Eight Year Outcome after Surgery for Lumbar Disc Herniation: A Comparison of Reoperated and not Reoperated Patients

Department of Neurosurgery, University Hospital in Trondheim, Norway.
Acta Neurochirurgica (Impact Factor: 1.77). 06/2001; 143(6):607-610; discussion 610-11. DOI: 10.1007/s007010170066
Source: PubMed

ABSTRACT A retrospective study of 211 patients with unilateral sciatica operated on for lumbar disc herniation during 1988 and 1989 was performed in order to compare the results of reoperated patients with the results of patients operated on only once. The patients completed a standardized questionnaire in 1997 which included questions about reoperations, back and leg pain, functional status and disability pension. Outcome scores were calculated, giving values from 0 (no pain/normal function) to 100 (totally disabled). A follow-up status of 80.1% was obtained; 163 patients answered the questionnaire while six patients had died. 23.9% of the patients (n = 39) had been reoperated on. A recurrent disc herniation at the same level was suspected before the reoperation in 18.4%, but a recurrence was found in only 8.6%. 3.7% were reoperated on more than once. Outcome score was worse among "reoperated" patients (median 45.0, range 0-94) than among patients who only had the primary operation (median 10.5, range 0-81) (P < 0.001). In addition, 34.3% of the "reoperated" patients received a disability pension compared to 9.9% of the patients not reoperated on (P < 0.01). Patients reoperated upon at the same level without peroperative signs of recurrent disc herniation, had an outcome score of 53.0 (range 0-82) compared to a score of 30.0 (range 0-66) in patients with a confirmed recurrence (P < 0.05). The percentage of disability pension was 53.8% versus 9.1%, respectively, for those two groups (P < 0.05). Eight years after operation for lumbar disc herniation, the outcome was significantly worse in "reoperated" patients than in patients operated on once. In addition, reoperated patients with peroperatively confirmed recurrence of the same disc, seemed to have a better outcome than patients without peroperative signs of a recurrence.

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    • "Re-operation is usually considered if the patient has a recurrent disc herniation with clinical symptoms and signs. Inferior results are reported after repeat disc surgery in patients with postoperative pain, but without recurrent disc herniation (Vik et al., 2001). According to evidence-based medicine, activity restriction is unnecessary after lumbar disc surgery (Ostelo et al., 2003). "
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    ABSTRACT: The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and cognitive intervention and exercises. Sixty patients aged 25-60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment (n=5) or changed groups (n=2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after cognitive intervention and exercises. The mean difference between treatments after adjustment for gender was -7.3 (95% CI -17.3 to 2.7, p=0.15). The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over cognitive intervention and exercises.
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    • "Surgery to relieve nerve root compression is not consistently successful, regardless of the technique used [4]; although short-term success rates are high, in the 80–90% range, a detailed analysis of long-term success rates shows lower values ranging from 40% to 80% [5] [6] [7] [8] [9] [10] [11] [12] [13]. In a retrospective study by Loupasis et al. [5] of 109 patients with a mean follow-up of 12.2 years (7–20 years), more than one third of the patients were dissatisfied with the surgical procedure. "
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