What is the prognosis of lumbar disc disease following surgery?

Updated: Sep 25, 2018
  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
  • Print
Answer

Almost every study measures the outcome from lumbar disc surgery differently. A good outcome may be defined as the decreased use of narcotics, prompt return to work, or reported reduction in pain. Understandably, outcome studies can be misinterpreted or misrepresented.

Patients who experienced symptoms 6 months or more prior to treatment (both operative and nonoperative) had worse outcomes following their treatment. Surgery’s relative benefit over nonoperative treatment was not dependent on the symptom duration. [28]

Approximately 75% of patients who undergo a microdiscectomy have long-term reduction of sciatic pain and, thus, are considered cured. Reported results vary from 65-95%. Predominance of leg pain is the best determinant of good outcome from surgery for lumbar disc herniation.

Unfortunately, a rather large fraction of individuals who have had surgery for lumbar disc disease have recurrent or residual pain, which can be a significant challenge to treat. A methodical postoperative evaluation is necessary, focusing on symptom clarification, careful examination, and repeat radiographic examinations and MRI with contrast.

Interestingly, a large multicenter trial found that surgical and nonsurgical outcomes at 2 years were similar, but that the surgical group experienced faster pain relief. [12, 13] The limitations of this study are outlined in an editorial. [14]

Also, some patients who are surgically treated are more prone to further problems such as recurrent herniations, arachnoiditis, and vertebral instability.

A long-term follow-up study shows that frequent strenuous physical activity at work plays a prominent role in later hospitalization for herniated lumbar disc disease. Additionally, it has been found that while body height is also a significant predictor for herniated lumbar disc disease, body weight is only insignificantly associated with it. [29]

A study of long-term results for lumbar disc herniation operations in 39,048 patients compared microdiscectomy, endoscopic microdiscectomy, and the 'classic operation,' laminectomy/laminotomy with discectomy. Laminectomy/laminotomy with discectomy was performed on 34,547 patients (88.5%), with a mean follow-up of 6.3 years, and 27,050 (78.3%) patients had good/excellent results. Microdiscectomy was performed on 3,400 patients (8.7%); the mean follow-up was 4.1 years, with 2,866 patients (84.3%) reporting good/excellent results. Endoscopic microdiscectomy was performed on 1,101 patients (2.8%), with mean follow-up of 2.9 years and 845 (76.8%) reporting good/excellent results. [30]


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!