The Microsurgical Treatment of Lumbar Disc Herniation

A Report of 158 Patients With a Mean Follow-up of More Than 32 Years

Benedikt W. Burkhardt, M.D.; Marietta Grimm, M.D; Karsten Schwerdtfeger M.D.; Joachim M. Oertel, M.D.

Disclosures

Spine. 2019;44(20):1426-1434. 

In This Article

Abstract and Introduction

Abstract

Study Design: Level 3, cohort study.

Objective: The aim of this study was to assess long-term clinical outcome, and rate of reoperation following microsurgical subtotal discectomy (MSD).

Summary of Background Data: Lumbar disc herniation (LDH) is a common cause of discomfort. Studies with >25 years of follow-up are rare and the reported rate of clinical success and reoperation are not well understood.

Methods: Retrospectively, files with complete documentation of preoperative and postoperative neurological status, process during hospitalization, detailed report of MSD, outpatient visit notes, and full contact information of patients who underwent MSD for the treatment of LDH with a minimum follow-up of 25 years were reviewed. Patients were contacted for personal follow-up assessment which included Oswestry Disability Index (ODI), EQ-5D, and MacNab criteria, usage of pain medication for leg and back pain, limitations in daily life, and repeated procedures at the lumbar spine.

Results: A total of 355 patients were randomly selected and contacted for final follow-up and 158 patients with a mean follow-up 32 years participated in the study. Clinical success rate was 86.0%, mean ODI was 9% (0–58%), 69.6% of the patients were pain free, 13.9% of patients reported the daily intake of pain medication for back and leg pain. Reoperations were performed in 47 of the patients (29.7%), whereas the rate for recurrent disc herniation at the same level was 8.2%. Reoperation within the first 2 years after initial MSD had negative influence on clinical success. The preoperative physical working status and sex and working status had no influence on the clinical success.

Conclusion: The MSD is an effective technique to achieve a high rate of patient satisfaction, and high rate of functional recovery. The overall reoperation rate is 30% within 30 years but only 8.2% of the patients underwent reoperation because of recurrent disc herniation at the same level.

Level of Evidence: 3

Introduction

Life expectancy has increased in the past decades because of aging of the society. As a result of this trend, a multitude of patients with degenerative spinal disorders will require treatment in the near future. Lumbar disc herniation (LDH) can cause back pain, radicular pain, and sensorimotor deficits. Once conservative treatment is not successful, operative treatment might be the last option to relieve pain and restore function.

Since the first description of a LDH and its surgical treatment by Mixter in 1937, there has been enormous progress in the further development of surgical techniques to the present day.[1] A microscope was used to perform a lumbar discectomy for the first time in 1977.[2,3] This technical advancement was probably one of the most substantial advances in spinal procedures. To this day, the most commonly performed procedure is the microsurgical discectomy. However, the clinical outcome may vary depending on the underlying type of the LDH, the amount of disc removal, and the technical nuances for the removal of disc herniation.[4–6]

Additionally, the rate of repeated procedures following the surgical intervention for the treatment of LDH has been reported to be highly variable.[7,8] There is a paucity of long-term data on the clinical outcome, on the quality of life, and on the rate of repeated procedures following the microsurgical treatment of LDH.

For a better understanding of the course of degenerative disorders, it is important to assess the clinical outcome in a long-term follow-up evaluation. In the present study, the authors have assessed the clinical outcome, the quality of life, and the cause and the rate of repeated procedures of patients who underwent microsurgical treatment of LDH more than 30 years ago.

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