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P109. Arthroscopic microdiscectomy: risk factors for painful postoperative radiculitis
Proceedings of the NASS 18th Annual Meeting / The Spine Journal 3 (2003) 67S–171S CONCLUSIONS: This new technology has the potential to supplant previous C1-2 procedures with improved safety and success. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: J. Patrick Johnson, MD, consultant: Depuy Acromed Inc. doi: 10.1016/S1529-9430(03)00400-5
P109. Arthroscopic microdiscectomy: risk factors for painful postoperative radiculitis William Reed, Jr. MD1,2, Nicholas Ahn, MD2, Cody Harlan, MD3, Harpreet Basran, MD3, Glenn Amundson, MD1,2; 1Heartland Hand and Spine Orthopaedic Center, Overland Park, KS, USA; 2University of Missouri-Kansas City School of Medicine, Overland Park, KS, USA; 3 University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA HYPOTHESIS: The purpose of this study is to determine the incidence of and risk factors for painful postoperative radiculitis after arthroscopic microdiskectomy. METHODS: 284 patients who underwent AMD by the primary author over a two year period were prospectively evaluated, as were 45 patients who underwent open diskectomy by the other authors. All procedures were performed for nonextruded lumbar HNP with radicular symptoms. Information was collected on age, sex, weight, level of herniation, smoking, diabetes, duration of surgery, and preoperative pain score on visual analog scale (VAS) in all patients. Information was also collected on type of disk herniation (foraminal or posterolateral). Postoperative information was collected at 2 weeks, 6 weeks, and 10 weeks during standard visits. Cases of painful postoperative neuritis were noted. Postoperative VAS and return to work were evaluated. Logistic regression analysis was used to determine risk factors for development of painful postoperative neuritis in patients
171S
who underwent AMD. Unpaired t-test was used to compare mean return to work time between patients who underwent open diskectomy vs. AMD. RESULTS: Forty seven patients who underwent AMD (16.5%) complained of moderate to severe postoperative neuritis requiring administration of a steroid taper postoperatively. This was nearly always temporary but was permanent in four patients (1.4%). The most significant risk factor for development of neuritis was duration of surgery. The odds of developing neuritis more than doubled when surgery lasted over 90 minutes (OR⫽3.24, p⫽0.02). Other significant risk factors included diskectomy at L5-S1 and presence of diabetes (p⬍0.05). AMD patients who did not develop neuritis did return to work sooner than did patients in the open diskectomy group (p⫽0.05). However, patients with neuritis had a slower return to work, and overall comparison of the two groups demonstrated no significant difference in return to work time (p⫽0.27). DISCUSSION: Arthroscopic microdiskectomy (AMD) was introduced in 1991 as a minimally invasive means of treating lumbar HNP. The long term results have generally been good and have been similar to those with open diskectomy with shorter duration of postoperative disability. However, even appropriate cannula and instrument placement may cause nerve root irritation which may lead to painful postoperative radiculitis. We studied a large number of AMD procedures which were performed by a single experienced surgeon to determine the risk factors for painful postoperative neuritis. CONCLUSIONS: Postoperative radiculitis is fairly common in patients who undergo AMD and can be very unpleasant for the patient and compromise results. The most significant risk factor for development of painful postoperative radiculitis is extended surgical time which is nearly always due to difficult cannula placement. AMD procedures which last over 90 minutes should be aborted and converted to open diskectomies. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/S1529-9430(03)00401-7
P109. Arthroscopic microdiscectomy: risk factors for painful postoperative radiculitis William Reed, Jr. MD1,2, Nicholas Ahn, MD2, Cody Harlan, MD3, Harpreet Basran, MD3, Glenn Amundson, MD1,2; 1Heartland Hand and Spine Orthopaedic Center, Overland Park, KS, USA; 2University of Missouri-Kansas City School of Medicine, Overland Park, KS, USA; 3 University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA HYPOTHESIS: The purpose of this study is to determine the incidence of and risk factors for painful postoperative radiculitis after arthroscopic microdiskectomy. METHODS: 284 patients who underwent AMD by the primary author over a two year period were prospectively evaluated, as were 45 patients who underwent open diskectomy by the other authors. All procedures were performed for nonextruded lumbar HNP with radicular symptoms. Information was collected on age, sex, weight, level of herniation, smoking, diabetes, duration of surgery, and preoperative pain score on visual analog scale (VAS) in all patients. Information was also collected on type of disk herniation (foraminal or posterolateral). Postoperative information was collected at 2 weeks, 6 weeks, and 10 weeks during standard visits. Cases of painful postoperative neuritis were noted. Postoperative VAS and return to work were evaluated. Logistic regression analysis was used to determine risk factors for development of painful postoperative neuritis in patients
171S
who underwent AMD. Unpaired t-test was used to compare mean return to work time between patients who underwent open diskectomy vs. AMD. RESULTS: Forty seven patients who underwent AMD (16.5%) complained of moderate to severe postoperative neuritis requiring administration of a steroid taper postoperatively. This was nearly always temporary but was permanent in four patients (1.4%). The most significant risk factor for development of neuritis was duration of surgery. The odds of developing neuritis more than doubled when surgery lasted over 90 minutes (OR⫽3.24, p⫽0.02). Other significant risk factors included diskectomy at L5-S1 and presence of diabetes (p⬍0.05). AMD patients who did not develop neuritis did return to work sooner than did patients in the open diskectomy group (p⫽0.05). However, patients with neuritis had a slower return to work, and overall comparison of the two groups demonstrated no significant difference in return to work time (p⫽0.27). DISCUSSION: Arthroscopic microdiskectomy (AMD) was introduced in 1991 as a minimally invasive means of treating lumbar HNP. The long term results have generally been good and have been similar to those with open diskectomy with shorter duration of postoperative disability. However, even appropriate cannula and instrument placement may cause nerve root irritation which may lead to painful postoperative radiculitis. We studied a large number of AMD procedures which were performed by a single experienced surgeon to determine the risk factors for painful postoperative neuritis. CONCLUSIONS: Postoperative radiculitis is fairly common in patients who undergo AMD and can be very unpleasant for the patient and compromise results. The most significant risk factor for development of painful postoperative radiculitis is extended surgical time which is nearly always due to difficult cannula placement. AMD procedures which last over 90 minutes should be aborted and converted to open diskectomies. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: No conflicts. doi: 10.1016/S1529-9430(03)00401-7