C. Haussen, Gustavo Pradilla, and Faiz U. Ahmad

L umbar disc herniation can lead to debilitating pain and discomfort. The surgical treatment of choice for acute disc herniation without spondylolisthesis is lumbar discectomy. Approximately 2 of every 1000 Medicare patients will undergo lumbar laminectomy with or without discectomy. 35 Even after discectomy, some patients continue to experience radicular pain. Many surgeons administer epidural steroids intraoperatively over the exposed dura and/or nerve root after discectomy to decrease postoperative pain. There is considerable variability among surgeons

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Ralph Rahme, Ronald Moussa, Rabih Bou-Nassif, Joseph Maarrawi, Tony Rizk, Georges Nohra, Elie Samaha, and Nabil Okais

period following lumbar discectomy, 2 , 34 the long-term impact of this procedure on the natural history of MCs remains unknown. Methods Study Population Between January 2004 and December 2005, 97 patients with a virgin (previously nonoperated) lumbar spine were operated on by the senior author (N.O.) for symptomatic lumbar disc herniation using a standard single-level microsurgical lumbar discectomy. These patients were contacted and invited to return for clinical evaluation and repeat MR imaging in 2007 and 2008. Of 54 consenting patients, 13 were excluded

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Atman Desai, Perry A. Ball, Kimon Bekelis, Jon D. Lurie, Sohail K. Mirza, Tor D. Tosteson, and James N. Weinstein

I ncidental durotomy is an infrequent, but well-recognized complication of lumbar discectomy. Various series have estimated the incidence of unintentional durotomy during lumbar spine surgery to be between 1% and 17%, 1 , 2 , 4 , 9 , 12–19 , 21–27 , 30 with higher incidence rates associated with repeat surgery, increased patient age, and reduced surgeon experience. 4 , 7–9 , 13 , 25 , 27 Various sequelae from dural tears in the lumbar spine have been reported, including spinal headaches, meningeal pseudocyst formation, and dural-cutaneous CSF fistulas

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Michael J. Ebersold, Lynn M. Quast, and Anthony J. Bianco Jr.

reviews contain a large number of patients in their late teens. Less than 3% of all lumbar disc operations are performed on patients younger than 20 years, although a single report of a group of Japanese adolescents suggested a higher percentage. 10 In a recent review of 9991 lumbar discectomies performed at the Mayo Clinic, only 0.5% of the patients were 16 years old or younger. 5 For further evaluation of the clinical and surgical aspects of lumbar discectomies in pediatric patients, the records of the 74 patients aged 16 years or younger who underwent discectomies

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Yong Ahn, Jin Uk Kim, Byung Hoi Lee, Sang-Ho Lee, Jong Dae Park, Dong Hyun Hong, and June Ho Lee

. Kim, and I. S. Cho for the help in preparing the manuscript and figures. References 1 Ahn Y , Lee SH , Park WM , Lee HY : Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note . J Neurosurg 99 : 3 Suppl 320 – 323 , 2003 2 Ahn Y , Lee SH , Park WM , Lee HY , Shin SW , Kang HY : Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases . Spine 15 : E326 – E332

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Peter D. Angevine and Paul C. McCormick

Lumbar discectomy is generally performed to reduce pain or disability and thereby improve quality of life. Important surgery-related results, therefore, include the patients' perceptions of the effect of surgery on their health and ability to perform daily tasks. Spine surgeons should have an understanding of basic concepts of outcome measurement and be able to select appropriate questionnaires and incorporate them into their clinical practices and research. A brief review of the fundamental principles of outcome research is presented, and the recent lumbar discectomy literature concerning these ideas is summarized. Properly designed, conducted, and reported outcome studies of lumbar discectomy will assist the spine surgeon in selecting appropriate patients for surgery, educating them regarding expected results, and comparing this procedure with novel treatments for lumbar disc disease.

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Robert G. Whitmore, Jill N. Curran, Zarina S. Ali, Praveen V. Mummaneni, Christopher I. Shaffrey, Robert F. Heary, Michael G. Kaiser, Anthony L. Asher, Neil R. Malhotra, Joseph S. Cheng, John Hurlbert, Justin S. Smith, Subu N. Magge, Michael P. Steinmetz, Daniel K. Resnick, and Zoher Ghogawala

in early improvement of symptoms. 2 , 8 , 20 , 22 , 28 Patient-reported outcomes data on the surgical treatment of lumbar disorders are of significant interest to numerous parties, including patients, clinicians, payers, and policy-makers. In 2010, the Neurosurgery Patient Outcomes IN Treating Spinal Disorders (NeuroPoint-SD) project was designed to establish a multicenter cooperative group to prospectively collect patient outcomes data on the surgical treatment of lumbar spinal disorders, including lumbar discectomy. Based on data from this registry, it was