Abstract
Aggressive open lumbar discectomy is the most commonly performed surgical procedure for patients with persistent low back and leg pain. In this retrospective study, 1,380 patients were evaluated for long-term results of aggressive discectomy for the single level lumbar disk herniation. Demographic data, surgical data, complications and reherniation rate were collected and clinical outcomes were assessed using visual analogue score (VAS), Oswestry disability index (ODI) and modified Mcnab criteria. The mean follow-up period was 28.8 months. According to the modified Mcnab criteria, the long-term results were excellent in 640 cases, good in 445 cases, fair in 255 cases, and poor in 40 cases. The mean VAS scores for back and radicular pains and ODI at the end of 2 years were 1.1 ± 1.0, 1.5 ± 0.5 and 6.6 ± 3.1% respectively. The complications were foot drop (n=7), dural tear (n=14), superficial wound infection (n=17), discitis (n=37) and reherniation (n=64). The dural tear and superficial wound infections resolved after treatment but 28 discitis patients were treated by conservatively and the remaining 9 underwent surgery. Among reherniation patients, 58 underwent revision discectomy and 4 underwent transforaminal lumbar interbody fusion and stabilization. Aggressive discectomy is an effective treatment of lumbar disk herniation and maintains a lower incidence of reherniation but leads to a collapse of disc height and in long run gives rise to intervertebral instability and accelerates spondylosis.
Highlights
Low back pain secondary to lumbar disc herniation is a cause of morbidity
We reviewed 1,380 patients who underwent aggressive open lumbar discectomy for a single level prolapsed lumbar intervertebral disc using a minimally invasive open technique
The results of this study showed that aggressive discectomy cannot increase the recurrence rate or any differences in post-operative visual analogue score (VAS) scores in back and radicular pains
Summary
Low back pain secondary to lumbar disc herniation is a cause of morbidity. The incidence of lumbar disc herniation is 1 to 2% in general population[1, 2] and 4.9 per 1,000 person-years in a young population.[3]There are many different options for lumbar herniated disk surgery, but open lumbar disc surgery using minimally invasive technique is still the most frequent and important intervention of spine even with the development of many surgical techniques.[4]. Low back pain secondary to lumbar disc herniation is a cause of morbidity. The incidence of lumbar disc herniation is 1 to 2% in general population[1, 2] and 4.9 per 1,000 person-years in a young population.[3]. Its recurrence (at the same level regardless of ipsilateral or contralateral herniation) following disc excision is reported to be 5 to 11%.8-10, 12. We reviewed 1,380 patients who underwent aggressive open lumbar discectomy for a single level prolapsed lumbar intervertebral disc using a minimally invasive open technique Among the different options one is aggressive discectomy, which means removal of the offending herniated disc as well as curettage of the normal disc[5] and other is limited discectomy which means removal of the offending disc fragment alone with or without minimum invasion of the disc space 6, 7 but the overall unsatisfactory rate after discectomy is 3 to 20%.8–12 Its recurrence (at the same level regardless of ipsilateral or contralateral herniation) following disc excision is reported to be 5 to 11%.8-10, 12
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