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Letters to the Editor to:

Scientific Articles:
Glenn D. Wera, Randall E. Marcus, Alexander J. Ghanayem, and Henry H. Bohlman
Failure within One Year Following Subtotal Lumbar Discectomy
J Bone Joint Surg Am 2008; 90: 10-15 [Abstract] [Full text] [PDF]
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Electronic letters published:

[Read Letter to the Editor] Dr. Wera et al. respond to Dr. Finnegan
Glenn D. Wera, M.D.,, Randall E. Marcus MD, Alexander J. Ghanayem MD, and Henry H. Bohlman MD   (11 March 2008)
[Read Letter to the Editor] Failure within one year following subtotal lumbar discectomy.
Walter J. Finnegan, M.D., J.D.   (25 February 2008)

Dr. Wera et al. respond to Dr. Finnegan 11 March 2008
Previous Letter to the Editor Top
Glenn D. Wera, M.D.,
Case Western Reserve University, Case Medical Center, Cleveland, OH,
Randall E. Marcus MD, Alexander J. Ghanayem MD, and Henry H. Bohlman MD

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Re: Dr. Wera et al. respond to Dr. Finnegan

gwera{at}yahoo.com Glenn D. Wera, M.D.,, et al.

We greatly appreciate Dr. Finnegan's constructive remarks regarding our recent article entitled “Failure within one year following subtotal lumbar discectomy”. A key benefit of subtotal lumbar discectomy is a very low reherniation rate which we and Carragee et al. have confirmed(1,2). As Dr. Finnegan has underscored, an evaluation, as we described, is critical when lumbar disc reherniation is suspected. We thank him for highlighting these points.

References:

1. Wera GD, Dean CL, Ahn UM, Marcus RE, Cassinelli EH, Bohlman H, Ahn NU. Reherniation and failure following lumbar discectomy: a comparison of fragment excision alone versus subtotal discectomy [abstract]. Spine J. 2006;6:103S.

2. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine. 2006 Mar 15;31(6):653-7.
Failure within one year following subtotal lumbar discectomy. 25 February 2008
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Walter J. Finnegan, M.D., J.D.,
Orthpedic Surgeon
Orthopedic Associates of Allentown, Allentown, PA

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Re: Failure within one year following subtotal lumbar discectomy.

orthomdjd{at}att.net Walter J. Finnegan, M.D., J.D.

To The Editor:

In the recent excellent article by Wera et al.(1),"Failure within one year following subtotal lumbar discectomy", two items were of great interest to me:

1.) A mere 1% incidence of early re-herniation.

2.) Notation that the average time until recurrence of symptoms was only 2.8 months, a radical departure from the time frame that we had published in 1979(2), wherein the greatest predictor of non-fibrosis pathology was a pain-free interval (PFI) of six months after disc excision.

We accept these new data at face value, and with appropriate humility, noting that "the only constant is change." Although disappointed to see that our experience was not reproducible, it is clearly important for spinal surgeons to be aware of the modest probability for recurrent disc herniation at the operated level in a much shorter time frame than we would have predicted. Also of note is the fact that more than half of the re-herniations were in a different direction from the original. 70% of those with recurrent herniation apparently were able to relate the occurence to a specific event such as lifting/twisting/jogging/fall.

We congratulate the authors for undertaking such a comprehensive and long-term study; of course, we did not have the benefit of Dr. Carregee's classification back in the 1970's.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

References:

1. Wera GD, Marcus RE, Ghanayem AJ, Bohlman HH. Failure within one year following subtotal lumbar discectomy. J bone Joint surg Am. 2008;90:10-15.

2. Finnegan, WJ et al. J Bone Joint Surg Am. 1979;61:1077-82