Factors associated with lumbar disc hernia recurrence after microdiscectomy | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

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Camino Willhuber, G. Kido, M. Mereles, J. Bassani, M. Petracchi, C. Elizondo, M. Gruenberg, C. Sola" "autores" => array:8 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Camino Willhuber" "email" => array:1 [ 0 => "gaston.camino@hospitalitaliano.org.ar" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Kido" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Mereles" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Bassani" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Petracchi" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Elizondo" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Gruenberg" ] 7 => array:2 [ "nombre" => "C." "apellidos" => "Sola" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1276 "Ancho" => 2250 "Tamanyo" => 240497 ] ] "descripcion" => array:1 [ "en" => "Male patient aged 25, who presented with an L4-L5 posterolateral hernia. Measurement of the spinal canal percentage occupied by the disc extrusion: (A) axial magnetic resonance at protrusion level; (B) measurement of the spinal canal diameter; (C) measurement of the hernia diameter." ] ] ] "textoCompleto" => "IntroductionLumbar disc hernia is a common spinal pathology, and is the main cause of spinal surgery.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It is more prevalent in men than in women (2:1 ratio) between the ages of 30 and 50, with the levels most frequently affected being L4-L5 and L5-S1. Its physiopathology is unknown but it is known that intrinsic factors present (hereditary, developmental and degenerative) as do extrinsic factors (nutrition, pressure, trauma, etc.).<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Lumbar microdisectomy continues to be one of the most commonly used surgical procedure in U.S.A., with a good outcome rate in 90–95%.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a>Among the most prevalent complications (5–-15%)<a class="elsevierStyleCrossRefs" href="#bib0030">6–8</a> are the recurrence of the discal hernia (defined as new herniation at this level, then an equal or greater symptomatic interval at 6 months<a class="elsevierStyleCrossRef" href="#bib0025">5</a>).It has not been clearly demonstrated whether previous degenerative changes, disc height or herniated disc volume are factors which predispose the development of a new hernia after carrying out a microdisectomy.<a class="elsevierStyleCrossRefs" href="#bib0045">9–11</a>The main objective of this study was to compare the factors associated with lumbar disc recurrence in patients who had undergone surgery for disc recurrence (cases) vs patients with microdisectomy with no recurrence (control group). The secondary objective was to analyse the intraoperative and postoperative complications and the rate of re-intervention in patients operated on for herniated disc.Material and methodsStudy sampleA retrospective study of 177 patients with disc herniation who underwent surgery in our centre between January 2010 and December 2014.Patients aged 18 or over were included, with a diagnosis of central lumbar or posterolateral disc hernia, who had undergone surgery with simple microdiscectomy, with a minimum follow-up of one year.Patients who had undergone previous surgery on the lumbar region, or associated procedures such as fixation, or decompression at more than one level were excluded. Foraminal and extraforaminal hernias were excluded. Patients with radicular compression at the expense of osseous components (facet hypertrophy) who required partial foraminotomy and facetectomy were also excluded.Surgical techniqueAll operations were carried out by the surgical team in our centre. In all cases a simple microdiscectomy was performed. This study was conducted by physicians trained in spine conditions who had not participated in the operations.Surgical technique: with the patient under general anaesthesia, they were positioned in ventral decubitus position on the radiolucent operating table. Presurgical and intrasurgical level marking with radioscopy was made. Unilateral laminotomy and precise removal of the ligament flavum was performed. Partial facetectomy was not performed, since this could have changed stability. Under magnified vision, we proceeded to remove the herniated fragment, preserving the content inside the disc. Standard intradiscal discectomy was not performed on any patient although the presence of free fragments in the posterior third of the disc space was explored. When a free fragment was present, it was removed.The rate of relapses and further operations was analysed descriptively as were those of infections and the need for arthrodesis. Age, gender and body mass index (BMI) were analysed.Qualitative analysisThe nuclear magnetic resonance imaging was analysed prior to surgical intervention in all cases. The level and type of discal hernia was analysed, the degree of discal degeneration through the Pfirrmann classification in sagittal T2 slices.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> Lumbar facet joint degeneration in magnetic resonance were analysed according to the Grogan classification.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Grade 1: uniformly thinned cartilage completely covers the joint surfaces. Grade 2: the cartilage totally covers the joint surface, but there are irregular regions of erosion. Grade 3: the cartilage does not completely cover the joint surface and there are areas of bone exposure. Grade 4: only “streaks” of cartilage are noticeable in the joint. Facet degeneration changes are considered to be present in grades 2, 3 and 4, and to be normal in grade 1. The presence of changes in the intervertebral discs were analysed according to the Modic classification,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> the extension of the herniated disc in T1 and T2 with differentiation between protrusion, extrusion and sequestration<a class="elsevierStyleCrossRef" href="#bib0075">15</a> in accordance with the Masaryk et al. method,<a class="elsevierStyleCrossRef" href="#bib0080">16</a> the disc height index using the Mochida et al.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> method (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and the canal percentage occupied by the herniated disc in T2 axial slices of the affected level (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). A comparison of the factors mentioned between the patients who did not present a relapse was subsequently carried out (group 1, control) and the patients who presented with relapses (group 2, cases).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The Surgimap version 2.2.1 programme was used for magnetic resonance measurements.Statistical analysisCategorical variables are described as relative and absolute frequencies (percentages). Quantitative variables are described as means and their standard deviation or as medians and interquartile ranges, in accordance with distribution. Comparisons of categorical variables between groups was performed using the Chi-square test or the Fisher exact test, in accordance with the assumptions. Comparisons of quantitative variables were performed using the student's t-test or with Wilcoxon rank-sum (Mann–Whitney) test, in accordance with the assumptions.The value of p<0.05 was considered to be statistically significant. For data analysis the software STATA v14 (Texas, U.S.A.) was used.Results255 patients were analysed, 32 of whom were lost to follow-up or who did not complete the year of follow-up; 25 patients presented with foraminal hernias and 6 with extraforaminal hernias, 5 had undergone surgery before, 7 presented with associated instrumentation and 3 required more than one level of decompression (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The final study sample comprised 177 patients, of whom 110 were male and 67 female, with an average age of 49.5 years and an average follow-up of 18.2 months (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).Thirty patients presented with relapses (16.9%), 27 of whom underwent further operations (6 months±10 days). In the group of re-operated patients, 19 required re-discectomy and 8 re-discectomy plus intersomatic arthrodesis. Finally, 3 patients with relapses did not require surgery and were treated with periradicular block injections.Age, gender and body mass indexThere were no significant differences with regards to age (p=0.16), male/female (p=0.9) and BMI (p=0.46) in both groups, and these variables therefore had no relationship in our study (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Disc height indexThe comparative analysis of the disc height index with respect to the upper vertebra demonstrated significant differences between both groups. The average disc height index in group 1 was 40.2% (SD 9.95), and in group 2 was 46.1% (SD 12.49) (p=0.0023).Percentage of disc occupancy of the spinal canalThe percentage of the spinal canal occupancy by the disc was significantly greater in group 2 (41.89 [SD 12.3]) compared with group 1 (36.3 [SD 11.5]) (p=0.02).With regards to the presence of disc extrusion, 112 patients of group 1 (77.6%) and 27 patients of group2 (90%) presented with disc extrusion; 22 patients (15%) from group1 presented with sequestration and 11 patients (7.5%) presented with protrusion; 2 patients of group 2 (6%) presented with protrusion and one (3%) patient presented with sequestration. No significant differences were observed between the groups (p=0.2).Comparison of degenerative changes at facet levelSignificant differences were observed with regards to the presence of facet degenerative changes between the groups under study, with higher percentages of compromise in patients with recurrence (90%) compared with the control group (57.5%) (p<0.001). The group with recurrence were also observed to suffer from higher levels of facet degeneration (grade1: 3 patients [10%]; grade 2: 7 patients [23%]; grade 3: 11 patients [36%], grade 4: 9 patients [30%]) compared with the group without recurrence (grade 1: 62 patients [42,5%], grade 2: 59 patients [40%], grade 3: 19 patients [13%], grade 4: 7 patients [4,7%]). In the group with recurrence grades 3 and 4 were the most prevalent compared with the control group control, where grades 1 and 2 were most common (p<0.001).Comparison of the extent of disc degeneration (Modic, Pfirrmann)With regard to the presence of Modic changes no significant differences were observed between the groups (p=0.19).We did not observe significant differences between disc changes with regards to the Pfirrmann classification (p=0.3) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Intraoperative and postoperative complications and reoperation rate<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> mentions the intra and postoperative complications in the series.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionMicrodiscectomy continues to be the gold standard for lumbar disc hernia when it does not respond to conservative treatment. In our series the rate of reoperation was 15.3% (27 patients). Kim et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> in a series of 12,816 patients who were operated on for lumbar disc hernia with microdiscectomy found that the rate of reoperation was 13.7%.Martin et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> reported a reoperation rate of 19% in non fusion surgery in patients operated on for lumbar disc hernia and of 24% in fusion surgery (arthrodesis) in a series of 24,882 patients. Lebow et al.,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> in a prospective study, analysed the rate of recurrence at 2 years in lumbar microdiscectomies, and observed a rate of 25% recurrence by magnetic resonance, the majority of which were asymptomatic. In our series we analyse clinical recurrence, so real incidence of hernia recurrence is sub-estimated.Many factors associated with recurrence in patients with lumbar disc hernia have been described, including demographic factors (age, gender, tobacco habit, BMI), morphological characteristics of the disc (size, location, type of hernia), degenerative changes and surgical characteristics (type of approach, volume removed and ring defect).By analysing demographic factors Suk et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> observed that the male gender, youth and a tobacco habit were risk factors related with recurrence. Furthermore, Keskimäki et al.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> observed that patients under 50 presented with a higher risk of recurrence. There was also a greater risk of recurrence in obese patients. As described in the work by Meredith et al.,<a class="elsevierStyleCrossRef" href="#bib0110">22</a> where the rate or recurrence was analysed in 75 patients (group recurrence: BMI 33.6±5.1 vs group without recurrence: BMI 26.9±3.9). In our series we did not observe any significant differences regarding age, gender and BMI.With regards to our comparative analysis between patients with good results and patients who were re-operated on, we found statistically significant differences between both groups with respect to the disc height index (46.1 in the group with recurrence vs 40.2 in the control group), the percentage of canal occupation (42 in the recurrence group vs 36.3 in the control group) and facet degeneration (89.2 in recurrence group vs 57.5 in the control group).Dora et al.,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> in their retrospective comparative analysis of 60 patients, did not observe any differences with regards to the disc protrusion percentage in the spinal canal and recurrence, but they found a greater degree of recurrence of hernia in patients with lower degenerative changes and higher disc height (Pfirrmann 1–3). In contrast, Cinotti et al.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> made a prospective study of 76 patients (group study: 26/control group: 50) and observed a higher rate of recurrence in patients with discs with advanced degenerative changes. The strength of the said study is that it is a controlled prospective study but presents heterogeneity in the group as it presents patients with associated stenosis or epidural healing. In our series, however, we observe significant differences with regard to the changes described by Pfirrmann; the results of which could be due to the sample size of our study.Kim et al.<a class="elsevierStyleCrossRef" href="#bib0120">24</a> analysed the recurrence factors of disc hernia in relation to radiological parameters (disc degeneration, disc height and range of sagittal mobility) at L4-L5. There was a higher incidence of discs with grades III, IV and V degeneration compared with grades I, II and VI (DHI<0.15). Furthermore, there was a significant difference on comparing group disc height with recurrence (0.37±0.09) vs the group with no recurrence (0.29±0.09). Similar results were obtained in our study where significant differences were observed between the recurrence group (0.46±0.1) and the control group (0.4±0.09) with regard to disc height index.With regard to Modic changes, the presence of the Modic 1 change has been connected to poor postoperative outcome, as has the persistence of lumbar pain.<a class="elsevierStyleCrossRef" href="#bib0125">25</a> However, Ohtori et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> concluded that there was no relationship between postoperative results and the presence of Modic type changes1 in patients who had undergone microdiscectomy, and there is therefore some controversy in the literature. In our study, we did not observe any relationship between Modic changes and disc recurrence. Probably there is a need for greater casuistic analysis to establish a possible relationship.With regard to the relationship between degenerative facet changes and the higher risk of recurrence, no articles have been found in the literature which mention said possible association. The presence of facet liquid and degenerative changes with segmental instability have been related,<a class="elsevierStyleCrossRefs" href="#bib0135">27,28</a> but the relationship between recurrence and facet degeneration has not been clearly established. In our series, when comparative analysis was made, we found there were significant differences, with a higher percentage of degenerative changes and a higher level of degeneration in the recurrence group compared with the control group. However, we cannot establish a direct causal relationship. Further study is needed for an in-depth analysis of this possible relationship.We also observed a higher rate of re-operation, more than half within the first postoperative year. This demonstrates the relevance for stricter control during the first year of surgery.We should mention the limitations of our study. Firstly, the retrospective analysis based on clinical history data and magnetic resonance outcomes are limiting. We are unaware of the real rate of recurrent hernia incidence, since we analysed the clinical recurrence of patients who required a new resonance due to the presence of clinical symptoms. It is probable that the some hernia recurrence was not clinically obvious and was therefore not included in the study.ConclusionRecurrence in patients who have undergone lumbar microdiscectomy is a common complication. In our series the most important factors associated with recurrence were: initial disc height, percentage of disc material in the canal and degenerative fact joint change.Further studies are required for a precise establishment of the factors associated with recurrence in patients with lumbar disc hernia.Level of evidenceEvidence level III.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this investigation.Confidentiality of dataThe authors declare that they have adhered to the protocols of their centre of work on patient data publication.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflict of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres941126" "titulo" => "Abstract" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec914344" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres941125" "titulo" => "Resumen" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0035" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0045" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0050" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0055" "titulo" => "Discusión" ] 5 => array:2 [ "identificador" => "abst0060" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec914343" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical technique" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Qualitative analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Age, gender and body mass index" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Disc height index" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Percentage of disc occupancy of the spinal canal" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Comparison of degenerative changes at facet level" ] 4 => array:2 [ "identificador" => "sec0060" "titulo" => "Comparison of the extent of disc degeneration (Modic, Pfirrmann)" ] 5 => array:2 [ "identificador" => "sec0065" "titulo" => "Intraoperative and postoperative complications and reoperation rate" ] ] ] 7 => array:2 [ "identificador" => "sec0070" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0075" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0080" "titulo" => "Level of evidence" ] 10 => array:3 [ "identificador" => "sec0085" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0095" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0100" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0105" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-30" "fechaAceptado" => "2017-07-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec914344" "palabras" => array:3 [ 0 => "Microdiscectomy" 1 => "Lumbar disc herniation" 2 => "Hernia recurrence" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec914343" "palabras" => array:3 [ 0 => "Microdiscectomía" 1 => "Hernia discal lumbar" 2 => "Recidiva herniaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionLumbar disc hernias are a common cause of spinal surgery. Hernia recurrence is a prevalent complication. ObjectiveTo analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution. Materials and methodsLumbar microdiscectomies between 2010 and 2014 were analysed, patients with previous surgeries, extraforaminales and foraminal hernias were excluded. Patients with recurrent hernia were the case group and those who showed no recurrence were the control group. Results177 patients with lumbar microdiscectomy, of whom 30 experienced recurrence (16%), and of these 27 were reoperated. Among the risk factors associated with recurrence, we observed a higher rate of disc height, higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes; we observed no differences in sex, body mass index or age. DiscussionPrevious studies show increased disc height and young patients as possible factors associated with recurrence. ConclusionIn our series we found that the higher rate of disc height, the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLas hernias de disco lumbares son una causa frecuente de cirugía lumbar. La recurrencia herniaria es una complicación prevalente. ObjetivoAnalizar los factores de riesgo asociados a recurrencia herniaria en pacientes intervenidos por hernia discal lumbar en nuestra institución. Materiales y métodosSe analizaron en forma retrospectiva una serie de 177 microdiscectomías lumbares entre 2010 y 2014; se excluyeron pacientes con cirugías previas, hernias foraminales y extraforaminales. Los pacientes con recurrencia herniaria constituyeron el grupo de casos y los que no presentaron recurrencia fueron el grupo control; se analizó: sexo, edad, índice de masa corporal, nivel, degeneración facetaria, altura discal y protrusión discal. ResultadosHubo 177 pacientes con microdiscectomía lumbar, de los cuales 30 (16%) presentaron recurrencia herniaria; de ellos, 27 fueron reoperados. Entre los factores de riesgo asociados a recurrencia observamos mayor índice de altura discal, mayor porcentaje de canal ocupado por la hernia y mayor presencia de cambios degenerativos facetarios; no observamos diferencias en cuanto al sexo, índice de masa corporal y edad. DiscusiónEstudios previos muestran el aumento de altura discal y pacientes jóvenes como posibles factores asociados a recidiva. ConclusiónEn nuestra serie encontramos que el mayor índice de altura discal, el porcentaje de canal ocupado por la hernia y los cambios degenerativos facetarios se asociaron a recurrencia herniaria." "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0035" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0045" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0050" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0055" "titulo" => "Discusión" ] 5 => array:2 [ "identificador" => "abst0060" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Camino Willhuber G, Kido G, Mereles M, Bassani J, Petracchi M, Elizondo C, et al. Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía. Rev Esp Cir Ortop Traumatol. 2017;61:397–403." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1375 "Ancho" => 1500 "Tamanyo" => 154431 ] ] "descripcion" => array:1 [ "en" => "Male patient aged 34 with a central lumbar disc hernia at L4-L5. Measurement of the percentage of the disc height at hernia level with respect to the superjacent vertebra: (a) sagittal slice from magnetic resonance imaging; (b) measurement of sagittal disc height and upper vertebral body. Disc height index (B/A×100)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1276 "Ancho" => 2250 "Tamanyo" => 240497 ] ] "descripcion" => array:1 [ "en" => "Male patient aged 25, who presented with an L4-L5 posterolateral hernia. Measurement of the spinal canal percentage occupied by the disc extrusion: (A) axial magnetic resonance at protrusion level; (B) measurement of the spinal canal diameter; (C) measurement of the hernia diameter." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 832 "Ancho" => 994 "Tamanyo" => 65558 ] ] "descripcion" => array:1 [ "en" => "Flow diagram of patients who underwent microdiscectomy." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">177 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Average age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.7±17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52.8±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.2±3.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.7±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L1-L2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L2-L3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (8.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (6.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L3-L4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (11.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L4-L5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83 (56%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (73%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">105 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L5-S1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1592764.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General sample characteristics." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Disc hernia index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.2±9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.1±12.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Percentage of spinal canal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.3±11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.9±12.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Modic changes (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.196 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Facet degeneration (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Disc extrusion (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Degeneration (Pfirrmann 1, 2, 3) (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Degeneration (Pfirrmann 4, 5, 6) (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1592765.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of factors related to a disc hernia." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">177 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.90% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arthrodesis at one year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dural sac injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.80% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1592763.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Intra and postoperative complications, and reoperation rate." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.I. Martin" 1 => "S.K. Mirza" 2 => "B.A. Comstock" 3 => "D.T. Gray" 4 => "W. Kreuter" 5 => "R.A. Deyo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "382" "paginaFinal" => "387" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new pathological classification of lumbar disc protrusion and its clinical significance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "X.L. Ma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/os.12152" "Revista" => array:6 [ "tituloSerie" => "Orthop Surg" "fecha" => "2015" "volumen" => "7" "paginaInicial" => "1" "paginaFinal" => "12" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25708029" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dartmouth atlas of musculoskeletal health care" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Dartmouth Atlas Working Group" "etal" => false "autores" => array:1 [ 0 => "J. Weinstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2000" "editorial" => "American Hospital Association Press" "editorialLocalizacion" => "Chicago, IL" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Low back pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. Deyo" 1 => "J.N. Weinstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200102013440508" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2001" "volumen" => "344" "paginaInicial" => "363" "paginaFinal" => "370" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11172169" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent lumbar disc herniation: results of operative management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.S. Suk" 1 => "H.M. Lee" 2 => "S.H. Moon" 3 => "N.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "672" "paginaFinal" => "676" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reoperation after lumbar disc surgery: results in 130 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Fandino" 1 => "C. Botana" 2 => "A. Viladrich" 3 => "J. Gomez-Bueno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Neurochir" "fecha" => "1993" "volumen" => "122" "paginaInicial" => "102" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8333299" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgery for recurrent lumbar disc herniation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E.S. Connolly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Neurosurg" "fecha" => "1992" "volumen" => "39" "paginaInicial" => "211" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1458740" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Yorimitsu" 1 => "K. Chiba" 2 => "Y. Toyama" 3 => "K. Hirabayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "652" "paginaFinal" => "657" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and annular competence" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.J. Carragee" 1 => "M.Y. Han" 2 => "P.W. Suen" 3 => "D. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2003" "volumen" => "85-A" "paginaInicial" => "102" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12533579" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Results of surgery in sciatica and low back pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.H. Burns" 1 => "R.H. Young" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2215-0366(14)70363-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1951" "volumen" => "1" "paginaInicial" => "245" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26360841" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lumbar disk herniation: do MRI imaging findings predict recurrence after surgical diskectomy?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Dora" 1 => "M.R. Schmid" 2 => "A. Elfering" 3 => "M. Zanetti" 4 => "J. Hodler" 5 => "N. Boos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2352040624" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2005" "volumen" => "235" "paginaInicial" => "562" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15858095" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance classification of lumbar intervertebral disc degeneration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.W. Pfirrmann" 1 => "A. Metzdorf" 2 => "M. Zanetti" 3 => "J. Hodler" 4 => "N. Boos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2001" "volumen" => "26" "paginaInicial" => "1873" "paginaFinal" => "1878" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lumbar facet joint tropism does not accelerate degeneration of the facet joints" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Grogan" 1 => "B. Nowicki" 2 => "T. Schmidt" 3 => "V. Haughton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1997" "volumen" => "18" "paginaInicial" => "1325" "paginaFinal" => "1329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9282864" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.T. Modic" 1 => "P.M. Steinberg" 2 => "J.S. Ross" 3 => "T.J. Masaryk" 4 => "J.R. Carter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.166.1.3336678" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1988" "volumen" => "166" "paginaInicial" => "193" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3336678" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The classification of lumbar disc protrusion and its surgical treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.W. Zhou" 1 => "Y.G. Hu" 2 => "J.X. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Zhonghua Gu Ke Za Zhi" "fecha" => "1988" "volumen" => "8" "paginaInicial" => "366" "paginaFinal" => "369" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High resolution MR imaging of sequestered lumbar intervertebral disks" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.J. Masaryk" 1 => "J.S. Ross" 2 => "M.T. Modic" 3 => "F. Boumphrey" 4 => "H. Bohlman" 5 => "G. Wilbert" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.150.5.1155" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "1988" "volumen" => "150" "paginaInicial" => "1155" "paginaFinal" => "1162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3258720" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of preserving disc structure in surgical approaches to lumbar disc herniation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Mochida" 1 => "K. Nishimura" 2 => "T. Nomura" 3 => "E. Toh" 4 => "M. Chiba" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "1996" "volumen" => "21" "paginaInicial" => "1556" "paginaFinal" => "1564" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reoperation rate after surgery for lumbar herniated intervertebral disc disease: Nationwide cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.H. Kim" 1 => "C.K. Chung" 2 => "C.S. Park" 3 => "B. Choi" 4 => "M.J. Kim" 5 => "B.J. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "581" "paginaFinal" => "590" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.I. Martin" 1 => "S.K. Mirza" 2 => "B.A. Comstock" 3 => "D.T. Gray" 4 => "W. Kreuter" 5 => "R.A. Deyo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "382" "paginaFinal" => "387" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.L. Lebow" 1 => "O. Adogwa" 2 => "S.L. Parker" 3 => "A. Sharma" 4 => "J. Cheng" 5 => "M.J. McGirt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Spine (Phila Pa 1976)" "fecha" => "2011" "volumen" => "36" "paginaInicial" => "2147" "paginaFinal" => "2151" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "15" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reoperations after lumbar disc surgery: a population based study of regional and interspecialty variations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Keskimäki" 1 => "S. Seitsalo" 2 => "H. Osterman" 3 => "P. 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Original Article

Factors associated with lumbar disc hernia recurrence after microdiscectomy

Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectomía

G. Camino Willhuber

Corresponding author

gaston.camino@hospitalitaliano.org.ar

Corresponding author.

, G. Kido, M. Mereles, J. Bassani, M. Petracchi, C. Elizondo, M. Gruenberg, C. Sola

Instituto de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

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        "titulo" => "Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectom&#237;a"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Male patient aged 25&#44; who presented with an L4-L5 posterolateral hernia&#46; Measurement of the spinal canal percentage occupied by the disc extrusion&#58; &#40;A&#41; axial magnetic resonance at protrusion level&#59; &#40;B&#41; measurement of the spinal canal diameter&#59; &#40;C&#41; measurement of the hernia diameter&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lumbar disc hernia is a common spinal pathology&#44; and is the main cause of spinal surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is more prevalent in men than in women &#40;2&#58;1 ratio&#41; between the ages of 30 and 50&#44; with the levels most frequently affected being L4-L5 and L5-S1&#46; Its physiopathology is unknown but it is known that intrinsic factors present &#40;hereditary&#44; developmental and degenerative&#41; as do extrinsic factors &#40;nutrition&#44; pressure&#44; trauma&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Lumbar microdisectomy continues to be one of the most commonly used surgical procedure in U&#46;S&#46;A&#46;&#44; with a good outcome rate in 90&#8211;95&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Among the most prevalent complications &#40;5&#8211;-15&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> are the recurrence of the discal hernia &#40;defined as new herniation at this level&#44; then an equal or greater symptomatic interval at 6 months<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It has not been clearly demonstrated whether previous degenerative changes&#44; disc height or herniated disc volume are factors which predispose the development of a new hernia after carrying out a microdisectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of this study was to compare the factors associated with lumbar disc recurrence in patients who had undergone surgery for disc recurrence &#40;cases&#41; vs patients with microdisectomy with no recurrence &#40;control group&#41;&#46; The secondary objective was to analyse the intraoperative and postoperative complications and the rate of re-intervention in patients operated on for herniated disc&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study sample</span><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective study of 177 patients with disc herniation who underwent surgery in our centre between January 2010 and December 2014&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients aged 18 or over were included&#44; with a diagnosis of central lumbar or posterolateral disc hernia&#44; who had undergone surgery with simple microdiscectomy&#44; with a minimum follow-up of one year&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Patients who had undergone previous surgery on the lumbar region&#44; or associated procedures such as fixation&#44; or decompression at more than one level were excluded&#46; Foraminal and extraforaminal hernias were excluded&#46; Patients with radicular compression at the expense of osseous components &#40;facet hypertrophy&#41; who required partial foraminotomy and facetectomy were also excluded&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Surgical technique</span><p id="par0045" class="elsevierStylePara elsevierViewall">All operations were carried out by the surgical team in our centre&#46; In all cases a simple microdiscectomy was performed&#46; This study was conducted by physicians trained in spine conditions who had not participated in the operations&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Surgical technique&#58; with the patient under general anaesthesia&#44; they were positioned in ventral decubitus position on the radiolucent operating table&#46; Presurgical and intrasurgical level marking with radioscopy was made&#46; Unilateral laminotomy and precise removal of the ligament flavum was performed&#46; Partial facetectomy was not performed&#44; since this could have changed stability&#46; Under magnified vision&#44; we proceeded to remove the herniated fragment&#44; preserving the content inside the disc&#46; Standard intradiscal discectomy was not performed on any patient although the presence of free fragments in the posterior third of the disc space was explored&#46; When a free fragment was present&#44; it was removed&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The rate of relapses and further operations was analysed descriptively as were those of infections and the need for arthrodesis&#46; Age&#44; gender and body mass index &#40;BMI&#41; were analysed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Qualitative analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">The nuclear magnetic resonance imaging was analysed prior to surgical intervention in all cases&#46; The level and type of discal hernia was analysed&#44; the degree of discal degeneration through the Pfirrmann classification in sagittal T2 slices&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Lumbar facet joint degeneration in magnetic resonance were analysed according to the Grogan classification&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Grade 1&#58; uniformly thinned cartilage completely covers the joint surfaces&#46; Grade 2&#58; the cartilage totally covers the joint surface&#44; but there are irregular regions of erosion&#46; Grade 3&#58; the cartilage does not completely cover the joint surface and there are areas of bone exposure&#46; Grade 4&#58; only &#8220;streaks&#8221; of cartilage are noticeable in the joint&#46; Facet degeneration changes are considered to be present in grades 2&#44; 3 and 4&#44; and to be normal in grade 1&#46; The presence of changes in the intervertebral discs were analysed according to the Modic classification&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> the extension of the herniated disc in T1 and T2 with differentiation between protrusion&#44; extrusion and sequestration<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> in accordance with the Masaryk et al&#46; method&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> the disc height index using the Mochida et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> method &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; and the canal percentage occupied by the herniated disc in T2 axial slices of the affected level &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; A comparison of the factors mentioned between the patients who did not present a relapse was subsequently carried out &#40;group 1&#44; control&#41; and the patients who presented with relapses &#40;group 2&#44; cases&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The Surgimap version 2&#46;2&#46;1 programme was used for magnetic resonance measurements&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">Categorical variables are described as relative and absolute frequencies &#40;percentages&#41;&#46; Quantitative variables are described as means and their standard deviation or as medians and interquartile ranges&#44; in accordance with distribution&#46; Comparisons of categorical variables between groups was performed using the Chi-square test or the Fisher exact test&#44; in accordance with the assumptions&#46; Comparisons of quantitative variables were performed using the student&#39;s <span class="elsevierStyleItalic">t</span>-test or with Wilcoxon rank-sum &#40;Mann&#8211;Whitney&#41; test&#44; in accordance with the assumptions&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered to be statistically significant&#46; For data analysis the software STATA v14 &#40;Texas&#44; U&#46;S&#46;A&#46;&#41; was used&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">255 patients were analysed&#44; 32 of whom were lost to follow-up or who did not complete the year of follow-up&#59; 25 patients presented with foraminal hernias and 6 with extraforaminal hernias&#44; 5 had undergone surgery before&#44; 7 presented with associated instrumentation and 3 required more than one level of decompression &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The final study sample comprised 177 patients&#44; of whom 110 were male and 67 female&#44; with an average age of 49&#46;5 years and an average follow-up of 18&#46;2 months &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Thirty patients presented with relapses &#40;16&#46;9&#37;&#41;&#44; 27 of whom underwent further operations &#40;6 months<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 days&#41;&#46; In the group of re-operated patients&#44; 19 required re-discectomy and 8 re-discectomy plus intersomatic arthrodesis&#46; Finally&#44; 3 patients with relapses did not require surgery and were treated with periradicular block injections&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Age&#44; gender and body mass index</span><p id="par0095" class="elsevierStylePara elsevierViewall">There were no significant differences with regards to age &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;16&#41;&#44; male&#47;female &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;9&#41; and BMI &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;46&#41; in both groups&#44; and these variables therefore had no relationship in our study &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Disc height index</span><p id="par0100" class="elsevierStylePara elsevierViewall">The comparative analysis of the disc height index with respect to the upper vertebra demonstrated significant differences between both groups&#46; The average disc height index in group 1 was 40&#46;2&#37; &#40;SD 9&#46;95&#41;&#44; and in group 2 was 46&#46;1&#37; &#40;SD 12&#46;49&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;0023&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Percentage of disc occupancy of the spinal canal</span><p id="par0105" class="elsevierStylePara elsevierViewall">The percentage of the spinal canal occupancy by the disc was significantly greater in group 2 &#40;41&#46;89 &#91;SD 12&#46;3&#93;&#41; compared with group 1 &#40;36&#46;3 &#91;SD 11&#46;5&#93;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With regards to the presence of disc extrusion&#44; 112 patients of group 1 &#40;77&#46;6&#37;&#41; and 27 patients of group<span class="elsevierStyleHsp" style=""></span>2 &#40;90&#37;&#41; presented with disc extrusion&#59; 22 patients &#40;15&#37;&#41; from group<span class="elsevierStyleHsp" style=""></span>1 presented with sequestration and 11 patients &#40;7&#46;5&#37;&#41; presented with protrusion&#59; 2 patients of group 2 &#40;6&#37;&#41; presented with protrusion and one &#40;3&#37;&#41; patient presented with sequestration&#46; No significant differences were observed between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;2&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Comparison of degenerative changes at facet level</span><p id="par0115" class="elsevierStylePara elsevierViewall">Significant differences were observed with regards to the presence of facet degenerative changes between the groups under study&#44; with higher percentages of compromise in patients with recurrence &#40;90&#37;&#41; compared with the control group &#40;57&#46;5&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The group with recurrence were also observed to suffer from higher levels of facet degeneration &#40;grade1&#58; 3 patients &#91;10&#37;&#93;&#59; grade 2&#58; 7 patients &#91;23&#37;&#93;&#59; grade 3&#58; 11 patients &#91;36&#37;&#93;&#44; grade 4&#58; 9 patients &#91;30&#37;&#93;&#41; compared with the group without recurrence &#40;grade 1&#58; 62 patients &#91;42&#44;5&#37;&#93;&#44; grade 2&#58; 59 patients &#91;40&#37;&#93;&#44; grade 3&#58; 19 patients &#91;13&#37;&#93;&#44; grade 4&#58; 7 patients &#91;4&#44;7&#37;&#93;&#41;&#46; In the group with recurrence grades 3 and 4 were the most prevalent compared with the control group control&#44; where grades 1 and 2 were most common &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Comparison of the extent of disc degeneration &#40;Modic&#44; Pfirrmann&#41;</span><p id="par0120" class="elsevierStylePara elsevierViewall">With regard to the presence of Modic changes no significant differences were observed between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;19&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We did not observe significant differences between disc changes with regards to the Pfirrmann classification &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#46;3&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Intraoperative and postoperative complications and reoperation rate</span><p id="par0130" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> mentions the intra and postoperative complications in the series&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">Microdiscectomy continues to be the gold standard for lumbar disc hernia when it does not respond to conservative treatment&#46; In our series the rate of reoperation was 15&#46;3&#37; &#40;27 patients&#41;&#46; Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> in a series of 12&#44;816 patients who were operated on for lumbar disc hernia with microdiscectomy found that the rate of reoperation was 13&#46;7&#37;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Martin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> reported a reoperation rate of 19&#37; in non fusion surgery in patients operated on for lumbar disc hernia and of 24&#37; in fusion surgery &#40;arthrodesis&#41; in a series of 24&#44;882 patients&#46; Lebow et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in a prospective study&#44; analysed the rate of recurrence at 2 years in lumbar microdiscectomies&#44; and observed a rate of 25&#37; recurrence by magnetic resonance&#44; the majority of which were asymptomatic&#46; In our series we analyse clinical recurrence&#44; so real incidence of hernia recurrence is sub-estimated&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Many factors associated with recurrence in patients with lumbar disc hernia have been described&#44; including demographic factors &#40;age&#44; gender&#44; tobacco habit&#44; BMI&#41;&#44; morphological characteristics of the disc &#40;size&#44; location&#44; type of hernia&#41;&#44; degenerative changes and surgical characteristics &#40;type of approach&#44; volume removed and ring defect&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">By analysing demographic factors Suk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> observed that the male gender&#44; youth and a tobacco habit were risk factors related with recurrence&#46; Furthermore&#44; Keskim&#228;ki et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> observed that patients under 50 presented with a higher risk of recurrence&#46; There was also a greater risk of recurrence in obese patients&#46; As described in the work by Meredith et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> where the rate or recurrence was analysed in 75 patients &#40;group recurrence&#58; BMI 33&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;1 vs group without recurrence&#58; BMI 26&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&#41;&#46; In our series we did not observe any significant differences regarding age&#44; gender and BMI&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">With regards to our comparative analysis between patients with good results and patients who were re-operated on&#44; we found statistically significant differences between both groups with respect to the disc height index &#40;46&#46;1 in the group with recurrence vs 40&#46;2 in the control group&#41;&#44; the percentage of canal occupation &#40;42 in the recurrence group vs 36&#46;3 in the control group&#41; and facet degeneration &#40;89&#46;2 in recurrence group vs 57&#46;5 in the control group&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Dora et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> in their retrospective comparative analysis of 60 patients&#44; did not observe any differences with regards to the disc protrusion percentage in the spinal canal and recurrence&#44; but they found a greater degree of recurrence of hernia in patients with lower degenerative changes and higher disc height &#40;Pfirrmann 1&#8211;3&#41;&#46; In contrast&#44; Cinotti et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> made a prospective study of 76 patients &#40;group study&#58; 26&#47;control group&#58; 50&#41; and observed a higher rate of recurrence in patients with discs with advanced degenerative changes&#46; The strength of the said study is that it is a controlled prospective study but presents heterogeneity in the group as it presents patients with associated stenosis or epidural healing&#46; In our series&#44; however&#44; we observe significant differences with regard to the changes described by Pfirrmann&#59; the results of which could be due to the sample size of our study&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Kim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> analysed the recurrence factors of disc hernia in relation to radiological parameters &#40;disc degeneration&#44; disc height and range of sagittal mobility&#41; at L4-L5&#46; There was a higher incidence of discs with grades <span class="elsevierStyleSmallCaps">III</span>&#44; <span class="elsevierStyleSmallCaps">IV</span> and <span class="elsevierStyleSmallCaps">V</span> degeneration compared with grades <span class="elsevierStyleSmallCaps">I</span>&#44; <span class="elsevierStyleSmallCaps">II</span> and <span class="elsevierStyleSmallCaps">VI</span> &#40;DHI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#41;&#46; Furthermore&#44; there was a significant difference on comparing group disc height with recurrence &#40;0&#46;37<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41; vs the group with no recurrence &#40;0&#46;29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46; Similar results were obtained in our study where significant differences were observed between the recurrence group &#40;0&#46;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;1&#41; and the control group &#40;0&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41; with regard to disc height index&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">With regard to Modic changes&#44; the presence of the Modic 1 change has been connected to poor postoperative outcome&#44; as has the persistence of lumbar pain&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> However&#44; Ohtori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> concluded that there was no relationship between postoperative results and the presence of Modic type changes<span class="elsevierStyleHsp" style=""></span>1 in patients who had undergone microdiscectomy&#44; and there is therefore some controversy in the literature&#46; In our study&#44; we did not observe any relationship between Modic changes and disc recurrence&#46; Probably there is a need for greater casuistic analysis to establish a possible relationship&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">With regard to the relationship between degenerative facet changes and the higher risk of recurrence&#44; no articles have been found in the literature which mention said possible association&#46; The presence of facet liquid and degenerative changes with segmental instability have been related&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a> but the relationship between recurrence and facet degeneration has not been clearly established&#46; In our series&#44; when comparative analysis was made&#44; we found there were significant differences&#44; with a higher percentage of degenerative changes and a higher level of degeneration in the recurrence group compared with the control group&#46; However&#44; we cannot establish a direct causal relationship&#46; Further study is needed for an in-depth analysis of this possible relationship&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">We also observed a higher rate of re-operation&#44; more than half within the first postoperative year&#46; This demonstrates the relevance for stricter control during the first year of surgery&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">We should mention the limitations of our study&#46; Firstly&#44; the retrospective analysis based on clinical history data and magnetic resonance outcomes are limiting&#46; We are unaware of the real rate of recurrent hernia incidence&#44; since we analysed the clinical recurrence of patients who required a new resonance due to the presence of clinical symptoms&#46; It is probable that the some hernia recurrence was not clinically obvious and was therefore not included in the study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Recurrence in patients who have undergone lumbar microdiscectomy is a common complication&#46; In our series the most important factors associated with recurrence were&#58; initial disc height&#44; percentage of disc material in the canal and degenerative fact joint change&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Further studies are required for a precise establishment of the factors associated with recurrence in patients with lumbar disc hernia&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Level of evidence</span><p id="par0200" class="elsevierStylePara elsevierViewall">Evidence level III&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Ethical disclosures</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Protection of human and animal subjects</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Confidentiality of data</span><p id="par0210" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocols of their centre of work on patient data publication&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Right to privacy and informed consent</span><p id="par0215" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Conflict of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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              "titulo" => "Disc height index"
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              "titulo" => "Percentage of disc occupancy of the spinal canal"
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              "titulo" => "Comparison of degenerative changes at facet level"
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              "titulo" => "Comparison of the extent of disc degeneration &#40;Modic&#44; Pfirrmann&#41;"
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              "titulo" => "Intraoperative and postoperative complications and reoperation rate"
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    "fechaAceptado" => "2017-07-12"
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          "clase" => "keyword"
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            0 => "Microdiscectomy"
            1 => "Lumbar disc herniation"
            2 => "Hernia recurrence"
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            0 => "Microdiscectom&#237;a"
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            2 => "Recidiva herniaria"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lumbar disc hernias are a common cause of spinal surgery&#46; Hernia recurrence is a prevalent complication&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyse the risk factors associated with hernia recurrence in patients undergoing surgery in our institution&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lumbar microdiscectomies between 2010 and 2014 were analysed&#44; patients with previous surgeries&#44; extraforaminales and foraminal hernias were excluded&#46; Patients with recurrent hernia were the case group and those who showed no recurrence were the control group&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">177 patients with lumbar microdiscectomy&#44; of whom 30 experienced recurrence &#40;16&#37;&#41;&#44; and of these 27 were reoperated&#46; Among the risk factors associated with recurrence&#44; we observed a higher rate of disc height&#44; higher percentage of spinal canal occupied by the hernia and presence of degenerative facet joint changes&#59; we observed no differences in sex&#44; body mass index or age&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Previous studies show increased disc height and young patients as possible factors associated with recurrence&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In our series we found that the higher rate of disc height&#44; the percentage of spinal canal occupied by the hernia and degenerative facet joint changes were associated with hernia recurrence&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
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            "titulo" => "Objective"
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            "identificador" => "abst0015"
            "titulo" => "Materials and methods"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introducci&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las hernias de disco lumbares son una causa frecuente de cirug&#237;a lumbar&#46; La recurrencia herniaria es una complicaci&#243;n prevalente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Analizar los factores de riesgo asociados a recurrencia herniaria en pacientes intervenidos por hernia discal lumbar en nuestra instituci&#243;n&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Materiales y m&#233;todos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se analizaron en forma retrospectiva una serie de 177 microdiscectom&#237;as lumbares entre 2010 y 2014&#59; se excluyeron pacientes con cirug&#237;as previas&#44; hernias foraminales y extraforaminales&#46; Los pacientes con recurrencia herniaria constituyeron el grupo de casos y los que no presentaron recurrencia fueron el grupo control&#59; se analiz&#243;&#58; sexo&#44; edad&#44; &#237;ndice de masa corporal&#44; nivel&#44; degeneraci&#243;n facetaria&#44; altura discal y protrusi&#243;n discal&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hubo 177 pacientes con microdiscectom&#237;a lumbar&#44; de los cuales 30 &#40;16&#37;&#41; presentaron recurrencia herniaria&#59; de ellos&#44; 27 fueron reoperados&#46; Entre los factores de riesgo asociados a recurrencia observamos mayor &#237;ndice de altura discal&#44; mayor porcentaje de canal ocupado por la hernia y mayor presencia de cambios degenerativos facetarios&#59; no observamos diferencias en cuanto al sexo&#44; &#237;ndice de masa corporal y edad&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discusi&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudios previos muestran el aumento de altura discal y pacientes j&#243;venes como posibles factores asociados a recidiva&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusi&#243;n</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">En nuestra serie encontramos que el mayor &#237;ndice de altura discal&#44; el porcentaje de canal ocupado por la hernia y los cambios degenerativos facetarios se asociaron a recurrencia herniaria&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Camino Willhuber G&#44; Kido G&#44; Mereles M&#44; Bassani J&#44; Petracchi M&#44; Elizondo C&#44; et al&#46; Factores asociados a recidiva de hernia de disco lumbar luego de una microdiscectom&#237;a&#46; Rev Esp Cir Ortop Traumatol&#46; 2017&#59;61&#58;397&#8211;403&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Male patient aged 34 with a central lumbar disc hernia at L4-L5&#46; Measurement of the percentage of the disc height at hernia level with respect to the superjacent vertebra&#58; &#40;a&#41; sagittal slice from magnetic resonance imaging&#59; &#40;b&#41; measurement of sagittal disc height and upper vertebral body&#46; Disc height index &#40;B&#47;A<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Male patient aged 25&#44; who presented with an L4-L5 posterolateral hernia&#46; Measurement of the spinal canal percentage occupied by the disc extrusion&#58; &#40;A&#41; axial magnetic resonance at protrusion level&#59; &#40;B&#41; measurement of the spinal canal diameter&#59; &#40;C&#41; measurement of the hernia diameter&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Number of patients&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;9&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "doi" => "10.1111/os.12152"
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                        "paginaInicial" => "1"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Dartmouth atlas of musculoskeletal health care"
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                          "autores" => array:1 [
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                      "titulo" => "Low back pain"
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                      "doi" => "10.1056/NEJM200102013440508"
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                            3 => "N&#46;H&#46; Kim"
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                      "titulo" => "Reoperation after lumbar disc surgery&#58; results in 130 cases"
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                            3 => "J&#46; Gomez-Bueno"
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                      "Revista" => array:6 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2003"
                        "volumen" => "85-A"
                        "paginaInicial" => "102"
                        "paginaFinal" => "108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12533579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results of surgery in sciatica and low back pain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;H&#46; Burns"
                            1 => "R&#46;H&#46; Young"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2215-0366(14)70363-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1951"
                        "volumen" => "1"
                        "paginaInicial" => "245"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26360841"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lumbar disk herniation&#58; do MRI imaging findings predict recurrence after surgical diskectomy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Dora"
                            1 => "M&#46;R&#46; Schmid"
                            2 => "A&#46; Elfering"
                            3 => "M&#46; Zanetti"
                            4 => "J&#46; Hodler"
                            5 => "N&#46; Boos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2352040624"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2005"
                        "volumen" => "235"
                        "paginaInicial" => "562"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15858095"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance classification of lumbar intervertebral disc degeneration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;W&#46; Pfirrmann"
                            1 => "A&#46; Metzdorf"
                            2 => "M&#46; Zanetti"
                            3 => "J&#46; Hodler"
                            4 => "N&#46; Boos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2001"
                        "volumen" => "26"
                        "paginaInicial" => "1873"
                        "paginaFinal" => "1878"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lumbar facet joint tropism does not accelerate degeneration of the facet joints"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Grogan"
                            1 => "B&#46; Nowicki"
                            2 => "T&#46; Schmidt"
                            3 => "V&#46; Haughton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "1997"
                        "volumen" => "18"
                        "paginaInicial" => "1325"
                        "paginaFinal" => "1329"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9282864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Degenerative disk disease&#58; assessment of changes in vertebral body marrow with MR imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;T&#46; Modic"
                            1 => "P&#46;M&#46; Steinberg"
                            2 => "J&#46;S&#46; Ross"
                            3 => "T&#46;J&#46; Masaryk"
                            4 => "J&#46;R&#46; Carter"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.166.1.3336678"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1988"
                        "volumen" => "166"
                        "paginaInicial" => "193"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3336678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The classification of lumbar disc protrusion and its surgical treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;W&#46; Zhou"
                            1 => "Y&#46;G&#46; Hu"
                            2 => "J&#46;X&#46; Sun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Zhonghua Gu Ke Za Zhi"
                        "fecha" => "1988"
                        "volumen" => "8"
                        "paginaInicial" => "366"
                        "paginaFinal" => "369"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High resolution MR imaging of sequestered lumbar intervertebral disks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;J&#46; Masaryk"
                            1 => "J&#46;S&#46; Ross"
                            2 => "M&#46;T&#46; Modic"
                            3 => "F&#46; Boumphrey"
                            4 => "H&#46; Bohlman"
                            5 => "G&#46; Wilbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.150.5.1155"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1988"
                        "volumen" => "150"
                        "paginaInicial" => "1155"
                        "paginaFinal" => "1162"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3258720"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The importance of preserving disc structure in surgical approaches to lumbar disc herniation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Mochida"
                            1 => "K&#46; Nishimura"
                            2 => "T&#46; Nomura"
                            3 => "E&#46; Toh"
                            4 => "M&#46; Chiba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "1996"
                        "volumen" => "21"
                        "paginaInicial" => "1556"
                        "paginaFinal" => "1564"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reoperation rate after surgery for lumbar herniated intervertebral disc disease&#58; Nationwide cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Kim"
                            1 => "C&#46;K&#46; Chung"
                            2 => "C&#46;S&#46; Park"
                            3 => "B&#46; Choi"
                            4 => "M&#46;J&#46; Kim"
                            5 => "B&#46;J&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2013"
                        "volumen" => "38"
                        "paginaInicial" => "581"
                        "paginaFinal" => "590"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;I&#46; Martin"
                            1 => "S&#46;K&#46; Mirza"
                            2 => "B&#46;A&#46; Comstock"
                            3 => "D&#46;T&#46; Gray"
                            4 => "W&#46; Kreuter"
                            5 => "R&#46;A&#46; Deyo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2007"
                        "volumen" => "32"
                        "paginaInicial" => "382"
                        "paginaFinal" => "387"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asymptomatic same-site recurrent disc herniation after lumbar discectomy&#58; results of a prospective longitudinal study with 2-year serial imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;L&#46; Lebow"
                            1 => "O&#46; Adogwa"
                            2 => "S&#46;L&#46; Parker"
                            3 => "A&#46; Sharma"
                            4 => "J&#46; Cheng"
                            5 => "M&#46;J&#46; McGirt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2011"
                        "volumen" => "36"
                        "paginaInicial" => "2147"
                        "paginaFinal" => "2151"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "15"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reoperations after lumbar disc surgery&#58; a population based study of regional and interspecialty variations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Keskim&#228;ki"
                            1 => "S&#46; Seitsalo"
                            2 => "H&#46; Osterman"
                            3 => "P&#46; Rissanen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2000"
                        "volumen" => "25"
                        "paginaInicial" => "1500"
                        "paginaFinal" => "1508"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;S&#46; Meredith"
                            1 => "R&#46;C&#46; Huang"
                            2 => "J&#46; Nguyen"
                            3 => "S&#46; Lyman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.spinee.2010.02.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine J"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "575"
                        "paginaFinal" => "580"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20347400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ipsilateral recurrent disc herniation&#58; a prospective&#44; controlled study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Cinotti"
                            1 => "G&#46;S&#46; Roysam"
                            2 => "S&#46;M&#46; Eisenstein"
                            3 => "F&#46; Postacchini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1998"
                        "volumen" => "80"
                        "paginaInicial" => "825"
                        "paginaFinal" => "832"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9768893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disc height and segmental motion as risk factors for recurrent lumbar disc herniation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46;T&#46; Kim"
                            1 => "S&#46;W&#46; Park"
                            2 => "Y&#46;B&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2009"
                        "volumen" => "34"
                        "paginaInicial" => "2674"
                        "paginaFinal" => "2678"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance imaging predictors of surgical outcome in patients with lumbar intervertebral disc herniation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "A&#46;N&#46; Tosteson"
                            3 => "T&#46;D&#46; Tosteson"
                            4 => "E&#46;J&#46; Carragee"
                            5 => "J&#46;A&#46; Carrino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
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                        "volumen" => "38"
                        "paginaInicial" => "1216"
                        "paginaFinal" => "1225"
                      ]
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                  ]
                ]
              ]
            ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low back pain after lumbar discectomy in patients showing endplate Modic type 1 change"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Ohtori"
                            1 => "M&#46; Yamashita"
                            2 => "K&#46; Yamauchi"
                            3 => "G&#46; Inoue"
                            4 => "T&#46; Koshi"
                            5 => "M&#46; Suzuki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
                        "fecha" => "2010"
                        "volumen" => "35"
                        "paginaInicial" => "E596"
                        "paginaFinal" => "E600"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0135"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Chaput"
                            1 => "D&#46; Padon"
                            2 => "J&#46; Rush"
                            3 => "E&#46; Lenehan"
                            4 => "M&#46; Rahm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Spine &#40;Phila Pa 1976&#41;"
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                        "volumen" => "32"
                        "paginaInicial" => "1883"
                        "paginaFinal" => "1887"
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                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease&#63;"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "J&#46;A&#46; Ulibarri"
                            3 => "C&#46; Tannoury"
                            4 => "W&#46;F&#46; Donaldson 3rd"
                            5 => "J&#46;D&#46; Kang"
                          ]
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Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2017.10.003

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Year/Month	Html	Pdf	Total

2024 November	15	0	15
2024 October	42	4	46
2024 September	76	10	86
2024 August	50	10	60
2024 July	43	11	54
2024 June	51	5	56
2024 May	67	5	72
2024 April	61	5	66
2024 March	72	5	77
2024 February	104	10	114
2024 January	99	11	110
2023 December	110	22	132
2023 November	128	17	145
2023 October	141	16	157
2023 September	81	8	89
2023 August	83	8	91
2023 July	132	12	144
2023 June	88	6	94
2023 May	124	11	135
2023 April	103	5	108
2023 March	111	7	118
2023 February	112	12	124
2023 January	94	8	102
2022 December	64	15	79
2022 November	69	18	87
2022 October	71	19	90
2022 September	78	30	108
2022 August	79	24	103
2022 July	65	20	85
2022 June	57	16	73
2022 May	86	24	110
2022 April	89	22	111
2022 March	88	19	107
2022 February	77	13	90
2022 January	142	14	156
2021 December	84	20	104
2021 November	73	18	91
2021 October	76	17	93
2021 September	63	13	76
2021 August	41	12	53
2021 July	43	4	47
2021 June	48	12	60
2021 May	33	10	43
2021 April	103	11	114
2021 March	52	10	62
2021 February	42	8	50
2021 January	28	12	40
2020 December	5	0	5

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