Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm?

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors assessed the efficacy and outcomes of lumbar microdiscectomy performed on an outpatient basis by administering six questionnaires before and at five time points after surgery. The results were compared with those reported in literature in which the success rates vary between 70% and 80% and in excess of 90%. The authors use the methodology and data derived from their study to evaluate critically the relevance of these two categories of success rates.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> This is a prospective study of 212 consecutive, eligible patients who underwent outpatient microscopic discectomy for the treatment of lumbar disc herniation; no previous lumbar lesion had been treated. Data were collected from questionnaires given to the patients before and at five time points after surgery, including at a variable final follow-up examination (mean 2 years postoperatively). Data were collated and analyzed independently by individuals other than the operating surgeons.</jats:p> <jats:p content-type="fine-print">In both bi- and multivariate analyses, only two preoperative parameters were prognostically significant. The first factor was Workers' Compensation status, which had a negative effect on outcome. The second factor was patient age, which also had a negative effect and was linear with increasing age between 25 years and 56 years—that is, the ages most commonly encountered in cases of herniated disc. Successful outcome rates were as follows: leg pain relief according to a visual analog scale (VAS), 80%; back pain relief (VAS), 77%; Oswestry Low Back Disability Index, 78%; satisfaction with the results of surgery, 76%; return to normal daily activities, 65%; and return to work, 61%.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The findings of this study support the evidence that lumbar microdiscectomy performed on an outpatient basis is a very safe and effective means of treating sciatic pain due to disc herniation. The authors believe that their outcome success rates of 75 to 80% are more realistic than those of 90% or more found in some reports.</jats:p>

The risk of ?getting worse? after lumbar microdiscectomy

“…The deterioration is significant, and it occurs within a larger cohort of patients with a favourable overall outcome, demonstrated by large effect sizes on all outcome measures. Similar results have been published elsewhere [2,9,17,21,25,26]. Patients who had been sicklisted for a longer period of time or had a better ODI score prior to operation were at a higher risk of "getting worse".…”

“…Their characteristics are listed in Table 3. A change of 10% in the ODI score is considered to be clinically relevant [2,13,27]. Of these patients 6 were evaluated with postoperative contrast-enhanced MRI scans.…”

“…Several predictors of an unfavourable outcome have been identified [1,2,12,20,25,28,30,31,32] and socioeconomic and psychological factors seem to play a major role [7,9,15,21,24]. Risk factors for deterioration of functional status and HRQL after microdiscectomy have not been reported.…”

“…Some studies reported on increase in pain after microdiscectomy [17,26,29] and one study reported on decrease in health-related quality of life (HRQL) after such operations [30]. Prospective studies focusing on deterioration of functional status after microdiscectomy are lacking.Several predictors of an unfavourable outcome have been identified [1,2,12,20,25,28,30,31,32] and socioeconomic and psychological factors seem to play a major role [7,9,15,21,24]. Risk factors for deterioration of functional status and HRQL after microdiscectomy have not been reported.…”

Engineering on the Straight and Narrow: The Mechanics of Nanofibrous Assemblies for Fiber-Reinforced Tissue Regeneration

“…10 Failed conservative treatment of lumbar disc herniation leads to surgical discectomy at a rate of over 250,000 per year, making it the most frequently performed neurosurgical procedure in the United States. 11 Notably, the rate of re-herniation is nearly 20%, often occurring at the same disc location. 12 In all of these instances, the limited vascularity and the hypocellularity of these tissues in the adult engender only limited endogenous repair processes.…”