Background and purpose Although there have been numerous publications on lumbar disc herniation (LDH) treated surgically, there has been little interest in sex differences. It has been shown in many studies that sex differences may be important in certain diseases. We therefore reviewed consecutive register material from one institution for possible gender differences in preand postoperative parameters in patients operated for lumbar disc herniation.Patients and methods Pre-and postoperative parameters for all patients operated on at the Department of Orthopedics, Lund University Hospital over 6 years (2000-2005 inclusive) (301 patients, 165 males) were analyzed regarding sex differences.Results Statistically significant and clinically relevant sex differences were found. Preoperatively, females had more pronounced back pain and disability, and also lower quality of life in some respects. At 1-year followup, females reported a higher rate of consumption of analgesics, a higher degree of postoperative back and leg pain, and less improvement regarding disability and some aspects of quality of life. Relative improvement, rate of return to work, and satisfaction with the outcome of surgery were not, however, statistically significantly different between females and males.Interpretation There are statistically significant differences between the sexes in lumbar disc herniation surgery regarding basic demographic status and postoperative status, whereas the surgical effect is similar. Further investigations should focus on whether there is a true sex difference or whether these differences are due to selection for surgery, differences in proneness to seek medical advice or to accept/choose surgery, or other unknown factors.

Introduction Decompression for lumbar spinal stenosis is one of the most frequent operations on the spine today. The most common complication seems to be a peroperative dural lesion. There are few prospective studies on this complication regarding incidence and effect on long-term outcome; this is the background for the current study. Materials and methods Swespine, the Swedish Spine Register documents the majority ([80%) of lumbar spine operations in Sweden today. Within the framework of this register, totally 3,699 operations for spinal stenosis during a 5-year period were studied regarding complications and 1-year postoperative outcome. Mean patient age was 66 (37-92) years and 44% were males. Fourteen percent were smokers and 19% had undergone previous lumbar spine surgery. Results The overall incidence of a peroperative dural lesion was 7.4%, 8.5% of patients undergoing decompressive surgery only and 5.5% of patients undergoing decompressive surgery ? fusion (p \ 0.001). A logistic regression analysis demonstrated that (high) age (p \ 0.0004), previous surgery (p \ 0.036) and smoking (p \ 0.049) were significantly predictive factors for dural lesions. An odds ratio estimate demonstrated an age-related risk increase with 2.7% per year. The risk for dural lesions also increased with number of levels decompressed. The 1-year outcome was identical in the two groups with and without a dural lesion.Conclusion A dural lesion was seen in 7.4% of decompressive operations for spinal stenosis. High age, previous surgery and smoking were risk factors for sustaining a lesion, which, however, did not affect the 1-year outcome negatively.

No abstract

In lumbar disc herniation surgery, dural lesions seem to be the most common complication today. Studies on incidence of and outcome after a dural lesion are mainly based on retrospective studies. In a prospective study within the framework of the Swedish Spine Register, 4,173 patients operated on for lumbar disc herniation were evaluated using pre-and 1-year postoperative protocols and complication registration. Mean patient age was 41 (18-81) years and 53% of the patients were male. 93% of the operations were performed on the two lowermost lumbar levels. The incidence of dural lesions in the material was 2.7%. In patients with previous disc surgery, the incidence was doubled, 5%, a significant increase (P = 0.02). Patients with dural lesions preoperatively had more back pain and inferior scores in general health and role emotional domains of the SF-36. These factors, however, were because they had been operated on previously, not related to the dural lesion as such. The relative improvement after surgery was similar whether a dural lesion had occurred or not. It is concluded that a dural lesion is a technical complication which must be solved at the time of surgery but which does not bear any negative implications on the long-term outcome for the patient.