Outpatient lumbar microdiscectomy: age relationship to outcome and tempered expectations

Abstract

Purpose of study: The present report evaluates multiple measures of outcomes over time after surgery in a prospective study of 212 patients presenting with virgin herniated discs and subjected to outpatient lumbar microdiscectomy in a private community neurosurgical practice by four neurosurgeons. We compare this objective method to historical data on outcomes for lumbar microdiscectomy.Methods used: Data were collected from questionnaires given before and at five time points after surgery, including a variable final follow-up (average, 2 years). Data were collated and analyzed independently from the operating surgeons.of findings: In both bivariate and multivariate analyses, only two preoperative parameters were prognostically significant. One was workers compensation status (negative effect on outcome). The second factor, patient age, was negative and linear (each year had a 6% worse failure rate than the prior year) with increasing age between 25 and 56 years old, that is, the ages most commonly encountered for herniated disk. Successful outcome rates were as follows: leg pain relief (visual analog scale [VAS]), 80%; back pain relief (VAS), 77%; Oswestry Pain and Disability Scale, 78%; satisfaction with the results of surgery, 76%; return to normal daily activities, 65% and return to work, 61%.Relationship between findings and existing knowledge: This study supports the evidence that outpatient lumbar microdiscectomy is a very safe and effective means of addressing sciatic pain resulting from disk herniation. We think it also represents a more realistic expectation to patients, insurers and physicians who routinely perform this procedure. The results provide a time-dependent outcome profile for these patients, which may be useful in postoperative patient management.Overall significance of findings: With increasing age, there is a direct and predictable negative correlation with satisfactory outcome from lumbar discectomy. A 75% to 80% success rate is a more realistic expectation for patients and physicians.Disclosures: No disclosures.Conflict of interest: No conflicts.