A long-term outcome analysis of 984 surgically treated herniated lumbar discs

Abstract

This paper presents a long-term follow-up study of 984 patients operated on for a herniated lumbar disc between 1959 and 1991. It was possible to follow 98% of patients from the time of operation to the time of writing. The mean follow-up period was 10.8 years. The most common presenting complaint was back pain with sciatica in one leg; the most frequent neurological finding was impaired straight-leg raising. Myelography confirmed the diagnosis in 80% of patients, but more recently enhanced computerized tomography and magnetic resonance imaging have been the preferred studies. The operative procedure was either hemilaminectomy or laminectomy with x 3.5 magnification and fiberoptic lighting. Herniated lumbar discs involved L4-5 and L5-S1 with equal frequency (47%). The recurrence rate was 6%, one-third of which developed during the 1st year after operation. The complication rate was 4%; there were no intraoperative vascular or intestinal injuries. The Prolo Functional Economic Outcome Rating Scale was used to measure long-term outcome and the results were compared to those of Pappas, et al. Patients who did sedentary work and housewives had statistically higher total and economic Prolo scores (p< 0.01) than those who did strenuous work. The majority of patients with the "failed-back syndrome" had pending legal or Workers' Compensation claims, or were at psychological risk for surgery. In 89% of patients the outcome was good--defined as a Prolo score of 8 in 10%, 9 in 19%, and 10 in 60%.

Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series

“…To obtain significant long-term results, a follow-up period of at least 4 years after surgery for lumbar disc herniation has been proposed [6]. Most of the publications pertaining to FELDHs, however, investigate short-and medium-term results with postoperative observation periods of \4 years or even \2 years.…”

“…To obtain significant long-term results, a follow-up period of at least 4 years after surgery for lumbar disc herniation has been proposed [6]. Whereas true long-term results are available for mediolateral disc herniations [25], the vast majority of publications pertaining to FELDHs do not meet this suggestion.…”

Does the choice of outcome scale influence prognostic factors for lumbar disc surgery?

“…Other studies apply the pain grading scale [12,20] and some use a combination of other findings, for example professional rehabilitation, residual symptoms, paresis or activities of daily living and narcotic medication at follow-up [1, 2, 12, 14, 16J. Pappas et al and Davis applied the Functional-Economic Rating Scale of Prolo et al, which takes into consideration professional rehabilitation and residual pain symptoms [3,18,19]. Looking at the results of these studies, the poor results ranged from 0% to 56% (Table 4).…”

Aspects of the failed back syndrome: role of litigation

“…The commonest cause was`failure to recognise abnormal pain behaviour before operation'. Another large surgical series 12 showed a rate of 6% recurrences of 984 operated patients of which onethird developed during the ®rst year after operation. An unsatisfactory outcome was found in 11%.`The majority of patients with the`failed-back syndrome' had pending legal or workers' compensation claims, or were at psychological risk for surgery.'…”

“…Invasive treatments include: (1) epidural spinal cord stimulation, 14,15 (2) laminectomy, foraminotomy, fusion, and other approaches to removal or decompression of protruding disk fragments, 16,17 ; (3) chirotherapy completed by rehabilitation of thè active motion apparatus', chemonucleolysis or percutaneous nucleotomy 18 (4) percutaneous rhizolysis 19 (5) intraspinal therapy: methylprednisolone 14,20 or intrathecal morphine, 21 (6) facet joint injection and facet nerve block, 22 (7) lumbosacral distraction spondylodesis, 23 and (8) osteopathy, chiropractic manipulation, acupuncture, transcutaneous nerve stimulators etc.…”