Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

Abstract

Study Design: Retrospective cohort study. Objectives: Discectomy alone or discectomy with fusion have been 2 polarized options in the management of large lumbar disc herniations presenting with leg-dominant pain in young patients. The objective of the study was to evaluate the outcomes of discectomy in young patients with large central lumbar disc herniation (CLDH) presenting with predominant leg pain. Material and Methods: Young patients (<45 years) presenting with predominant leg pain and MRI confirmed diagnosis of CLDH between April 2007-January 2017 were included in the study. All patients underwent tubular microdiscectomy. Outcomes of surgery were evaluated using visual analogue score (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Macnab’s criteria. Results: Ninety patients fulfilled the inclusion criteria. The mean age of patients was 34.9 years (range 19-45 years). Mean follow-up was 5.09 years (range 2-10 years). The incidence of CLDH in young adults was 30% and incidence among all “operated” lumbar disc herniations was 15.9%. The mean VAS for leg pain improved from 7.48 ± 0.9 to 2.22 ± 0.84 ( P < .05) and the mean ODI changed from 60.53 ± 7.84 to 18.33 ± 6.20 ( P < .05). Fifty-nine patients (65.6%) reported excellent, 25 patients (27.8%) reported good, 3 patients each (3.3%) as fair and poor outcomes respectively. Conclusion: Discectomy alone for CLDH with predominant leg pain is associated with high success rate and low need for a secondary surgical procedure. Patient selection in terms of leg-dominant pain may be the main attribute for lower incidence of recurrence, postoperative back-pain, and instability needing a secondary procedure. Minimally invasive discectomy may provide an added advantage of preserving normal spinal anatomy, thus minimizing the need for primary spinal fusion in these patients.

Clinical comparison of unilateral biportal endoscopic discectomy with percutaneous endoscopic lumbar discectomy for single l4/5‐level lumbar disk herniation

“…This kind of decompression method could preserve the facet joints better than others, even more, it was reported to maintain more than 70% stiffness of the intact spine 14,15 . To achieve an adequate recovery after operation, a variety of approaches have been used to reduce injury to the paraspinal muscles and further minimize the surgical wounds, such as: open, tubular retractor assisted, microscopic, endoscopic, microendoscopic, or full‐endoscopic 16–18 . Nevertheless, the superiority of minimal invasiveness must be tested against the inferiority of limited working place, limited visual field, radiation exposure, cost, steep learning curve, compromised treatment results, and complications 19 …”

“…14,15 To achieve an adequate recovery after operation, a variety of approaches have been used to reduce injury to the paraspinal muscles and further minimize the surgical wounds, such as: open, tubular retractor assisted, microscopic, endoscopic, microendoscopic, or full-endoscopic. [16][17][18] Nevertheless, the superiority of minimal invasiveness must be tested against the inferiority of limited working place, limited visual field, radiation exposure, cost, steep learning curve, compromised treatment results, and complications. 19 Since 2002, the UBE decompression technique has been regarded as a minimally invasive surgical technique for the treatment of spinal canal stenosis and LDH.…”

Chemonucleolysis with Chondroitin Sulfate ABC Endolyase for Treating Lumbar Disc Herniation: Exploration of Prognostic Factors for Good or Poor Clinical Outcomes

“…Nevertheless, a spinal canal occupancy ratio ≥ 40% is highly predictive of improvement in leg pain. Various surgical approaches from decompression alone to fixation, have been reported for the treatment of large central LDHs, which are difficult to treat [ 32 , 33 , 34 , 35 , 36 ]. In recent years, transforaminal discectomy by FESS has been reported to have good results for large central LDHs [ 37 , 38 , 39 ].…”

Chemonucleolysis with Chondroitin Sulfate ABC Endolyase for Treating Lumbar Disc Herniation: Exploration of Prognostic Factors for Good or Poor Clinical Outcomes

“…Nevertheless, a spinal canal occupancy ratio ≥ 40% is highly predictive of improvement in leg pain. Various surgical approaches from decompression alone to fixation, have been reported for the treatment of large central LDH, which are difficult to treat [33][34][35][36][37]. In recent years, transforaminal discectomy by FESS has been reported to have good results for large central LDH [38][39][40].…”