Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy

Schaller, Bernhard

doi:10.1007/s00586-003-0632-x

Cited by 63 publications

(51 citation statements)

References 26 publications

(36 reference statements)

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“…Instead, we relied on clinical criteria of SI which may better correlate with patient outcome after LMD 7,8,10 .…”

Section: Methodsmentioning

confidence: 99%

“…Our finding is supported by the works of Yorimitsu et al 9 and Schaller 10 who observed that the majority of patients suffering from severe LBP and SI were young. This might be explained by a more active degenerative process in younger patients 9 , a more advanced stage of DDD leading to a lower risk of post-operative instability in older patients 10 , and more frequent involvement of younger patients in intense physical activity 9 .…”

Section: Clinical Prognosticatorsmentioning

confidence: 99%

“…Low back pain (LBP) is the usual cause for the drop in patient satisfaction and has been linked to the development of post-operative segmental instability (SI) 1,[6][7][8][9][10][11][12][13] .However, whether instability is a direct consequence of surgery or whether it is part of the natural history of lumbar degenerative disc disease (DDD) is still a matter of debate 6,14,15 . Some authors have suggested that post-operative disc space collapse (DSC) of more than 25-30% after aggressive ABSTRACT: Background: The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear.…”

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confidence: 99%

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confidence: 99%

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Lumbar Microdiscectomy: A Clinicoradiological Analysis of Outcome

Rahme

Moussa

Bou-Nassif

et al. 2011

Can. J. Neurol. Sci.

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While short-term results of lumbar microdiscectomy (LMD) are favorable in over 85% of cases, long-term outcome is often less rewarding and tends to be similar to that of nonoperative management of lumbar disc herniation (LDH), with only 55-70% favorable results [1][2][3][4][5][6] . Low back pain (LBP) is the usual cause for the drop in patient satisfaction and has been linked to the development of post-operative segmental instability (SI) 1,[6][7][8][9][10][11][12][13] .However, whether instability is a direct consequence of surgery or whether it is part of the natural history of lumbar degenerative disc disease (DDD) is still a matter of debate 6,14,15 . Some authors have suggested that post-operative disc space collapse (DSC) of more than 25-30% after aggressive ABSTRACT: Background: The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear. We sought to analyze the interaction between clinical, functional, and radiological variables and their impact on patient outcome. Methods: All patients who underwent LMD in 2004-2005 were invited to participate in this retrospective cohort study. Patients were re-evaluated clinically and radiologically after a three to five year follow-up. Results: Forty-one of 97 eligible patients were enrolled. Twelve patients (29.3%) reported moderate-to-severe sciatica, 12 (29.3%) had moderate LBP, and 13 (31.7%) exhibited clinical evidence of segmental instability. Thirty-eight patients (92.7%) had minimal disability and 3 (7.3%) had moderate disability. Twenty-three patients (56.1%) were fully satisfied, while 18 (43.9%) had only partial satisfaction, having expected a better outcome. Thirty-three patients (80.5%) returned to full-time work. Median disc space collapse (DSC) was 20% (range 5-66%) and L4-L5 was particularly affected. Prevalence of Modic changes increased from 46.3% to 78% with type 2 predominance. Multivariate logistic regression analysis identified the following negative prognostic factors: female sex, young age, lack of regular exercise, and chronic preoperative LBP. There was no correlation between the course of Modic changes, DSC, and patient outcome. Conclusion: Although many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome.RÉSUMÉ: Analyse clinico-radiologique des résultats de la microdiscectomie lombaire. Contexte : Le résultat à long terme de la microdiscectomie lombaire (MDL) peut être influencé par la douleur lombaire (DL) et l'instabilité segmentaire dont les facteurs déterminants sont mal connus. Le but de notre étude était d'analyser l'interaction entre des variables cliniques, fonctionnelles et radiologiques ainsi que leur impact sur le résultat chez le patient. Méthode : Tous les pat...

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“…Instead, we relied on clinical criteria of SI which may better correlate with patient outcome after LMD 7,8,10 .…”

Section: Methodsmentioning

confidence: 99%

Section: Clinical Prognosticatorsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Lumbar Microdiscectomy: A Clinicoradiological Analysis of Outcome

Rahme

Moussa

Bou-Nassif

et al. 2011

Can. J. Neurol. Sci.

View full text Add to dashboard Cite

show abstract

“…The paper by Schaller et al [21] presents a retrospective review of 2,353 patients who had a microdisectomy, and in this group 12 required a subsequent operation at a mean of 2 years after the primary procedure. Patients prior to surgery were carefully evaluated for features of ''spinal instability'', using methods of examination that, in the main, have not been validated as indicating abnormal translational movement, but certainly may indicate that the patients were not uncomplicated disc herniations, but had features of a more significant disturbance of spinal function.…”

mentioning

confidence: 99%