gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Lumbar disc surgery – A 32 year follow-up study

Meeting Abstract

  • Benedikt W. Burkhardt - Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
  • Marietta Grimm - Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
  • Karsten Schwerdtfeger - Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
  • Joachim M. K. Oertel - Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.12.06

doi: 10.3205/16dgnc302, urn:nbn:de:0183-16dgnc3029

Veröffentlicht: 8. Juni 2016

© 2016 Burkhardt et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

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.