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International Orthopaedics

, Volume 43, Issue 4, pp 869–874 | Cite as

Lumbar disc herniation: long-term outcomes after mini-open discectomy

  • Ahmed BenzakourEmail author
  • Thami BenzakourEmail author
Original Paper

Abstract

Purpose

The outcomes of mini open discectomy in lumbar disc herniation are usually satisfying. Our study aims at finding if its results are still good at long-term follow-up.

Methods

We reviewed 552 patients operated between 1993 and 2013 by mini open discectomy procedure. Our main evaluation criterion is a modified Stauffer and Coventry classification applied during follow-up visits at three months, one year, five years, and every five years. The secondary criterion was the Oswestry Disability Index.

Results

The outcomes are considered good to very good in 87.3% of the cases at one year follow-up. These results deteriorate after an average follow-up of 14.7 years but remain satisfactory with 63.7%. The global decrease is 23.6%. The Oswestry Score decreases by 35 points at the same follow-up. In addition, 6.52% of patients required fusion at first revision and 1.08% at second revision. We also noticed 51 (9.2%) post-operative recurrences at the same level. In 23 (4.16%) of them, we proceeded to a new discectomy in an average interval of 41.4 months. At an adjacent level, 29 patients (5.2%) presented a new symptomatic disc herniation; among them, eight cases (1.44%) needed discectomy. The re-operative rate (including recurrent disc herniation and fusion for degenerative indications) is 10.68% at the last follow-up.

Conclusions

Nearly 2/3 of our patient series keep satisfactory outcomes after about 15-year follow-up. The mini open discectomy remains a reliable surgical technique provided we respect the indications and surgical requirements. This procedure also avoids excessive instrumentation and its possible iatrogenic complications. Powerful randomized and controlled trials are needed to strengthen these deductions.

Keywords

Long-term outcome Discectomy Lumbar disc herniation 

Notes

References

  1. 1.
    Seidler A, Euler U, Bolm-Audorff U et al (2011) Physical workload and accelerated occurrence of lumbar spine diseases: risk and rate advancement periods in a German multicenter case-control study. Scand J Work Environ Health 37:30–36CrossRefGoogle Scholar
  2. 2.
    Harper R, Klineberg E (2018) The evidence-based approach for surgical complications in the treatment of lumbar disc herniation. Int Orthop.  https://doi.org/10.1007/s00264-018-4255-6
  3. 3.
    Reiman MP, Sylvain J, Loudon JK, Goode A (2016) Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis. Br J Sports Med 50:221–230.  https://doi.org/10.1136/bjsports-2015-094691 CrossRefGoogle Scholar
  4. 4.
    Wang JC, Dailey AT, Mummaneni PV et al (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine 21:48–53.  https://doi.org/10.3171/2014.4.SPINE14271 CrossRefGoogle Scholar
  5. 5.
    Deyo RA, Weinstein JN (2001) Low Back pain. N Engl J Med 344:363–370.  https://doi.org/10.1056/NEJM200102013440508 CrossRefGoogle Scholar
  6. 6.
    Delamarter R, McCullough J (1996) Microdiscectomy and microsurgical laminotomies. In: Frymoyer J (ed) The Adult Spine: Principles and Practice. 2nd ed. Lippincott-Raven Publishers, PhiladelphiaGoogle Scholar
  7. 7.
    Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13:696–706CrossRefGoogle Scholar
  8. 8.
    Stauffer RN, Coventry MB (1972) Anterior interbody lumbar spine fusion. Analysis of Mayo Clinic series. J Bone Joint Surg Am 54:756–768CrossRefGoogle Scholar
  9. 9.
    Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine 25:2940–2952 discussion 2952 CrossRefGoogle Scholar
  10. 10.
    Loupasis GA, Stamos K, Katonis PG et al (1999) Seven- to 20-year outcome of lumbar discectomy. Spine 24:2313–2317CrossRefGoogle Scholar
  11. 11.
    Bergmann A, Bolm-Audorff U, Ditchen D et al (2017) Do occupational risks for low Back pain differ from risks for specific lumbar disc diseases?: results of the German lumbar spine study (EPILIFT). Spine 42:E1204–E1211.  https://doi.org/10.1097/BRS.0000000000002296 CrossRefGoogle Scholar
  12. 12.
    Padua R, Padua S, Romanini E et al (1999) Ten- to 15-year outcome of surgery for lumbar disc herniation: radiographic instability and clinical findings. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 8:70–74CrossRefGoogle Scholar
  13. 13.
    Son I-N, Kim Y-H, Ha K-Y (2015) Long-term clinical outcomes and radiological findings and their correlation with each other after standard open discectomy for lumbar disc herniation. J Neurosurg Spine 22:179–184.  https://doi.org/10.3171/2014.10.SPINE131126 CrossRefGoogle Scholar
  14. 14.
    Findlay GF, Hall BI, Musa BS et al (1998) A 10-year follow-up of the outcome of lumbar microdiscectomy. Spine 23:1168–1171CrossRefGoogle Scholar
  15. 15.
    Cheng J, Wang H, Zheng W et al (2013) Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop 37:1511–1517.  https://doi.org/10.1007/s00264-013-1925-2 CrossRefGoogle Scholar
  16. 16.
    Shin E-H, Cho K-J, Kim Y-T, Park M-H (2018) Risk factors for recurrent lumbar disc herniation after discectomy. Int Orthop.  https://doi.org/10.1007/s00264-018-4201-7
  17. 17.
    Puvanesarajah V, Hassanzadeh H (2017) The true cost of a Dural tear: medical and economic ramifications of incidental Durotomy during lumbar discectomy in elderly Medicare beneficiaries. Spine 42:770–776.  https://doi.org/10.1097/BRS.0000000000001895 CrossRefGoogle Scholar
  18. 18.
    Parker SL, Grahovac G, Vukas D et al (2013) Cost savings associated with prevention of recurrent lumbar disc herniation with a novel annular closure device: a multicenter prospective cohort study. J Neurol Surg Part Cent Eur Neurosurg 74:285–289.  https://doi.org/10.1055/s-0033-1341416 CrossRefGoogle Scholar
  19. 19.
    Prolo DJ, Oklund SA, Butcher M (1986) Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 11:601–606CrossRefGoogle Scholar
  20. 20.
    Spengler DM, Ouellette EA, Battié M, Zeh J (1990) Elective discectomy for herniation of a lumbar disc. Additional experience with an objective method. J Bone Joint Surg Am 72:230–237CrossRefGoogle Scholar
  21. 21.
    Guo JJ, Yang H, Tang T (2009) Long-term outcomes of the revision open lumbar discectomy by fenestration: a follow-up study of more than 10 years. Int Orthop 33:1341–1345.  https://doi.org/10.1007/s00264-008-0648-2 CrossRefGoogle Scholar
  22. 22.
    Chaichana KL, Mukherjee D, Adogwa O et al (2011) Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine 14:261–267.  https://doi.org/10.3171/2010.10.SPINE10190 CrossRefGoogle Scholar
  23. 23.
    Atlas SJ, Keller RB, Wu YA et al (2005) Long-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 30:927–935CrossRefGoogle Scholar
  24. 24.
    Weinstein JN, Tosteson TD, Lurie JD et al (2006) Surgical vs nonoperative treatment for lumbar disc herniation: the spine patient outcomes research trial (SPORT): a randomized trial. JAMA 296:2441–2450.  https://doi.org/10.1001/jama.296.20.2441 CrossRefGoogle Scholar
  25. 25.
    Çaçan MA, Uçar BY (2018) What every spine surgeon should know about transforaminal lumbar interbody fusion surgery for herniated discs. Int Orthop.  https://doi.org/10.1007/s00264-018-4251-x
  26. 26.
    Le Huec J-C, Faundez A, Dominguez D et al (2015) Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop 39:87–95.  https://doi.org/10.1007/s00264-014-2516-6 CrossRefGoogle Scholar
  27. 27.
    Chevillotte T, Coudert P, Cawley D et al (2018) Influence of posture on relationships between pelvic parameters and lumbar lordosis: comparison of the standing, seated, and supine positions. A preliminary study. Orthop Traumatol Surg Res OTSR 104:565–568.  https://doi.org/10.1016/j.otsr.2018.06.005 CrossRefGoogle Scholar
  28. 28.
    Vazifehdan F, Karantzoulis VG, Igoumenou VG (2018) Sagittal alignment assessment after short-segment lumbar fusion for degenerative disc disease. Int Orthop.  https://doi.org/10.1007/s00264-018-4222-2
  29. 29.
    Watters WC, McGirt MJ (2009) An evidence-based review of the literature on the consequences of conservative versus aggressive discectomy for the treatment of primary disc herniation with radiculopathy. Spine J Off J North Am Spine Soc 9:240–257.  https://doi.org/10.1016/j.spinee.2008.08.005 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Orthopaedic and Traumatology Surgery Department Bicêtre University HospitalParis-Sud University OrsayLe Kremlin BicetreFrance
  2. 2.Zerktouni Orthopaedic ClinicCasablancaMorocco

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