gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Reoperation rate after microsurgical operations performed at the upper lumbar disc levels

Meeting Abstract

  • S. Hopf - Neurochirurgische Klinik, Ev. Luth. Diakonissenanstalt Flensburg
  • R. Buchalla - Neurochirurgische Klinik, Ev. Luth. Diakonissenanstalt Flensburg
  • V. Klotz-Regener - Neurochirurgische Klinik, Ev. Luth. Diakonissenanstalt Flensburg
  • O. Rubarth - Neurochirurgische Klinik, Ev. Luth. Diakonissenanstalt Flensburg
  • W. Börm - Neurochirurgische Klinik, Ev. Luth. Diakonissenanstalt Flensburg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP11-02

doi: 10.3205/09dgnc365, urn:nbn:de:0183-09dgnc3657

Veröffentlicht: 20. Mai 2009

© 2009 Hopf et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Disc herniations of the upper lumbar spine (L 1-2 and L 2-3) have a frequency of 1 to 2 % of all lumbar disc herniations. In this study we compare outcome, recurrence, and frequency of instability after sequestrectomy or microdiscectomy.

Methods: A retrospective assessment of 141 patients (59 women and 82 men) operated between 1995 and 2007 was performed. The following clinical data were collected: age, femoral stretch test, motor strength, sensory disturbance, autonomic disturbances and tendon reflexes. Intraoperative parameters as well as pre- and postoperative symptoms were documented. Long-term outcome (range 7-144 months, mean follow-up 62 months) was characterized using the Oswestry Disability Index (ODI Version 2.0) and the modified Prolo Economic Rating system in comparison to literature.

Results: Mean age at time of operation was 61.8 years (SD ±10.3, range 30-83). Foraminal and far lateral disc herniation occurred in 18 patients (11.5%). The median operation time was 86.97 (SD ±34.37) minutes. Complications including epidural hematoma, dural lacerations and thromboembolic complications were observed in 6.4%. Reherniation occurred in 10 patients after discectomy (6.4%), but none after sequestrectomy. Long-term follow-up was available in 107 patients (68.1%). 8 patients (5.7%) died in the follow-up period. 1 patient (0.7%) needed a fusion procedure due to instability. 14.4% were able to work in their previous profession without restrictions. 17.5% were able to work part-time in their previous occupation or with limited assignment. 11.3% had to change their profession, while 39% were not able to gain any occupation postoperatively and retired. With longer follow-up periods the ODI score was better.

Conclusions: There is only a small rate of postoperative instability after microsurgical disc surgery performed at the L1-L2 and L2-L3 levels. The reoperation rate of upper disc levels is comparable to lower disc levels according to literature. Microdiscectomy entails a higher rate of recurrence compared to sequestrectomy.