Studies in Failures of Discectomies

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Copyright: Chen, Xiaolong
Abstract
The different discectomy techniques for symptomatic lumbar disc herniation (LDH) patients provide excellent short-term clinical outcomes. However, a high rate of recurrence or complications is observed, which represents a significant burden on healthcare systems worldwide. This thesis presents series of studies investigating a hierarchy of complication rates following different discectomy techniques, and then explores factors like surgical technique variations, altered tissue molecular markers, and disc height (DH) measurements in the context of discectomy. The findings revealed that a plethora of techniques used for measuring disc height index (DHI) were never subjected to the proper evaluation. First, a meta-analysis and network meta-analysis was performed by ranking of complications hierarchy and then evaluating their rates following different discectomy techniques. The findings revealed a 20% complication rates and 10% reoperation rates. Percutaneous endoscopic lumbar discectomy (PELD) had the lowest ranking for complication rates. Subsequently, an online survey of orthopaedic surgeons and neurosurgeons in Australia and New Zealand (ANZ) was conducted. The findings revealed that surgeons’ annual practice volume had important implications in the perception of surgical complications when treating primary LDHs, but there was no significant difference in the selection of surgical techniques. A clinical study demonstrated an association between poor clinical outcome and inflammatory dysregulation in subcutaneous fat overlying the back region. Another systematic review of observational studies to access the pre-post changes in DH showed that discectomy produces significant and quantifiable reductions in DH. A strong association between the reduction in DH and the decrease in LBP after discectomy was observed. Finally, an intra- and inter-rater agreement and reliability on seven previously reported DHI measurement methods revealed four of them as sensitive and valid tools. In summary, PELD offers the lowest complication rates, however, it has a learning curve, that surgeons in ANZ do not have any variation in practice that may impact outcomes of primary discectomy. The subcutaneous fat of patients with poorer outcomes has evidence of inflammation, that DH diminishes after discectomy. In case DH has to be used for a clinical trial evaluating annular closures or nucleus replacement, the issue of concern is the method of reliable measurement.
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Publication Year
2021
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Thesis
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PhD Doctorate
UNSW Faculty
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