Does the Fusion of a Lumbar Disk Herniation Improve the Clinical Outcome? An Investigation With a Minimum 10-Year Follow-up

Abstract

A retrospective long-term (minimum 10 y) follow-up and comparative study. To compare the clinical outcome of surgically treated primary lumbar disk herniation (LDH) by conventional discectomy alone and discectomy with posterolateral fusion without instrumentation. Primary LDH is usually treated by discectomy alone. The long-term outcome of discectomy alone is generally satisfactory. However, the superiority of a discectomy alone in comparison with a discectomy with fusion for primary LDH has yet to be determined. Conventional discectomy without fusion was performed in 39 patients in hospital A (without-fusion group) and conventional discectomy with posterolateral fusion without instrumentation was performed in 109 patients in hospital B (with-fusion group). The subjective symptoms (analgesic use, continuing gait time, 4-grade modified outcome criteria, numerical rating scale of pain and satisfaction with the operation, and the Japanese version of the Roland-Morris Disability Questionnaire) and objective symptoms (straight leg raising test, manual muscle test, and sensory disturbance) were assessed. There were no differences detected in the subjective and objective symptoms between the without-fusion and with-fusion group. Routine fusion surgery for a primary LDH was therefore found to have no apparent benefit even in the long-term outcome.