gms | German Medical Science

Objective: A prospective single cohort study with 7,5 year outcome data. The aim of the study was to analyse long-term outcome of one side single level back surgery in 6850 unselected consecutive patients with degenerative lumbar disc diseases randomly assigned to 8 participant neurosurgeons.

Methods: Starting in 1990, all patients with a single level degenerative lumbar disc disease/stenosis were randomly assigned to a neurosurgeon for microdiscectomy. Operative demographics were collected and evaluated. A randomly selected cohort of 100 patients were thoroughly evaluated in regard to clinical results, functional outcome, social integration before and after surgery after a mean follow-up of 7,5 years (range). The performance of each individual surgeon was investigated.

Results: Operative demographics: the mean age was 50.85 years (±12,4),the average length of surgery 44 minutes (±14), blood loss 93 ml (±143), tissue lesions occurred in 4.4 %. In two cases, a transfusion was necessary. The preoperative duration of symptoms was 20 months with a mean VAS of 8.38. Nine patients had prior lumbar surgery. The perioperative complication rate was 9 %. 10 % had to be reoperated. After a mean follow up of 7.5 years, 32 % of the patients did not report any problems at all. 56 % had no medication. Back pain persisted in 52 % of which 72 % were clearly improved. 58 % of patients had persisting leg pain (36%). The mean postoperative VAS was 3.2, muscular weakness remained in 10 %, reduced sensation in 20 %. 79 % were back to work with either no problem at all or slightly impacted in every day life (97 %) and practicing sports (80 %). The odom scale shows 32 % with an excellent result, 56 % with a good result, 7 % with a fair result and 5 % with a poor outcome. The over all patient satisfaction with surgery was 5.75 on a 1 (poor) to 7 (excellent) scale. 84 % would choose the same treatment again. There was no significant (p>05) statistical difference between the participating neurosurgeons.

Conclusions: One side single level back surgery proofs to be a routine procedure with predictable results. As shown in the literature risks are good to calculate without persisting defecits. The patients benefit remains over years for carefully selected patients not depending on one particular surgeons performance.