Artikel
Lumbar disc surgery – A 32 year follow-up study
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Since the 1930s, surgery of lumbar disc herniation is one of the most common neurosurgical procedures. Since the introduction of the microscope in the 1970s, the so-called microscopic discectomy (MD) has represented the “gold standard” technique until today. In the past decades new surgical techniques and approaches have been introduced and were constantly refined. Studies with a follow-up of more than 20 years and a large number of patients are rare. Here the authors present clinical outcome of two different surgical techniques in the treatment of lumbar disc herniation with a mean follow-up of more than 30 years.
Method: A retrospective outcome study enrolled 85 patients (36 female and 49 male) who underwent a 1-2 level MD (50 patients) or standard open discectomy (SOD) (35 patients) 27-40 years ago. The pre- and postoperative clinical status and the surgical record were analysed for all patients. A standardized questionnaire, which included the current neurological status, EQ-5D, PSI, Odom's criteria, Oswestry Disability Index (ODI), and limitations in quality of life due to the operation was answered by each patient. A neurological examination was offered.
Results: Average age was 36 years at initial surgery with a mean follow of 32.1 years. Preoperatively average NPRS was 9 and postoperatively 1 for leg pain. At last follow-up median EQ-5D was 6. Ninety-three-per-cent of the patients were satisfied according to PSI; and 91% of the patients reported good to excellent functional recovery according to Odom's criteria. Mean ODI was 15% (range 0-60%). Eight patients had a second surgery during follow-up due to re-herniation, thirteen patients had a second surgery during follow-up due to a new disc prolapse at a different level. Two patients had a third surgery with fusion of the segment. The re-herniation rate was 8% in the MD group and 12% in SOD group. One-hundred-per-cent of all patients would undergo surgery as therapy again.
Conclusions: The long-term follow-up data of this study reveals excellent clinical results even after more than 30 years. Overall rate for second surgery was 25%. About 15% of all patients needed a second surgery due to a disc herniation at the adjacent segment. No difference in long-term clinical outcome could be demonstrated for microdiscectomy and open discectomy.