Surgery for extraforaminal lumbar disc herniation: a single center comparative observational study

Background Surgery on extraforaminal lumbar disc herniation (ELDH) is a commonly performed procedure. Operating on this type of herniation is known to come with more difficulties than on the frequently seen paramedian lumbar disc herniation (PLDH). However, no comparative data are available on the effectiveness and safety of this operation. We sought out to compare clinical outcomes at 1 year following surgery for ELDH and PLDH. Methods Data were collected through the Norwegian Registry for Spine Surgery (NORspine). The primary outcome measure was change at 1 year in the Oswestry Disability Index (ODI). Secondary outcome measures were quality of life measured with EuroQol 5 dimensions (EQ-5D); and numeric rating scales (NRSs). Results Data of a total of 1750 patients were evaluated in this study, including 72 ELDH patients (4.1%). One year after surgery, there were no differences in any of the patient reported outcome measurements (PROMs) between the two groups. PLDH and ELDH patients experienced similar changes in ODI (- 30.92 vs. - 34.00, P = 0.325); EQ-5D (0.50 vs. 0.51, P = 0.859); NRS back (- 3.69 vs. - 3.83, P = 0.745); and NRS leg (- 4.69 vs. - 4.46, P = 0.607) after 1 year. The proportion of patients achieving a clinical success (defined as an ODI score of less than 20 points) at 1 year was similar in both groups (61.5% vs. 52.7%, P = 0.204). Conclusions Patients operated for ELDH reported similar improvement after 1 year compared with patients operated for PLDH.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Surgery for degenerative cervical myelopathy: a nationwide registry-based observational study with patient-reported outcomes

BACKGROUND: Indications and optimal timing for surgical treatment of degenerative cervical myelopathy (DCM) remain unclear, and data from daily clinical practice are warranted.OBJECTIVE: To investigate clinical outcomes following decompressive surgery for DCM.METHODS: Data were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in the neck disability index (NDI) 1 yr after surgery. Secondary endpoints were the European myelopathy score (EMS), quality of life (EuroQoL 5D [EQ-5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, complications, and perceived benefit of surgery assessed by the Global Perceived Effect (GPE) scale.RESULTS: We included 905 patients operated between January 2012 and June 2018. There were significant improvements in all patient-reported outcome measures (PROMs) including NDI (mean -10.0, 95% CI -11.5 to -8.4, P<.001), EMS (mean 1.0, 95% CI 0.8-1.1, P<.001), EQ-5D index score (mean 0.16, 95% CI 0.13-0.19, P<.001), EQ-5D visual analogue scale (mean 13.8, 95% CI 11.7-15.9, P<.001), headache NRS (mean -1.1, 95% CI -1.4 to -0.8, P<.001), neck pain NRS (mean-1.8, 95% CI-2.0 to-1.5, P<.001), and arm pain NRS (mean -1.7, 95% CI -1.9 to -1.4, P<.001). According to GPE scale assessments, 229/513 patients (44.6%) experienced "complete recovery" or felt "much better" at 1 yr. There were significant improvements in all PROMs for both mild and moderate-to-severe DCM. A total of 251 patients (27.7%) experienced adverse effects within 3 mo.CONCLUSION: Surgery for DCM is associated with significant and clinically meaningful improvement across a wide range of PROMs.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie