Morphological changes after open lumbar microdiscectomy at 2-year follow-up.

Abstract

It is known that a possible decrease in disc height (DH) and foraminal size after open lumbar microdiscectomy (OLM) may cause pain in the long term. However, there is still insufficient information about the short- or long-term pathoanatomical and morphological effects of microdiscectomy. For example, the exact temporal course of the change in DH is not well known. The purpose of this study was to examine morphological changes in DH and foramen dimensions after OLM. In patients who underwent OLM for single-level lumbar disc herniation, MRI scans were obtained before surgery, and at an average of two years after surgery. In addition to DH measurements, foraminal area (FA), foraminal height (FH), superior foraminal width (SFW), and inferior foraminal width (IFW), were measured bilaterally. A postoperative increase in DH was observed at all vertebral levels, with an average of 5.5%. The mean right FHs were 15.3mm and 15.7mm before and after surgery, respectively (p= 0.062), while the left FHs were 14.8mm and 15.8mm before and after surgery (p= 0.271). The mean right SFW was 5.4mm before surgery and 5.7mm after surgery, while the mean right IFW ranged from 3.6mm to 3.9mm. The mean left SFW was 4.8mm before surgery and 5.2mm after surgery, while the mean left IFW ranged from 3.5mm to 3.9mm. Before surgery, the FAs were, on average, 77.1mm2 and 75.6mm2 on the right and left sides, respectively. At the 2-year follow-up, the mean FAs were 84.0mm2 and 80.2mm2 on the right and left sides, respectively. Contrary to prevalent belief, in patients who underwent single-level unilateral OLM, we observed that there may be an increase rather than a decrease in DH or foramen size at the 2-year follow-up. Our findings need to be confirmed by studies with larger sample sizes and longer follow-ups.