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Microdiscectomy for the treatment of lumbar disc herniation: an evaluation of reoperations and long-term outcomes.

ABSTRACT: Design?Retrospective case series. Objective?The objective of this study was to assess the reoperation rate after microdiscectomy for the treatment of lumbar disc herniation (LDH) in patients with???5-year follow-up and identify demographic, perioperative, and outcome-related differences between patients with and without a reoperation. Methods?The medical records, operative reports, and office notes of patients who had undergone microdiscectomy at a single institution between March 1994 and December 2007 were reviewed and long-term follow-up was assessed via a telephone questionnaire. Results?Forty patients (M:24, F:16) with an average age at surgery of 39.9?±?12.5 years (range: 18-80) underwent microdiscectomy at the levels L5-S1 (n?=?28, 70%), L4-L5 (n?=?9, 22.5%), L3-L4 (n?=?2, 5.0%), and L1-L2 (n?=?1, 2.5%). After an average of 40.4?±?40.1 months (range: 1-128), 25% of patients (10/40) required further spine surgery related to the initial microdiscectomy. At an average postoperative follow-up of 11.1?±?4.0 years (range: 5-19), additional symptoms apart from back and leg pain were reported more frequently by patients who underwent a reoperation (p?=?0.005). Patient satisfaction was significantly higher in patients who did not undergo a reoperation (p?=?0.041). For the Oswestry disability index, pain intensity (p?=?0.036), and pain-related sleep disturbances (p?=?0.006) were reported to be more severe in the reoperation group. Conclusions?Microdiscectomy for the treatment of LDH results in a favorable long-term outcome in the majority of cases. The reoperation rate was higher in our series than reported in previous investigations with shorter follow-up. Although there were no statistically significant pre-/perioperative differences between patients with and without reoperation, our findings suggest a difference in self-reported long-term outcome measures.

SUBMITTER: Aichmair A

PROVIDER: S-EPMC4174230 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

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Microdiscectomy for the treatment of lumbar disc herniation: an evaluation of reoperations and long-term outcomes.

Aichmair Alexander A Du Jerry Y JY Shue Jennifer J Evangelisti Gisberto G Sama Andrew A AA Hughes Alexander P AP Lebl Darren R DR Burket Jayme C JC Cammisa Frank P FP Girardi Federico P FP

Evidence-based spine-care journal 20141001 2

Design Retrospective case series. Objective The objective of this study was to assess the reoperation rate after microdiscectomy for the treatment of lumbar disc herniation (LDH) in patients with ≥ 5-year follow-up and identify demographic, perioperative, and outcome-related differences between patients with and without a reoperation. Methods The medical records, operative reports, and office notes of patients who had undergone microdiscectomy at a single institution between March 1994 and Decem ...[more]

PMID: 25278881

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Project description:As part of a comprehensive nonsurgical approach, epidural injections often are used in the management of lumbar disc herniation. Recent guidelines and systematic reviews have reached different conclusions about the efficacy of epidural injections in managing lumbar disc herniation.In this systematic review, we determined the efficacy (pain relief and functional improvement) of the three anatomic approaches (caudal, lumbar interlaminar, and transforaminal) for epidural injections in the treatment of disc herniation.We performed a literature search from 1966 to June 2013 in PubMed, Cochrane library, US National Guideline Clearinghouse, previous systematic reviews, and cross-references for trials studying all types of epidural injections in managing chronic or chronic and subacute lumbar disc herniation. We wanted only randomized controlled trials (RCTs) (either placebo or active controlled) to be included in our analysis, and 66 studies found in our search fulfilled these criteria. We then assessed the methodologic quality of these 66 studies using the Cochrane review criteria for RCTs. Thirty-nine studies were excluded, leaving 23 RCTs of high and moderate methodologic quality for analysis. Evidence for the efficacy of all three approaches for epidural injection under fluoroscopy was strong for short-term (< 6 months) and moderate for long-term (? 6 months) based on the Cochrane rating system with five levels of evidence (best evidence synthesis), with strong evidence denoting consistent findings among multiple high-quality RCTs and moderate evidence denoting consistent findings among multiple low-quality RCTs or one high-quality RCT. The primary outcome measure was pain relief, defined as at least 50% improvement in pain or 3-point improvement in pain scores in at least 50% of the patients. The secondary outcome measure was functional improvement, defined as 50% reduction in disability or 30% reduction in the disability scores.Based on strong evidence for short-term efficacy from multiple high-quality trials and moderate evidence for long-term efficacy from at least one high quality trial, we found that fluoroscopic caudal, lumbar interlaminar, and transforaminal epidural injections were efficacious at managing lumbar disc herniation in terms of pain relief and functional improvement.The available evidence suggests that epidural injections performed under fluoroscopy by trained physicians offer improvement in pain and function in well-selected patients with lumbar disc herniation.

Dataset Information

Microdiscectomy for the treatment of lumbar disc herniation: an evaluation of reoperations and long-term outcomes.

Publications

Microdiscectomy for the treatment of lumbar disc herniation: an evaluation of reoperations and long-term outcomes.

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