Single Level Lumbar Disk Herniation: Conventional Discectomy versus Interbody Fusion with Bilateral Pedicular Fixation

Abstract

OBJECTIVE: The objective of the study was to compare between the conventional discectomy and the interbody fusion with bilateral pedicular screw fixation in the management of single level lumbar disk herniation.
 METHODS: This is a prospective study done on 50 patients (25 in each group) at Cairo University Hospitals in the period between October 2018 and June 2019 fulfilling the inclusion criteria. Diagnosis was made clinically with history (low back pain and sciatica),examination (motor power assessment, straight leg raising test), and radiological findings (MRI, CT and X-ray lumbar spine). The pain status (VAS) was pre and postoperatively evaluated and followed up every 3 months for 1 year.
 RESULTS: The study included 50 patients (25 in each group) (mean age 40.4 years old) with slight female predominance. The most common clinical findings presented at diagnosis were low back pain followed by lower limb pain in the form of claudication and sciatica. L5-S1 disk prolapse was the most common level affected in both groups followed by L4-5 level. Regarding the clinical outcome, there was statistical significance in the VAS of low back pain at 9 months and 1-year follow-up favoring the fusion group with mean VAS 0.40 and 1.32 (p < 0.05).
 CONCLUSION: Clinical outcome was excellent in both groups. However, the reduction in low back pain after surgery was greater in the fusion group (p < 0.05). The rate of recurrent disk herniation at the surgical level in the nonfusion group was higher, but intraoperative blood loss, operation time, length of hospital stay, and total cost of procedure were all less in the patients undergoing discectomy alone. Although there is still controversy regarding the pros and cons of fusion in association with disk excision without instability, fusion results were highly favorable.