Factors Influencing the Outcome of Surgical Treatment of Lumbar Disc Herniation

Česká verzia

Authors: P. Vaněk ¹; O. Bradáč ¹; K. Saur ¹; M. Říha ²
Authors place of work: ÚVN Praha Neurochirurgická klinika 1. LF UK ¹; ÚVN Praha Oddělení rehabilitace ²
Published in the journal: Cesk Slov Neurol N 2010; 73/106(2): 157-163
Category: Original Paper

Summary

Surgery for lumbar disc herniation is the most often‑performed procedure for treatment of degenerative disease of the lumbar spine. Despite this, it remains unclear as to what factors definitely established before surgery influence the results of that treatment. One hundred and fifty‑four patients were enrolled and followed for four years in this prospective study. The results of the treatment were monitored using standardized questionnaires: the Oswestry disability index (ODI), the Roland Morris score (RM) and a visual analogue score (VAS). The effects on the result of surgical treatment were evaluated in terms of symptom duration before surgery, immediate clinical situation before surgery, body mass index (BMI), smoking, occupation, presence of Modic changes (Modic I–II) on MRI, significant low back pain – similar intensity compared to radicular pain – and neurological deficit. The efficacy of surgical treatment of lumbar disc herniation was confirmed. A significant decrease of values in the questionnaires and significant improvement in patients’ clinical situations were recorded. These results tended towards slight deterioration as the four‑year follow‑up progressed; however, significant clinical improvement and decrease of scale values remained. The pre‑operative presence of significant low back pain and duration of symptoms longer than one year had significantly negative effects on satisfactory clinical response to surgical treatment. Significant influence on outcome on the part of the immediate clinical situation before surgery, BMI, smoking, occupation, presence of the neurological deficit and Modic changes to clinical outcome was not demonstrated by this study.

Key words:
lumbar disc herniation – factor influencing the outcome – surgical treatment

Zdroje

1. Rhee J, Schaufele M, Abdu W. Radiculopathy and herniated disc: controversies regarding pathophysiology and management. J Bone Joint Surg 2006; 88(9): 2069–2080.

2. Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: update Cochrane Review. Spine 2007; 32(16): 1735–1747.

3. Gotfryd A, Avanzi O. A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations. Int Orthop 2009; 33(1): 11–17.

4. Hrabálek L, Novotný J, Koluchová J, Vaverka M, Kalita O, Langová K. Změny parametrů páteře po implantaci bederní interspinózní rozpěrky DIAM. Cesk Slov neurol N 2009; 72/105(4): 337–342.

5. Hrabálek L, Macháč M, Vaverka M. Implantace interspinózní rozpěrky DIAM u pacientů s degenerativním onemocněním lumbosakrální páteře. Acta Chir Orthop Traum čech 2009; 76(5): 417–423.

6. McGregor AH, Burton AK, Sell P, Wadell G. The development of an evidence‑based patient booklet for patients undergoing lumbar discectomy and un‑instrumented decompression. Eur Spine J 2007; 16(3): 339–346.

7. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22): 2940–2953.

8. Stratford PW, Binkley JM. Measurement properties of the RM‑18. A modified version of the Roland‑Morris Disability Scale. Spine 1997; 22(20): 2416–2421.

9. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16(1): 87–101.

10. Prolo DJ, Oklund SA, Butcher M. Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 1986; 11(6): 601–606.

11. Mariconda M, Galasso O, Secondulfo V, Rotonda GD, Milano C. Minimum 25‑year outcome and functional assessment of lumbar discectomy. Spine 2006; 31(22): 2593–2599.

12. Smorgick Y, Floman Y, Millgram MA, Anekstein Y,Pekarsky I, Mirovsky Y. Mid‑ to long term outcome of disc excision in adolescent disc herniation. Spine J 2006; 6(4): 380–384.

13. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long‑outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 8 to 10 year results from the maine lumbar spine study. Spine 2005; 30(8): 847–849.

14. Vucetic N, Astrand P, Guntner P, Svensson O. Diagnosis and prognosis in lumbar disc herniation. Clin Orthop Relat Res 1999; 361: 116–122.

15. Ng LC, Sell P. Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study. J Bone Joint Surg Br 2004; 86(4): 546–549.

16. Rothoerl RD, Woertgen C, Brawanski A. When should conservative treatment for lumbar disc herniation be ceased and surgery considered. Neurosurg Rev 2002; 25(3): 162–165.

17. Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine:prevalence of intervertebral disk extrusion and sequestration, nerve root compression, and plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998; 209(3): 661–666.

18. Chin KR, Tomlinson DT, Auerbach JD, Shatsky JB, Deirmengian CA. Success of lumbar microdiscectomy in patients with modic changes and low‑back pain: a prospective pilot study. J Spinal Disord Tech 2008; 21(2): 139–144.

19. Barth M, Diepers M, Weiss Ch, Thomé C. Two year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine 2008; 33(3): 273–279.

20. Park P, Upadhyaya Ch, Garton H, Foley K. The impact of minimally invasive spine surgery on perioperative complication in overweight or obese patients. Neurosurgery 2008; 62(3): 693–699.

21. Rosen DS, Ferguson SD, Ogden AT, Huo D, Fessler RG. Obesity and self reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery 2008; 63(5): 956–960.

22. DeBerard MS, LaCaille RA, Spielmans G, Colledge A,Parlin MA. Outcome and presurgery correlates of lumbar discectomy in Utah Workers’ Compensation patients. Spine J 2009; 9(3): 193–203.

23. Atlas SJ, Chang Y, Kammann E, Keller RB, Deyo RA, Singer DE. Long‑term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation. J Bone Joint Surg Am 2000; 82(1): 4–15.

24. Quigley MR, Bost J, Maroon JC, Elrifai A, Panahandeh M. Outcome after microdiscectomy: results of a prospective single institutional study. Surg Neurol 1998; 49(3): 263–267.

25. Ronnberg K, Lind B, Zoega B, Halldin K, Gellerstedt M, Brisby H. Patient’s satisfaction with provided care/information and expectations on clinical outcome after lumbar disc surgery. Spine 2007; 32(2): 256–261.

26. Wang JC, Shapiro MS, Hatch JD, Knight J, Dorey FJ, Delamarter RB. The outcome of lumbar discectomy in elite athletes. Spine 1999; 24(6): 570–573.