Artikel
The microsurgical treatment of lumbar disc herniation – a report of 158 patients with a mean follow-up of more than 32 years
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Autoren
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Benedikt Burkhardt
- Universitätsklinikum des Saarlandes, Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Homburg, Deutschland
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Marietta Grimm
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Karsten Schwerdtfeger
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Lumbar disc herniation (LDH) is a common cause of radicular pain and sensorimotor deficit. Long-term follow-up studies are rare and the reported rate of clinical success and reoperation is not well understood. To assess the long-term clinical outcome, the cause and rate of reoperation following microsurgical sequestrectomy and subtotal discectomy (MSD).
Methods: Retrospectively, hospital records of 355 patients who underwent MSD for the treatment of LDH with a minimum follow-up of 25 years were reviewed. Information about pre- and postoperative course, and complications was analyzed. All patients were contacted for follow-up assessment. A standardized questionnaire which included Oswestry Disability Index, EQ-5D, MacNab criteria, and further focused on pain and reoperations were performed.
Results: One-hundred and fifty-eight patients with a mean follow-up 32 years participated at the study. Clinical success was noted in 88.6% of patients and 94.3% were satisfied with their results. The mean ODI was 9% and 69.6% of patients were completely free of pain. In 29.7% a reoperation was performed whereas the rate for recurrent disc herniation was 7.7%. Patients who underwent repeated procedure for new lumbar disc herniation within 2 years of the initial MSD had a clinical success rate of 55.6%, and 55.6% of those patients underwent at least three reoperations.
In patients who underwent repeated procedure for lumbar disc herniation more than two years after the initial MSD a clinical success rate of 83.3% was noted and 10% among those patients underwent further procedures. In 13.9% of patients the daily intake of pain medication for back and leg pain was noted. The rate of retraining to remain in employment or prematurely retirement was about 20% among patients who did heavy physical work prior to MSD. Gender and working status had no influence on the clinical success. A significant higher reoperation rate was noted for male patients.
Conclusion: The surgical treatment of LDH by MSD is an effective technique to achieve a high rate of patient satisfactory, and high rate of functional recovery. The overall reoperation rate is 30% but in only 7.7% due to recurrent disc herniation.
