gms | German Medical Science

Objective: Patients with recurrent lumbar disc herniations frequently undergo surgical therapy. However, there is only few data available concerning patient outcome and quality of life (QoL) after repeated surgery. Therefore, this retrospective study aimed to assess the patients’ physical and mental health status and pain development after surgical treatment of recurrent lumbar disc herniation.

Methods: For the time period between January 2006 and December 2007 50 patients who had undergone surgery for recurrent disc herniations were identified. In a retrospective manner patients were questioned concerning their current clinical status. Standard questionnaires for quality of life including SF-36, ODI, EQ-5D, PROLO and pain status (VAS) were used. Additionally, information about medication, suchas intake and type of analgesics, were included. The patient datawere classified into 2 groups regarding the patient age at the time of surgery (≤50 years vs. >50 years).

Results: Patient mean age was 53 years (range, 33–84), mean follow-up was 13 months (range, 5–24). Following surgery, low back pain improvedfrom 8 to 4 while leg pain as well from 8 to 4 (median, both significant). However, patients under 50 years had more benefit concerning back (∆ 4.5) and leg pain (∆ 4.5) compared to patients over 50 years (∆ 3 and 4, respectively). Though patients experienced pain relief mean ODI after surgery was 41% (severe disability) only (≤50 years = 35% = mild disability, >50 years = 42% = severe disability). SF-36 data showed limitations in all aspects compared to a German normative sample. EQ-5D after surgery in all groups was only slightly better than the 50% range (100% = best status). PROLO showed overall Grade 2 average with 6 points while 2–3 points representing normal status and 10 points worst case. About 80% of the patients needed the same amount, less or no pain relievers after surgery.

Conclusions: Though surgical therapy for recurrent disc herniations is believed to result in good clinical outcome the present data shows, that overall ODI, PROLO, EQ-5D and SF-36 results are not satisfying at all. Therefore, prognostic parameters indicating a potential favourable or unfavourable outcome should be identified to support decisions for surgical treatment. To achieve this goal prospective studies including radiographic and clinical parameters have to be designed.