Outcome Analysis in 654 Surgically Treated Lumbar Disc Herniations

Abstract

This article reports the outcomes of 654 consecutive patients treated during a 4.5-year period. Patients had a microdiscectomy, a laminectomy plus microdiscectomy, or a decompressive laminectomy with a microdiscectomy. The causes of ruptured discs were lifting (31.4%), falls (10.2%), and sports (10.0%). Almost all patients had complained of leg pain (99%), and 79% had radicular pain in a dermatomal distribution. Thirty-three percent of the patients had been involved in industrial accidents, and 6% had legal claims pending during the surgical period. Almost 11% of the patients had complications, and there was one death caused by abdominal arterial bleeding. Patients were also rated according to the Prolo Functional-Economic Outcome Rating Scale to improve the ability to compare series in the future. Almost 80% of the patients had good outcomes as defined by scores on this scale of 8 (16.2%), 9 (33.2%), and 10 (26.9%). Several conclusions can be drawn from the results of this series: 1) most patients had good outcomes; 2) patients with nonindustrial injuries had better outcomes than did patients with industrial injuries; 3) professionals with legal concerns and laborers with industrial insurance had good outcomes; and 4) the Functional-Economic Outcome Rating Scale appears to be a useful tool for comparing different procedures more objectively and for comparing the outcomes across series.

Clinical Presentation and Anatomic Position of L3-L4 Disc Herniation

“…The incidence of L3-L4 disc herniation was reported to account for 1.8-9% of all disc herniations. [1][2][3][4] Nevertheless, previous studies reported that in 24-37% of patients operated on for far lateral disc herniation, the pathology was located at the L3-L4 level. [7][8][9] As these studies were originally dedicated to describing the surgical approach to lateral disc herniation, only patients that had undergone surgery were included.…”

“…[1][2][3][4] Few reports have described the typical features of upper lumbar disc herniation. It was found that patients with L3-L4 disc herniation are older than patients with disc herniation in lower segments 1,5 and that a significant number of patients had previous lumbar spine disc surgery.…”

Association Between Peridural Scar and Recurrent Radicular Pain After Lumbar Discectomy: Magnetic Resonance Evaluation

“…reports suggesting that fibrosis and adhesions can cause compression or tethering of the nerve root, which may cause recurrent radicular pain and physical impairment. The literature does not establish a definite rate of fibrosis-related problems following lumbar discectomy, but it is repeatedly suggested that fibrosis may be a major cause of recurrent symptoms when no alternative bony or disc pathology can be discerned (2,3,7,9,14,19,20,22,25,28,29,38). While it has been suggested that fibrosis may be causal in as much as 24% of all failed back surgery syndrome cases (6,35), no previous studies have provided proof of a correlation between peridural scar and recurrent radicular pain.…”

The Effect of Previous Low Back Surgery on General Health Status

“…20,21 Failure of spinal surgery leading to reoperation is a major contributor of personal and social disability. 20,21 Failure of spinal surgery leading to reoperation is a major contributor of personal and social disability.…”