Hostname: page-component-77c89778f8-vsgnj Total loading time: 0 Render date: 2024-07-19T06:00:26.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Lumbar Microdiscectomy: A Clinicoradiological Analysis of Outcome

Published online by Cambridge University Press:  02 December 2014

Ralph Rahme ,
Ronald Moussa ,
Rabih Bou-Nassif ,
Joseph Maarrawi ,
Tony Rizk ,
Georges Nohra ,
Elie Samaha  and
Nabil Okais
Ralph Rahme
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Ronald Moussa
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Rabih Bou-Nassif
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Joseph Maarrawi
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Tony Rizk
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Georges Nohra
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Elie Samaha
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Nabil Okais*
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
*
Department of Neurosurgery, Hôtel-Dieu de France, Ashrafieh, Beirut, Lebanon
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear. We sought to analyze the interaction between clinical, functional, and radiological variables and their impact on patient outcome.

Methods:

All patients who underwent LMD in 2004-2005 were invited to participate in this retrospective cohort study. Patients were re-evaluated clinically and radiologically after a three to five year follow-up.

Results:

Forty-one of 97 eligible patients were enrolled. Twelve patients (29.3%) reported moderate-to-severe sciatica, 12 (29.3%) had moderate LBP, and 13 (31.7%) exhibited clinical evidence of segmental instability. Thirty-eight patients (92.7%) had minimal disability and 3 (7.3%) had moderate disability. Twenty-three patients (56.1%) were fully satisfied, while 18 (43.9%) had only partial satisfaction, having expected a better outcome. Thirty-three patients (80.5%) returned to full-time work. Median disc space collapse (DSC) was 20% (range 5-66%) and L4-L5 was particularly affected. Prevalence of Modic changes increased from 46.3% to 78% with type 2 predominance. Multivariate logistic regression analysis identified the following negative prognostic factors: female sex, young age, lack of regular exercise, and chronic preoperative LBP. There was no correlation between the course of Modic changes, DSC, and patient outcome.

Conclusion:

Although many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome.

Résumé:

Résumé:Contexte:

Le résultat à long terme de la microdiscectomie lombaire (MDL) peut être influencé par la douleur lombaire (DL) et l’instabilité segmentaire dont les facteurs déterminants sont mal connus. Le but de notre étude était d’analyser l’interaction entre des variables cliniques, fonctionnelles et radiologiques ainsi que leur impact sur le résultat chez le patient.

Méthode:

Tous les patients qui ont subi une MDL en 2004-2005 ont été invités à participer à cette étude rétrospective de cohorte. Tous les patients ont subi une nouvelle évaluation clinique et radiologique après un suivi variant de 3 à 5 ans.

Résultats:

Quarante et un des 97 patients éligibles ont participé à l’étude. Douze patients (29,3%) présentaient une sciatalgie de modérée à sévère, 12 (29,3%) présentaient une DL modérée et 13 (31,7%) présentaient des signes cliniques d’instabilité segmentaire. Trente-huit patients (92,7%) avaient une invalidité minime et 3 (7,3%) avaient une invalidité modérée. Trente-trois patients (56,1%) étaient entièrement satisfaits du résultat et 18 (43,9%) s’étaient attendus à de meilleurs résultats et étaient donc partiellement satisfaits. Trente-trois patients (80,5%) étaient retournés au travail à temps complet. L’affaissement médian de l’espace discal (AED) était de 20% (écart de 5% à 66%) et l’espace L4-L5 était particulièrement touché. La prévalence de changements Modic a augmenté de 46,3% à 78%, avec prédominance de changements de type 2. L’analyse de régression logistique multivariée a identifié les facteurs indiquant un pronostic défavorable : le sexe féminin, le jeune âge, l’absence d’exercice régulier et la présence de DL chronique avant la chirurgie. Il n’existait pas de corrélation entre l’évolution des changements Modic, l’AED et le résultat chez le patient.

Conclusion:

Bien que plusieurs patients éprouvent des symptômes après la MDL, ils présentent rarement une invalidité significative ou de l’insatisfaction. Certains facteurs, tels le sexe féminin, le jeune âge, le manque d’exercice et la DL chronique préopératoire, peuvent prédire un moins bon résultat. L’affaissement de l’espace discal est une constatation universelle, particulièrement au niveau L4-L5. Ni l’AED, ni les changements Modic ne semblent influencer le résultat chez le patient.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 439 - 445
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1 Weber, H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine. 1983;8:131–40.CrossRefGoogle ScholarPubMed
2 Atlas, SJ, Deyo, RA, Keller, RB, et al. The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica. Spine. 1996;21:1777–86.CrossRefGoogle ScholarPubMed
3 Atlas, SJ, Keller, RB, Chang, Y, Deyo, RA, Singer, DE. Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the Maine Lumbar Spine Study. Spine. 2001;26:1179–87.CrossRefGoogle ScholarPubMed
4 Atlas, SJ, Keller, RB, Wu, YA, Deyo, RA, Singer, DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine lumbar spine study. Spine. 2005;30:927–35.CrossRefGoogle ScholarPubMed
5 Weinstein, JN, Lurie, JD, Tosteson, TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296:2451–9.CrossRefGoogle ScholarPubMed
6 Awad, JN, Moskovich, R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:183–97.Google ScholarPubMed
7 Kotilainen, E, Valtonen, S. Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir (Wien). 1993;125:120–6.CrossRefGoogle ScholarPubMed
8 Kotilainen, E. Long-term outcome of patients suffering from clinical instability after microsurgical treatment of lumbar disc herniation. Acta Neurochir (Wien). 1998;140:120–5.CrossRefGoogle ScholarPubMed
9 Yorimitsu, E, Chiba, K, Toyama, Y, Hirabayashi, K. Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine. 2001;26:652–7.CrossRefGoogle ScholarPubMed
10 Schaller, B. Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy. Eur Spine J. 2004;13:193–8.CrossRefGoogle ScholarPubMed
11 Thomé, C, Barth, M, Scharf, J, Schmiedek, P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2005;2:271–8.CrossRefGoogle ScholarPubMed
12 Barth, M, Weiss, C, Thomé, C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine. 2008;33:265–72.CrossRefGoogle ScholarPubMed
13 Barth, M, Diepers, M, Weiss, C, Thomé, C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine. 2008;33:273–9.CrossRefGoogle ScholarPubMed
14 Loupasis, GA, Stamos, K, Katonis, PG, Sapkas, G, Korres, DS, Hartofilakidis, G. Seven- to 20-year outcome of lumbar discectomy. Spine. 1999;24:2313–7.CrossRefGoogle ScholarPubMed
15 Padua, R, Padua, S, Romanini, E, Padua, L, de Santis, E. Ten- to 15- year outcome of surgery for lumbar disc herniation: radiographic instability and clinical findings. Eur Spine J. 1999;8:70–4.CrossRefGoogle ScholarPubMed
16 Mochida, J, Nishimura, K, Nomura, T, Toh, E, Chiba, M. The importance of preserving disc structure in surgical approaches to lumbar disc herniation. Spine. 1996;21:1556–64.CrossRefGoogle ScholarPubMed
17 Modic, MT. Modic type 1 and type 2 changes. J Neurosurg Spine. 2007;6:150–1.CrossRefGoogle ScholarPubMed
18 Rahme, R, Moussa, R. The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008;29:838–42.CrossRefGoogle ScholarPubMed
19 Fairbank, JC, Pynsent, PB. The Oswestry Disability Index. Spine. 2000;25:2940–52.CrossRefGoogle ScholarPubMed
20 Daltroy, LH, Cats-Baril, WL, Katz, JN, Fossel, AH, Liang, MH. The North American spine society lumbar spine outcome assessment instrument: reliability and validity tests. Spine. 1996;21:741–9.CrossRefGoogle ScholarPubMed
21 Fountas, KN, Kapsalaki, EZ, Feltes, CH, et al. Correlation of the amount of disc removed in a lumbar microdiscectomy with long-term outcome. Spine. 2004;29:2521–6.CrossRefGoogle Scholar
22 Leone, A, Guglielmi, G, Cassar-Pullicino, VN, Bonomo, L. Lumbar intervertebral instability: a review. Radiology. 2007;245:62–77.CrossRefGoogle ScholarPubMed
23 Javedan, S, Sonntag, VK. Lumbar disc herniation: microsurgical approach. Neurosurgery. 2003;52:160–4.Google ScholarPubMed
24 McGirt, MJ, Ambrossi, GL, Datoo, G, et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery. 2009;64:338–45.CrossRefGoogle ScholarPubMed
25 Watters, WC 3rd, McGirt, MJ. An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J. 2009;9:240–57.CrossRefGoogle ScholarPubMed
26 Hanley, EN Jr, Shapiro, DE. The development of low-back pain after excision of a lumbar disc. J Bone Joint Surg Am. 1989;71: 719–21.Google ScholarPubMed
27 Weinstein, JN, Lurie, JD, Tosteson, TD, et al. Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine. 2008;33:2789–800.CrossRefGoogle ScholarPubMed
28 Graver, V, Ljunggren, AE, Loeb, M, Haaland, AK, Lie, H, Magnaes, B. Background variables (medical history, anthropometric and biological factors) in relation to the outcome of lumbar disc surgery. Scand J Rehabil Med. 1998;30:221–5.Google Scholar
29 Hurme, M, Alaranta, H. Factors predicting the result of surgery for lumbar intervertebral disc herniation. Spine. 1987;12:933–8.CrossRefGoogle ScholarPubMed
30 Nygaard, OP, Romner, B, Trumpy, JH. Duration of symptoms as a predictor of outcome after lumbar disc surgery. Acta Neurochir (Wien). 1994;128:53–6.CrossRefGoogle ScholarPubMed
31 Nygaard, OP, Kloster, R, Solberg, T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg. 2000;92 Suppl 2:131–4.Google Scholar
32 Ng, LC, Sell, P. Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study. J Bone Joint Surg Br. 2004;86:546–9.CrossRefGoogle ScholarPubMed
33 den Boer, JJ, Oostendorp, RA, Beems, T, Munneke, M, Oerlemans, M, Evers, AW. A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery. Eur Spine J. 2006;15:527–36.CrossRefGoogle ScholarPubMed
34 Chin, KR, Tomlinson, DT, Auerbach, JD, Shatsky, JB, Deirmengian, CA. Success of lumbar microdiscectomy in patients with modic changes and low-back pain: a prospective pilot study. J Spinal Disord Tech. 2008;21:139–44.CrossRefGoogle ScholarPubMed