Summary
Background. Microsurgical discectomies are an established procedure in spinal surgery. This operating technique was first used in the Department of Neurosurgery in Iceland in 1981 and has become standard operative treatment for herniated lumbar discs. There is a great variability in outcome reports regarding recurrence rate and re-operation rate. Few articles are based on follow-up of more than 10 years. This article presents the results of a 20 years follow-up study.
Methods. A retrospective study of all patients undergoing microsurgical discectomy for herniated lumbar disc, from June 1, 1981 to December 31, 1984. Outcome, based on recurrence rate, return to work and patient satisfaction was determined by a self-evaluation questionnaire, phone interviews and patient medical records.
Findings. Of the 170 patients, 134 (78.8%) were included in the study (M:F, 58:42%). Preoperative symptoms: back pain with sciatica 108 (80.6%), sciatica 20 (14.9%), back pain 2 (1.5%). Mean follow-up time was 20.7 years (19.5–22.8). Recurrence rate was 12.7%. 19 patients (14.2%) underwent a subsequent lumbar operation at a different level or side. A majority of patients 108 (80.6%) returned to previous level of work, 26 (19.4%) lost some or all working capabilities. Patient satisfaction was high, 91.1% reporting excellent (68.7%) or good (22.4%) results. 5.2% of patients rated the outcome fair and 3.7% poor. Women reported worse outcome than men, excellent M:F 74.7:60.7%, and poor 7.1:1.3%. There was no significant difference in patient satisfaction in patients undergoing additional operations or those with recurrence of the herniated disc.
Conclusions. Outcome was very good with 92.0% return to work and 91.1% patient satisfaction. The recurrence rate was 12.7% with a substantial number of cases occuring 10–20 years after operation. To conclude, microsurgical discectomies maintain a high success rate in the long-term.
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References
CD Abernathy MG Yasargil (1990) Results in Microsurgery RW Williams (Eds) et al. Microsurgery of the lumbar spine Aspen Publishers Rockville 223–226
HL Asch PJ Lewis DB Moreland JG Egnatchik YJ Yu DE Clabeaux AH Hyland (2002) ArticleTitleProspective multiple outcomes study of outpatient lumbar microdiscectomy: should 75–80% success rates be the norm? J Neurosurg 96 34–44 Occurrence Handle11795712
SJ Atlas Y Chang E Kammann RB Keller RA Deyo DE Singer (2000) ArticleTitleLong-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation J Bone Joint Surg Am 82 4–15 Occurrence Handle10653079 Occurrence Handle1:STN:280:DC%2BD3c7hs1Orsg%3D%3D
SJ Atlas RB Keller Y Chang RA Deyo DE Singer (2001) ArticleTitleSurgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the maine lumbar spine study Spine 26 1179–1187 Occurrence Handle11413434 Occurrence Handle10.1097/00007632-200105150-00017 Occurrence Handle1:STN:280:DC%2BD3MzkvVWgsg%3D%3D
SJ Atlas RB Keller YA Wu RA Deyo DE Singer (2005) ArticleTitleLong-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the maine lumbar spine study Spine 30 927–935 Occurrence Handle15834338 Occurrence Handle10.1097/01.brs.0000158954.68522.2a
Caspar W (1977) A new surgical procedure for lumbar disc herniation causing less tissue damage through a microsurgical approach. Adv Neurosurg, pp 74–77
P Donceel BM Du (1998) ArticleTitleFitness for work after surgery for lumbar disc herniation: a retrospective study Eur Spine J 7 29–35 Occurrence Handle9548355 Occurrence Handle10.1007/s005860050023 Occurrence Handle1:STN:280:DyaK1c3gvVWgsA%3D%3D
GF Findlay BI Hall BS Musa MD Oliveira SC Fear (1998) ArticleTitleA 10-year follow-up of the outcome of lumbar microdiscectomy Spine 23 1168–1171 Occurrence Handle9615370 Occurrence Handle10.1097/00007632-199805150-00019 Occurrence Handle1:STN:280:DyaK1c3nslKjtg%3D%3D
C Fisher V Noonan P Bishop M Boyd D Fairholm P Wing M Dvorak (2004) ArticleTitleOutcome evaluation of the operative management of lumbar disc herniation causing sciatica J Neurosurg 100 317–324 Occurrence Handle15070138
EW Fritsch J Heisel S Rupp (1996) ArticleTitleThe failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments Spine 21 626–633 Occurrence Handle8852320 Occurrence Handle10.1097/00007632-199603010-00017 Occurrence Handle1:STN:280:DyaK2s%2FgsFSjuw%3D%3D
JN Gibson IC Grant G Waddell (1999) ArticleTitleThe Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis Spine 24 1820–1832 Occurrence Handle10488513 Occurrence Handle10.1097/00007632-199909010-00012 Occurrence Handle1:STN:280:DyaK1MvhvVWgtQ%3D%3D
V Graver M Loeb F Rasmussen H Lie AE Ljunggren (1998) ArticleTitleClinical overall score: outcome evaluation after lumbar disc surgery, assessments of reliability and validity Scand J Rehabil Med 30 227–233 Occurrence Handle9825387 Occurrence Handle10.1080/003655098443977 Occurrence Handle1:STN:280:DyaK1M%2Fkt1yhug%3D%3D
J Howe JW Frymoyer (1985) ArticleTitleThe effects of questionnaire design on the determination of end results in lumbar spinal surgery Spine 10 804–805 Occurrence Handle4089654 Occurrence Handle10.1097/00007632-198511000-00004 Occurrence Handle1:STN:280:DyaL287itlWmtA%3D%3D
E Kotilainen S Valtonen CA Carlson (1993) ArticleTitleMicrosurgical treatment of lumbar disc herniation: follow-up of 237 patients Acta Neurochir (Wien) 120 143–149 Occurrence Handle10.1007/BF02112033 Occurrence Handle1:STN:280:DyaK3s3ht1Kmsg%3D%3D
GA Loupasis K Stamos PG Katonis G Sapkas DS Korres G Hartofilakidis (1999) ArticleTitleSeven- to 20-year outcome of lumbar discectomy Spine 24 2313–2317 Occurrence Handle10586454 Occurrence Handle10.1097/00007632-199911150-00005 Occurrence Handle1:STN:280:DC%2BD3c%2Flt12jsw%3D%3D
JC Maroon (2002) ArticleTitleCurrent concepts in minimally invasive discectomy Neurosurgery 51 S137–S145 Occurrence Handle12234441
WJ Mixter JS Barr (1934) ArticleTitleRupture of the intervertebral disc with involvement of the spinal canal N Engl J Med 211 210–215 Occurrence Handle10.1056/NEJM193408022110506
AJ Moore JD Chilton D Uttley (1994) ArticleTitleLong-term results of microlumbar discectomy Br J Neurosurg 8 319–326 Occurrence Handle7946021 Occurrence Handle1:STN:280:DyaK2M%2Fjt1ygtg%3D%3D
CV Morgan-Hough PW Jones SM Eisenstein (2003) ArticleTitlePrimary and revision lumbar discectomy. A 16-year review from one centre J Bone Joint Surg Br 85 871–874 Occurrence Handle12931809 Occurrence Handle1:STN:280:DC%2BD3szpsVGisQ%3D%3D
OP Nygaard R Kloster T Solberg (2000) ArticleTitleDuration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up J Neurosurg 92 131–134 Occurrence Handle10763681 Occurrence Handle1:STN:280:DC%2BD3c3isVOmsw%3D%3D
CT Pappas T Harrington VK Sonntag (1992) ArticleTitleOutcome analysis in 654 surgically treated lumbar disc herniations Neurosurgery 30 862–866 Occurrence Handle1614587 Occurrence Handle1:STN:280:DyaK38zhtVKnsg%3D%3D
F Postacchini (1996) ArticleTitleResults of surgery compared with conservative management for lumbar disc herniations Spine 21 1383–1387 Occurrence Handle8725934 Occurrence Handle10.1097/00007632-199606010-00023 Occurrence Handle1:STN:280:DyaK28zjvV2mtQ%3D%3D
F Postacchini (1999) ArticleTitleManagement of herniation of the lumbar disc J Bone Joint Surg Br 81 567–576 Occurrence Handle10463723 Occurrence Handle10.1302/0301-620X.81B4.10213 Occurrence Handle1:STN:280:DyaK1MzptFeltg%3D%3D
MR Quigley J Bost JC Maroon A Elrifai M Panahandeh (1998) ArticleTitleOutcome after microdiscectomy: results of a prospective single institutional study Surg Neurol 49 263–267 Occurrence Handle9508112 Occurrence Handle10.1016/S0090-3019(97)00448-5 Occurrence Handle1:STN:280:DyaK1c7mslGgtQ%3D%3D
RD Rothoerl C Woertgen A Brawanski (2002) ArticleTitleWhen should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25 162–165 Occurrence Handle12135229 Occurrence Handle10.1007/s101430100184
A Schoeggl M Reddy C Matula (2003) ArticleTitleFunctional and economic outcome following microdiscectomy for lumbar disc herniation in 672 patients J Spinal Disord Tech 16 150–155 Occurrence Handle12679669 Occurrence Handle1:STN:280:DC%2BD3s7mt1CgtA%3D%3D
AS Sigurdsson G Gudmundsson B Hannesson K Gudmundsson (1991) ArticleTitleMicrosurgical lumbar discectomies. Outcome study of the Neurosurgical department in Iceland, 1981–1984 Icelandic Med J 77 249–253
TK Solberg OP Nygaard K Sjaavik D Hofoss T Ingebrigtsen (2005) ArticleTitleThe risk of “getting worse” after lumbar microdiscectomy Eur Spine J 14 49–54 Occurrence Handle15138862 Occurrence Handle10.1007/s00586-004-0721-5
C Thome M Barth J Scharf P Schmiedek (2005) ArticleTitleOutcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study J Neurosurg Spine 2 271–278 Occurrence Handle15796351 Occurrence Handle10.3171/spi.2005.2.3.0271
A Vik JA Zwart G Hulleberg OP Nygaard (2001) ArticleTitleEight year outcome after surgery for lumbar disc herniation: a comparison of reoperated and not reoperated patients Acta Neurochir (Wien) 143 607–610 Occurrence Handle10.1007/s007010170066 Occurrence Handle1:STN:280:DC%2BD3MvptF2nsw%3D%3D
H Weber (1983) ArticleTitleLumbar disc herniation. A controlled, prospective study with ten years of observation Spine 8 131–140 Occurrence Handle6857385 Occurrence Handle10.1097/00007632-198303000-00003 Occurrence Handle1:STN:280:DyaL3s3itlyqsg%3D%3D
M Wenger L Mariani A Kalbarczyk U Groger (2001) ArticleTitleLong-term outcome of 104 patients after lumbar sequestrectomy according to Williams Neurosurgery 49 329–334 Occurrence Handle11504108 Occurrence Handle10.1097/00006123-200108000-00013 Occurrence Handle1:STN:280:DC%2BD3MvlslOrsA%3D%3D
RW Williams (1978) ArticleTitleMicrolumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc Spine 3 175–182 Occurrence Handle663769 Occurrence Handle10.1097/00007632-197806000-00015 Occurrence Handle1:STN:280:DyaE1c3gsVGjsQ%3D%3D
RW Williams (1990) Results in lumbar microsurgery RW Williams (Eds) et al. Microsurgery of the lumbar spine Aspen Publishers Rockville 211–214
C Woertgen RD Rothoerl K Breme J Altmeppen M Holzschuh A Brawanski (1999) ArticleTitleVariability of outcome after lumbar disc surgery Spine 24 807–811 Occurrence Handle10222533 Occurrence Handle10.1097/00007632-199904150-00013 Occurrence Handle1:STN:280:DyaK1M3jvFSguw%3D%3D
Yasargil MG (1977) Microsurgical operation of herniated lumbar disc. Adv Neurosurg, pp 81–81
E Yorimitsu K Chiba Y Toyama K Hirabayashi (2001) ArticleTitleLong-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years Spine 26 652–657 Occurrence Handle11246379 Occurrence Handle10.1097/00007632-200103150-00019 Occurrence Handle1:STN:280:DC%2BD3M3mvFKmsw%3D%3D
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Jensdottir, M., Gudmundsson, K., Hannesson, B. et al. 20 years follow-up after the first microsurgical lumbar discectomies in Iceland. Acta Neurochir (Wien) 149, 51–58 (2007). https://doi.org/10.1007/s00701-006-1068-y
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DOI: https://doi.org/10.1007/s00701-006-1068-y