Advertisement

Clinical outcomes after lumbar spine microdiscectomy: a 5-year follow-up prospective study in 100 patients

  • Ioannis D. Gelalis
  • Evangelos I. Papanastasiou
  • Emilios E. Pakos
  • Avraam Ploumis
  • Dimitrios Papadopoulos
  • Maria Mantzari
  • Ioannis S. Gkiatas
  • Marios D. Vekris
  • Anastasios V. Korompilias
Original Article • SPINE - MICROSURGERY

Abstract

Background

To evaluate the effect of lumbar microdiscectomy (LM) in pain, disability and quality of life in a 5-year period and to identify potential demographic and clinical risk factors.

Methods

One hundred patients who underwent LM by the same surgeon participated in this prospective study. Clinical assessment was made with validated questionnaires preoperatively and up to 5 years postoperatively. Subsequently, associations between clinical outcomes and demographic data were recorded.

Results

In every assessment questionnaire, there was a significant improvement in the first postoperative month, which lasted up to 1 year post-discectomy. After that, improvement was statistically significant (p < 0.05) but without clinical importance. Women reported more pain preoperatively and 1 month after surgery. Urban residents also presented more pain preoperatively. Older patients had more pain, disability and worse quality of life 1–5 years postoperatively. Similarly, patients with lower education presented the worst scores in every questionnaire at the same time. Smokers reported less pain 1.5–4 postoperative years. Higher alcohol consumption and obesity were associated with lower levels of preoperative pain. However, obese patients had worse SF-36 and ODI scores after the 6th postoperative month. Patients with heavy jobs presented the worst preoperative ODI scores.

Conclusion

Significant clinical improvement was recorded from the first postoperative month to the first postoperative year; stabilization was noticed later on. Feminine gender, urban residency, older age, low level of education, obesity and heavy physical occupation were negative prognostic factors. Oddly smoking and alcohol were correlated with less pain.

Keywords

Lumbar microdiscectomy Clinical improvement Demographic risk factors 

Abbreviations

AUDIT

Alcohol Use Disorders Identification Test

BMI

Body mass index

LDH

Lumbar disc herniation

LM

Lumbar microdiscectomy

MC

Modic changes

MRI

Magnetic resonance imaging

ODI

Oswestry Disability Index

RMDQ

Roland Morris Disability Questionnaire

SD

Standard deviation

SPORT

Spine Patient Outcomes Research Trial

SPSS

Statistical Package for Social Sciences

VAS

Visual analogue scale

WHO

World Health Organization

Notes

Compliance with ethical standards

Conflict of interest

Authors Ioannis D Gelalis, Evangelos I Papanastasiou, Emilios E Pakos, Avraam Ploumis, Dimitrios V Papadopoulos, Maria Mantzari, Ioannis S. Gkiatas, Marios D. Vekris and Anastasios V. Korompilias declare that they do not have any conflict of interest.

References

  1. 1.
    Kelsey JL, White AA (1980) Epidemiology and impact of low-back pain. Spine 5(2):133–142CrossRefPubMedGoogle Scholar
  2. 2.
    Deyo RA (1991) Nonsurgical care of low back pain. Neurosurg Clin N Am 2(4):851–862CrossRefPubMedGoogle Scholar
  3. 3.
    Asch HL, Lewis PJ, Moreland DB et al (2002) Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm? J Neurosurg 96(1 Suppl):34–44PubMedGoogle Scholar
  4. 4.
    Mohanlal P, Pal D, Timothy J (2006) Localisation of spinal level in lumbar microdiscectomy. Eur J Orthop Surg Traumatol 16:207.  https://doi.org/10.1007/s00590-005-0059-7 CrossRefGoogle Scholar
  5. 5.
    Boscainos PJ, Sapkas G, Stilianessi E, Prouskas K, Papadakis SA (2003) Greek versions of the Oswestry and Roland-Morris disability questionnaires. Clin Orthop Relat Res Number 411:40–53.  https://doi.org/10.1097/01.blo.0000068361.47147.79 CrossRefGoogle Scholar
  6. 6.
    Deyo R, Loeser J, Bigos S (1990) Herniated lumbar intervertebral disc. Αnn Intern Med 112:598Google Scholar
  7. 7.
    Ahmadi SA, Burkert IP, Steiger HJ et al (2018) Multidimensional long-term outcome analysis after single-level lumbar microdiscectomy: a retrospective single-centre study. Eur J Orthop Surg Traumatol 28:189.  https://doi.org/10.1007/s00590-017-2043-4 CrossRefPubMedGoogle Scholar
  8. 8.
    Lurie J, Tosteson T, Tosteson A et al (2014) Surgical versus non-operative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial (SPORT). Spine 39(1):3–16.  https://doi.org/10.1097/BRS.0000000000000088 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McGirt MJ, Eustacchio S, Varga P et al (2009) A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy. Factors associated with recurrent disc herniation and disc height loss. Spine 34(19):2044–2051.  https://doi.org/10.1097/BRS.0b013e3181b34a9a CrossRefPubMedGoogle Scholar
  10. 10.
    Thomé C, Barth M, Scharf J, Schmiedek P (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2(3):271–278.  https://doi.org/10.3171/spi.2005.2.3.0271 CrossRefPubMedGoogle Scholar
  11. 11.
    Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S (2006) A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine 31(6):653–657.  https://doi.org/10.1097/01.brs.0000203714.76250.68 CrossRefPubMedGoogle Scholar
  12. 12.
    Gelalis ID, Papanastasiou EI, Theodorou DJ et al (2018) Postoperative MRI findings 5 years after lumbar microdiscectomy. Eur J Orthop Surg Traumatol.  https://doi.org/10.1007/s00590-018-2338-0 CrossRefPubMedGoogle Scholar
  13. 13.
    Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K (2001) Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine 26(6):652–657CrossRefPubMedGoogle Scholar
  14. 14.
    Loupasis GA, Stamos K, Katonis PG, Sapkas G, Korres DS, Hartofilakidis G (1999) Seven- to 20-year outcome of lumbar discectomy. Spine 24(22):2313CrossRefPubMedGoogle Scholar
  15. 15.
    Barth M, Weiss C, Thomé C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine 33(3):265–272.  https://doi.org/10.1097/BRS.0b013e318162018c CrossRefPubMedGoogle Scholar
  16. 16.
    Dora C, Schmid MR, Elfering A, Zanetti M, Hodler J, Boos N (2005) Lumbar disk herniation: do MR imaging findings predict recurrence after surgical discectomy? Radiology 235(2):562–567.  https://doi.org/10.1148/radiol.2352040624 CrossRefGoogle Scholar
  17. 17.
    McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZLBA (2009) Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery 64(2):338–344.  https://doi.org/10.1227/01.NEU.0000337574.58662.E2 CrossRefGoogle Scholar
  18. 18.
    Swartz KR, Trost GR (2003) Recurrent lumbar disc herniation. Neurosurg Focus 15(3):E10PubMedPubMedCentralGoogle Scholar
  19. 19.
    Weber H (1983) Lumbar disc herniation: a controlled, prospective study with ten years of observation. Spine 8(2):131–140CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Dalgic A, Yildirim AE, Okay O et al (2015) Initial discectomy associated with aging lead to adjacent disc disease and recurrence. Turk Neurosurg 26(4):595–600.  https://doi.org/10.5137/1019-5149.JTN.13206-14.0 CrossRefGoogle Scholar
  21. 21.
    Ganzer D, Giese K, Hunfeld T et al (2002) Lumbar microdiscectomy with and without prophylaxis of perineural scar formation using ADCON-L barrier gel: 2-year results. Eur J Orthop Surg Traumatol 12:1.  https://doi.org/10.1007/s00590-002-0011-z CrossRefGoogle Scholar
  22. 22.
    Li T, Han D, Liu B et al (2014) Clinical assessment of reformed lumbar microdiscectomy. Eur J Orthop Surg Traumatol 24:23.  https://doi.org/10.1007/s00590-012-1123-8 CrossRefPubMedGoogle Scholar
  23. 23.
    Cinotti G, Roysam GS, Eisenstein SM, Postacchini F (1998) Ipsilateral recurrent lumbar disc herniation. A prospective, controlled study. J Bone Joint Surg Br 80(5):825–832CrossRefPubMedGoogle Scholar
  24. 24.
    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(5):1341–1345.  https://doi.org/10.1007/s00264-008-0648-2 CrossRefPubMedGoogle Scholar
  25. 25.
    Atlas SJ, Keller RB, Chang Y et al (2001) Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: five-year outcomes from the maine lumbar spine study. Spine 26:1179–1187CrossRefPubMedGoogle Scholar
  26. 26.
    Koerner JD, Glaser J, Radcliff K (2015) Which variables are associated with patient-reported outcomes after discectomy? review of SPORT disc herniation studies. Clin Orthop Relat Res 473(6):2000–2006.  https://doi.org/10.1007/s11999-014-3671-1 CrossRefPubMedGoogle Scholar
  27. 27.
    Huang W, Han Z, Liu J, Yu L, Yu X (2016) Risk factors for recurrent lumbar disc herniation. A systematic review and meta-analysis. Medicine 95(2):e2378.  https://doi.org/10.1097/MD.0000000000002378 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Akmal M, Kesani A, Anand B, Singh A, Wiseman M, Goodship A (2004) Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine 29:568–575.  https://doi.org/10.1097/01.BRS.0000101422.36419.D8 CrossRefPubMedGoogle Scholar
  29. 29.
    Schmidt H, Kettler A, Heuer F et al (2007) Intradiscal pressure, shear strain, and fiber strain in the intervertebral disc under combined loading. Spine 32:748–755.  https://doi.org/10.1097/01.brs.0000259059.90430.c2 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Ioannis D. Gelalis
    • 1
  • Evangelos I. Papanastasiou
    • 1
    • 3
  • Emilios E. Pakos
    • 1
  • Avraam Ploumis
    • 2
  • Dimitrios Papadopoulos
    • 1
  • Maria Mantzari
    • 1
  • Ioannis S. Gkiatas
    • 1
  • Marios D. Vekris
    • 1
  • Anastasios V. Korompilias
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Ioannina, School of MedicineIoanninaGreece
  2. 2.Physical Medicine and Rehabilitation ClinicUniversity of Ioannina Medical SchoolIoanninaGreece
  3. 3.LarissaGreece

Personalised recommendations