Seven- to 20-Year Outcome of Lumbar Discectomy

Abstract

The long-term results of standard lumbar discectomy are not very satisfying. More than one-third of the patients had unsatisfactory results and more than one quarter complained of significant residual pain. Heavy manual work, particularly agricultural work, and low educational level were negative predictors of a good outcome. These indicators should be used preoperatively to identify patients who are at high risk for an unfavorable long-term result.

Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests

“…On the follow-up assessment, after informed consent was obtained from each, the patients' weight and height were recorded. All the participants then underwent a structured assessment using an expanded outcome set mainly based upon previously published measures and definitions [2,8,18,19,23] which is summarized in Table 2. Final results of Oswestry Disability Index (ODI) were categorized into groups of increasing functional impairment as follows 0-20% (minimal disability), 20-40% (moderate disability), and more than 41% (severe disability) [19].…”

“…Patients who had undergone lumbar discectomy many years earlier usually have a satisfactory functional outcome [20,28,36] but they often complain of residual low back pain (LBP) [19,20,36]. Plain radiography is frequently required in elderly people with LBP [17] because of its low cost and easy availability, although there is not evidence that the routine use of this imaging test is associated with an improvement in the outcome of these patients [7,17].…”

“…Plain radiography is frequently required in elderly people with LBP [17] because of its low cost and easy availability, although there is not evidence that the routine use of this imaging test is associated with an improvement in the outcome of these patients [7,17]. Several studies investigated postoperative changes in the lumbar spine of patients who had undergone discectomy for lumbar disc herniation (LDH), visualized on both radiographies and magnetic resonance imaging (MRI) at variable follow-up intervals [3,11,16,19,26,28,33,36], and these changes have been associated to LBP [16,36]. As no data on radiographic degenerative changes at minimum of 20 years from surgery is available, it would be of interest to assess whether a previous discectomy may influence these long-term alterations and what is their clinical meaning.…”

Proprioceptive use and sit-to-stand-to-sit after lumbar microdiscectomy: The effect of surgical approach and early physiotherapy

“…When persistent nerve root compression caused by disc herniation is present, lumbar microdiscectomy is recommended. Despite the high success rate of first-time lumbar microdiscectomy in terms of neural repair, residual functional complaints are not infrequent (Loupasis et al, 1999). Short term after surgery, lumbar microdiscectomy provides more rapid recovery than non-operative treatment, but no difference in functionality and pain is found in the long run (Jacobs et al, 2011b;Loupasis et al, 1999).…”

“…Despite the high success rate of first-time lumbar microdiscectomy in terms of neural repair, residual functional complaints are not infrequent (Loupasis et al, 1999). Short term after surgery, lumbar microdiscectomy provides more rapid recovery than non-operative treatment, but no difference in functionality and pain is found in the long run (Jacobs et al, 2011b;Loupasis et al, 1999). The underlying mechanisms of these residual complaints remain largely unknown, although identification of these factors is listed as a high research priority in this research area (Costa et al, 2013;McGregor et al, 2006).…”