Frequency and clinical meaning of long-term degenerative changes after lumbar discectomy visualized on imaging tests

Abstract

The aim of this retrospective controlled study was to evaluate radiographic degeneration in the lumbar spine of patients who had undergone lumbar discectomy minimum 21 years earlier and its clinical meaning. Indeed, no previous investigation on degenerative changes occurring after lumbar discectomy with a comparable long follow-up has been published. The study participants consisted of 50 patients who had undergone discectomy for lumbar disc herniation. The mean length of follow-up was 25.3 ± 3.0 years. Patients were assessed by Short Form-36 Health Survey (SF-36), Oswestry Disability Index, and a study-specific questionnaire. Radiographic views of the lumbar spine were obtained from all patients and compared to those of 50 asymptomatic controls. A five-step published classification was used to assess the increasing severity of radiographic changes. CT or MRI scans were also available for 27 patients who had undergone discectomy. Moderate to severe radiographic changes were present in 45 patients (90%) and 34 controls (68%), respectively (P = 0.013). The most prevalent MRI/CT changes were loss of disc height (89%), facet joint arthritis (89%), and endplate changes (57%). Thirty-two of 33 subjects (97%) reporting pain during the last 12 months had significant degeneration on their radiographs, and the frequency of changes was higher with respect to subjects without pain (P = 0.040).In conclusion, standard lumbar discectomy frequently leads to long-term degenerative changes on imaging tests. The presence of moderate to severe degeneration is associated with self-reported pain.

Long-term clinical outcomes and radiological findings and their correlation with each other after standard open discectomy for lumbar disc herniation

“…8,11,18,21 Other authors have proposed that back pain after an OLD is associated with disc degeneration as a result of disc space narrowing or endplate sclerosis. 13,15,16 Because it is difficult to establish whether specific radiological findings are associated with certain clinical outcomes, we wanted to determine which radiological findings may be associated with common clinical outcomes of an OLD. Moreover, to focus on the long-term effects of OLD for LDH on radiological and clinical outcomes, only patients treated with OLD who had been followed up for 10 years or longer were included in this study.…”

“…2,8,11,13,18,21,23 Yorimitsu et al 23 reported a 25% loss of the disc height 10 years after a discectomy, and Barth et al…”

“…[3][4][5] Several studies have observed long-term postoperative changes of the lumbar spine in patients who had undergone discectomy for an LDH. 2,8,11,13,18,21,23 Yorimitsu et al 23 reported a 25% loss of the disc height 10 years after a discectomy, and Barth et al 2 reported a significant increase in endplate degeneration after discectomies. However, long-term follow-up studies of the relationship between these radiological findings and clinical outcomes are rare.…”

Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy

“…All patients were asked to answer questions regarding their satisfaction with the original operation and reoperation (if applicable). Satisfaction with the operation was expressed through a four-step incremental scale (0 = dissatisfied, 1 = low satisfaction, 2 = moderate satisfaction, 3 = complete satisfaction) [9]. A single author who was uninvolved in the patients' primary care and who was unaware of the questionnaire results performed all the clinical assessments.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

“…If it is decided to treat conservatively, then we must be certain that the patients are not off work whilst they recover. The paper by Mariconda et al [27] looks at the frequency and clinical significance of the long-term degenerative changes in the disc 10 years after discectomy. Although those who had had a disc operation had more disc space narrowing, facet arthritis and endplate changes than a control group, there was little clinical difference between them.…”