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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>This retrospective study was designed to evaluate the clinical outcomes and radiological findings after open lumbar discectomy (OLD) in patients who were followed up for 10 years or longer.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors classified 79 patients who had a mean age (± SD) of 53.6 ± 13.6 years (range 30–78 years) into 4 groups according to the length of their follow-up. Patients in Group 1 were followed up for 10–14 years, in Group 2 for 15–19 years, in Group 3 for 20–24 years, and in Group 4 for more than 25 years. In all of these patients, the clinical outcomes were assessed by using patients' self-reported scores on visual analog scales (VASs) measuring back and leg pain and by using scores from the Oswestry Disability Index (ODI). In addition, 10 radiological parameters suggesting degenerative changes or instability at the operated segment were recorded at various time points and used to calculate a numeric radiological finding (NRF) score by rating a presence for each finding of spinal degeneration or instability as 1.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The authors observed that OLD decreased pain and disability scores in all groups. Numeric radiological findings were highest in Group 4, and a significant correlation was detected between NRFs and VAS scores of back pain (p = 0.039). In this cohort, the reoperation rate was 13.9% during a mean follow-up period of 15.3 years. Clinical outcomes tended to be most favorable in Group 1, representing patients who had OLD most recently, and they tended to deteriorate in the other 3 groups, indicating some worsening of outcomes over time. Degeneration of the spine at the operated level measured with radiographic methods tended to increase over time, but some stabilization was observed. Although spinal degeneration was stable, clinical outcomes deteriorated over time.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This cross-sectional assessment of a retrospective cohort indicates that outcomes after OLD deteriorate over time. Increased back pain indicated a worsening of clinical outcomes, and this worsening was correlated with radiological findings of degeneration at the operated segment.</jats:p></jats:sec>

Percutaneous endoscopic lumbar discectomy: minimally invasive technique for multiple episodes of lumbar disc herniation

“…A recent study on the long-term outcomes of the OLD shows that the outcome deteriorates over time. Worsening of clinical outcome was correlated with radiologic degeneration at operated segment [ 7 ]. The discectomy causes a narrowing of the disc space, leading to an overloading of the facet joints.…”

Single Level Lumbar Disk Herniation: Conventional Discectomy versus Interbody Fusion with Bilateral Pedicular Fixation

“…Il-Nam et al proved in his study that included 79 patients operated upon by standard open discectomy for lumbar disk herniation that the VAS scores for back or leg pain and the ODI scores were low in the 1 st 10-year post-operative and increased slightly over time through the 15-20-year follow-up correlating with increase in radiological findings of spinal degeneration or instability. It has been suggested that these progressive degeneration in radiological findings make it more likely that clinical outcomes for these patients are the result of spinal degeneration [16].…”

“…Il-Nam et al found in his study marked improvement in the VAS score for the lower limb pain whom were operated for open lumbar discectomy over time, unlike the VAS score for the back pain that improved for 10 years and then started to worsen. However, it remains unclear whether worsening was due to spinal degeneration progressing with the natural aging process or was the result of accelerated degeneration after an OLD [16].…”

Comparison of postoperative outcomes between patients with positive and negative straight leg raising tests who underwent full-endoscopic transforaminal lumbar discectomy

“…Traditional open lumbar microdiscectomy (OLM) is considered the gold standard of LDH treatment for its good efficacy in long-term follow-up 3 , 4 . In recent years, minimally invasive techniques have developed rapidly, and minimally invasive discectomy (MID) has been gradually applied to treat lumbar intervertebral disc herniation; this method is more minimally invasive and conducive to postoperative rehabilitation than open surgery 5 .…”