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Ankur Saxena and Sam Eljamel

M icrodiscectomy for lumbar intervertebral disc prolapse is one of the most common surgeries performed in neurosurgery worldwide. Minimally invasive techniques are used to remove prolapsed lumbar discs via high-resolution surgical microscopes, better instruments, and endoscopes. This has led to a rapid increase in patient turnover; most patients are discharged within 48 hours after surgery. Previous reports stated that on average, less than 100 ml of blood is lost during lumbar microdiscectomy. It is, however, common practice to “group and save” (type and

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Michael F. Shriver, Jack J. Xie, Erik Y. Tye, Benjamin P. Rosenbaum, Varun R. Kshettry, Edward C. Benzel, and Thomas E. Mroz

verify the claims that MIS techniques for lumbar microdiscectomy are better than conventional methods. 34 Complications related to lumbar microdiscectomy are typically analyzed from an institutional or individual surgeon perspective. 4 , 5 , 31 A systematic review and meta-analysis of complications following the various surgical techniques to perform lumbar microdiscectomy has not been previously performed. Accurate knowledge of complication rates following conventional open, MED, and percutaneous approaches can be used to help educate patients and surgeons during

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Ebru Tarıkçı Kılıç, Tuncay Demirbilek, and Sait Naderi

-level lumbar microdiscectomy before and after we instituted an ERAS pathway. Methods Study Designs This was a retrospective study, involving 120 patients with American Society of Anesthesiologists (ASA) Physical Status Classification of class 1, who underwent single-level lumbar microdiscectomy. Data were collected by manual review of the electronic medical record. All procedures were performed in strict accordance with the principles set by the Declaration of Helsinki. The records of 60 patients who had undergone surgery who were treated just after ERAS implementation (ERAS

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Daniel Huttman, Mathew Cyriac, Warren Yu, and Joseph R. O'Brien

from asymptomatic to high-output cardiac failure that causes death from an undiagnosed arteriovenous fistula (AVF). In this report, we present the case of a patient with AVF and pseudoaneurysm formation after lumbar microdiscectomy. Although these are usually diagnosed late, our patient presented acutely with a pulmonary embolism due to a thrombus that formed at the vascular injury site. Case Report This 35-year-old woman had a body mass index of 28.3 kg/m 2 and no medical history. She experienced intractable right leg pain and weakness that lasted for several

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Claudio Irace and Claudio Corona

such a grim prospect, wrong-disc surgery is sometimes considered inconsequential 21 and not necessarily followed by worsening of a patient's symptoms; preoperative symptoms may even regress. 7 In this report we describe our experience in this matter, explaining our strategy for trying to avoid wrong-level and wrong-side errors in lumbar microdiscectomy. We compare our strategy with the different methods proposed by other authors. Methods Patient Population and Data Between January 1, 2001, and December 31, 2005, 818 consecutive patients underwent lumbar

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Vassilios Dimopoulos, Kostas N. Fountas, Theofilos G. Machinis, Carlos Feltes, Induk Chung, Kim Johnston, Joe Sam Robinson, and Arthur Grigorian

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

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Kevin S. Cahill, Ian Dunn, Thorsteinn Gunnarsson, and Mark R. Proctor

. Length of postoperative hospitalization was also determined. Postoperative complications were defined as any adverse outcome that occurred within the first 30 days after surgery and included new neurological deficit or the need for repeat surgery (1 patient who presented with a CSF leak 2 months after surgery was also included in those with postoperative complications). Long-Term Outcomes The primary long-term outcome was the need for repeat lumbar microdiscectomy or additional lumbar surgery. Repeat interventions were classified at the same level as the

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Jon Kimball, Andrew Yew, and Daniel C. Lu

Symptomatic disc herniation is a common indication for spinal operations. The open microscopic discectomy has been the traditional method of addressing this pathology, but minimally invasive techniques are increasingly popular.

Potential advantages of the MIS microdiscectomy approach include decreased muscle and soft tissue disruption, shorter length of stay and decreased postoperative pain. Here we demonstrate an MIS microdiscectomy on a 24-year-old female with a left L-4 and L-5 radiculopathy secondary to a large L4–5 disc herniation.

The video can be found here: http://youtu.be/aXyZ2FJMh2s.

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Martin N. Stienen, Holger Joswig, Ivan Chau, Marian C. Neidert, David Bellut, Thomas Wälchli, Karl Schaller, and Oliver P. Gautschi

. 15 , 16 In addition, the heterogeneous study designs make it difficult to derive firm conclusions concerning the effectiveness of intraoperative ES application. 26 In view of this controversial debate, 5 , 26 more studies using validated subjective and objective outcome measures are warranted. Therefore, the present study aimed to investigate whether the direct application of ES on the decompressed nerve root during lumbar microdiscectomy improves objective functional impairment (OFI) and subjective clinical outcome. Methods A retrospective review of a

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Jonathan G. Thomas, Steven W. Hwang, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen, and Andrew Jea

= length of hospital stay; min = minimal; MSK = musculoskeletal; RP = radicular pain. † Minimal blood loss was defined as < 5 ml. Discussion Recent reports have indicated that in cohorts of adult patients who undergo surgical and conservative treatment for lumbar disc herniation similar long-term outcomes are exhibited, but the outcome is unknown in children because the treatment has not been studied in the pediatric age group. 9 In the largest series of pediatric patients undergoing lumbar microdiscectomy to date, Cahill et al. 3 noted that although pediatric