Single-level Microdiscectomy Research Articles

The Relationship Between Disc Herniation Morphology and Patient-Reported Outcomes after Microdiscectomy

ObjectiveDetermine if herniation morphology based on the Michigan State University (MSU) Classification is associated with differences in (1) patient-reported outcome measures (PROMs) or (2) surgical outcomes after a microdiscectomy. MethodsAdult patients undergoing single-level microdiscectomy between 2014 – 2021 were identified. Demographics and surgical characteristics were collected through a query search and manual chart review. The MSU classification, which assesses disc herniation laterality (zone A was central, zone B/C was lateral) and degree of extrusion into the central canal (grade 1 was up to 50% of the distance to the intra-facet line, grade >1 was beyond this line), was identified on preoperative MRIs. PROMs were collected at preoperative, three-month, and one-year postoperative time points. ResultsOf 233 patients, 84 had zone A versus 149 zone B/C herniations while 76 had grade 1 disc extrusion and 157 had >1 grade. There was no difference in surgical outcomes between groups (p>0.05). Patients with extrusion grade >1 were found to have lower PCS at baseline. On bivariate and multivariable logistic regression analysis, extrusion grade >1 was a significant independent predictor of greater improvement in PCS at three months (estimate=7.957; CI: 4.443 – 11.471, p<0.001), but not at one year. ConclusionsAlthough all patients were found to improve after microdiscectomy, patients with disc herniations extending further posteriorly reported lower preoperative physical function but experienced significantly greater improvement three months after surgery. However, improvement in VAS leg and back, ODI, and MCS at three and twelve months was unrelated to laterality or depth of disc herniation.

Microdiscectomy for sciatica: reality check study of long-term surgical treatment effects of a Lumbosacral radicular syndrome (LSRS).

It remains unclear whether the long-term results of RCTs regarding the outcome of microdiscectomy for lumbosacral radicular syndrome (LSRS) are generalizable. The purpose of this study was to determine the external validity of the outcome preseneted in RCTs after microdicectomy for LSRS in a patient cohort from a high-volume spine center. Between 2007 and 2010, 539 patients had a single level microdiscectomy for MRI disk-related LSRS of whom 246 agreed to participate. Questionnaires includedvisual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36 and Likert scores for recovery, leg and back pain. Lumbar re-operation(s) were registered. Mean age was 51.3, and median time of follow-up was 8.0years. Re-operation occurred in 64 (26%) patients. Unfavorable perceived recovery was noted in 85 (35%) patients, and they had worse leg and back pain than the 161 (65%) patients with a favorable recovery: median VAS for leg pain 28/100mm versus 2/100mm and median VAS for back pain 9/100mm versus 3/100mm, respectively. In addition, the median RDQ and OLBD scores differed significantly: 9 vs 3 for RDQ and 26 vs 4 for OLBD, respectively (p < 0.001). In this cohort study, the long-term results after microdiscectomy for LSRSwere less favorable than those obtained in RCTs, possibly caused by less strict patient selection than in RCTs. Our findings emphasize that patients, who do not meet the same inclusion criteria for surgery as in RCTs, should be informed about the chances of a less favorable result.

Lumbar Disc Prolapse: Microdiscectomy and its Clinical Outcomes

Background: Prolapse lumbar intervertebral disc (PLID) is a localized disc displacement outside its margins is the most common source of sciatica pain, involving 1%-5% of the population annually. Standard management includes conservative management initially for a period of around 6 weeks. In general, microdiscectomy (MD) is considered a standard procedure for symptomatic cases, with approximately 60%-80% of satisfactory results. In this study, we aimed in describing experience of MD in patients diagnosed with PLID. Methods: This retrospective study has been conducted at Dr. Ziauddin University hospital, Karachi; Pakistan. The medical records from 2018 to 2020, of microdiscectomy for prolapsed intervertebral lumbar disc were studied. All patients of 18 years or more admitted with symptomatic PLID, and proceeded to single level MD have been included. The regular pre-operative work-up, surgical technique and post-operative management was followed. Data collection was performed using a standard proforma. Utilizing SPSS version 23.0, all statistical analyses were carried out a p &lt;0.05 was considered statistically significant. Results: Mean age of patients was 43 to 42 years and Male: Female ratio was 1.6:1 and pre-operative neurological deficit was observed in 28 (42.4%) patients. Most common affected disc spaces were L4-L5 35(53%) and L5-S1 26 (39.4%). Left side disc Prolapse was found more affected as 39(59.1%) cases reported among the total. Visual analog scale (VAS) score dropped from more than 5 to no pain after surgery. Conclusion: Microdiscectomy is a safe treatment in prolapsed intervertebral lumbar disc for patients with failed conservative therapy and reported excellent outcomes with earlier surgical intervention. Keywords: Discectomy; Intervertebral Disc Displacement; Radiculopathy.

Tramadol-paracetamol combination for postoperative pain relief in elective single level lumbar microdiscectomy surgery: A comparison of two different doses of tramadol

Pain is a suffering and every individual has the right to be pain free. Moreover, pain in the post -operative period may lead to sense of being unwell as well as many complications like nausea, vomiting, hypertension, tachycardia, restricted mobility, breathlessness etc. Thus, it is essential to obtain sufficient pain relief in the perioperative period. The objective of our study was to compare the postoperative pain scores in patients receiving two different doses of tramadol, 1mg/kg and 1.5mg/kg in combination with paracetamol 1gm for elective single-level microdiscectomy. Patients were randomly divided into two groups of thirty each. Group A received injection tramadol 1mg/kg intravenously and group B received injection tramadol 1.5mg/kg intravenously. In addition, both groups received injection paracetamol 1gm intravenous infusion. Pain intensity (VAS score) recorded at 1 minute, 30 minutes, 1 hour, 2, 3 and 4 hours in both the groups. Side effects like nausea, vomiting, sedation was also noted. Injection fentanyl 1 mcg/kg intravenously was used as rescue analgesic. Total dose of fentanyl used was also noted. Data was analyzed using appropriate statistical tests. On the basis of the present study, paracetamol(1g) and tramadol (1mg/kg or 1.5mg/kg) intravenously were found to be safe and effective in post-operative pain relief in elective single-level microdiscectomy surgery.

Role of Pregabalin to Decrease Postoperative Pain in Microdiscectomy: A Randomized Clinical Trial.

PurposeThe purpose of this study is to compare the effect of pregabalin in reducing the neuropathic pain in postoperative patients who have undergone single-level microdiscectomy for prolapsed intervertebral lumbar disc.MethodsA randomized control clinical trial was conducted from June 2018 to April 2020 in three campuses Dr. Ziauddin University Hospital, Karachi, by two spinal surgeons. This study included 84 patients who underwent either emergency or elective microdiscectomy surgery. The patients randomized into two equal groups of 42, (group-A: pregabalin) and (group-B: placebo). Both groups also received routine analgesia along with the pregabalin and placebo capsules. In the intervention group, pregabalin was administered preoperative and postoperative defined times. The pain scores were recorded by visual analog scale (VAS) and Roland-Morris score system on the preoperative day and compared to the scores on follow-up on postoperative day seven.ResultsThe pain scores were significantly better in group-A compared to group-B with similar baseline variables. The mean VAS scores of pains in group-A on postoperative day seven on follow-up were compared to VAS pain scores in group-B showing better pain control. The Roland-Morris scores were also significantly better for group-A.ConclusionsThe use of pregabalin in addition to the routine analgesia has better control of postoperative neuropathic pain in patients with single-level microdiscectomy compared to the patients who are receiving only routine analgesia. Other factors like cost, dose, side effects, and frequency should also be considered.

185. Reoperation rates after single-level lumbar discectomy in the military health system

BACKGROUND CONTEXT Despite advances in surgical techniques, rates of recurrent lumbar disc herniation (LDH) range from 5-24%, representing the most common cause of surgical failure and subsequent reoperation. PURPOSE Our goal was to determine the reoperation rate, time to reoperation and type of revision procedures performed after single-level discectomy for LDH within the military health system. STUDY DESIGN/SETTING Restrospective. PATIENT SAMPLE Military health system. METHODS Using CPT codes to capture lumbar microdiscectomy procedures, 3,999 patients undergoing primary single-level microdiscectomy for lumbar disc herniation were identified between October 2012 and November 2017. Demographic data, as well as number and type of revision surgical intervention were investigated. Rates of subsequent procedures involving instrumented fusion and complications were recorded. RESULTS We identified 415 patients (10.3%) who required a revision surgery for a same-level reherniation. Of these patients requiring revision surgery at the same level of the index procedure, 9.3% required more than one revision surgery. The majority of first-time revision procedures consisted of revision microdiscectomy (290/415, 69.9%); however, 125 patients (30.1%) underwent single- or multi-level fusion for definitive treatment at time of first revision. Of the 40 patients requiring more than one revision, 21 (52.5%) eventually required a fusion procedure, which was significantly higher than patients having only one revision (p= CONCLUSIONS In our retrospective study of 3,999 patients undergoing single-level microdiscectomy for lumbar disc herniation, we identified 415 patients (10.4%) undergoing subsequent reoperation for a recurrent LDH at the same level. Within this group, 9.6% would require two or more reoperations, and 52.5% of these patients would ultimately undergo a lumbar arthrodesis at the same level as the initial disc herniation. Our findings characterize the lumbar disc reherniation population in the military, with major implications for the prognosis and treatment strategy of these commonly-treated injuries. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals.

Study Design:Retrospective cohort study.Objective:As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system.Methods:Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs.Results:A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions (P < .001) per level fused; the CH performed more interbody fusions (P = .007). Cost of performing microdiscectomy (P < .001) and laminectomy (P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy (P < .001) and laminectomy with single-level fusion (P < .001), but trended toward significance for laminectomy without fusion (P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH (P = .019).Conclusions:We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

Drivers of Variability in 90-day Cost for Primary Single-level Microdiscectomy.

The healthcare reimbursement models are rapidly transitioning to pay-per-performance episode of care payment models. These models, if designed well, must account for the variability in the cost of index surgeries during the global period. To analyze the variability in 90-d cost and determine the drivers of the variability in total 90-d cost associated with single-level microdiscectomy. A total of 203 patients undergoing primary microdiscectomy for degenerative lumbar conditions were included in the study. The total 90-d cost was derived as the sum of cost of surgery, cost associated with postdischarge utilization. A multivariable linear regression model for total 90-d cost was built. The mean total cost within 90-d after single-level primary microdiscectomy was $7962±$2092. In a multivariable linear regression model, obesity, history of myocardial infarction, factors that lengthen the time of surgery and hospital stay, complications and readmission within 90-d, postdischarge healthcare utilization including emergency room visits, time to opioid independence, number of days on nonopioid pain medications, diagnostic imaging, and the number of days in outpatient and inpatient rehabilitation contribute to the total 90-d cost. The model performance as measured by R2 is 0.76. Utilizing prospectively collected data, we highlight major drivers of variation in cost following a single-level primary microdiscectomy. Our model explains about three-quarters of the variation in cost. The risk-adjusted cost estimates powered by models such as the one presented here can be used to formulate a sustainable total 90-d episode of care bundle payment.

Clinical outcomes in patients undergoing microlumbar discectomy for lumbar disc herniation

Introduction: Lumbar microdiscectomy has been associated with high rates of success and low postoperative morbidity. We aimed to evaluate the clinical outcome of patients undergoing lumbar microdisectomy for disc herniations. Methodology: The study was performed in the Department of Orthopedics, Lokmanya Hospital Chinchwad and Lokmanya Hospital Nigdi, Pune from August 2002 till May 2004 on all patients scheduled for microlumbar discectomy for lumbar disc herniation. Intra-operatively, type and level of prolapse and operative time was noted. We also noted the length of hospital stay and any complications experienced by the patient. For assessing the patients, instruments like Visual Analog Scale (VAS) for pain at the end of first week and return to normal activity of daily living (ADL) and satisfaction with the result of surgery at the end of six months were used. Results: All surgeries were single level microdiscectomy. Operative time on the average was 85 minutes and 83% of the patients had a stay of less than 5 days in the hospital. Disc sequestration and disc exclusion were the most commonly seen types of prolapse. Pre-operatively five patients had a back pain VAS of more than 4 and four patients had a leg pain VAS of more than 4. On assessing the outcome in patients in terms of returning to activities of daily living and satisfaction with surgery only four and five patients had a score more than two respectively. Conclusions: Proper preoperative planning and correct surgical technique can prevent complications in these cases. Future multicentric studies with larger sample size and longer follow up periods are needed to support our findings.

Lumbar microdiscectomy for sciatica in adolescents: a multicentre observational registry-based study

BackgroundLumbar disc herniation (LDH) is rare in the adolescent population. Factors predisposing to LDH in adolescents differ from adults with more cases being related to trauma or structural malformations. Further, there are limited data on patient-reported outcomes after lumbar microdiscectomy in adolescents. Our aim was to compare clinical outcomes at 1 year following single-level lumbar microdiscectomy in adolescents (13–19 years old) compared to younger adults (20–50 years old) with LDH.MethodsData were collected through the Norwegian Registry for Spine Surgery. Patients were eligible if they had radiculopathy due to LDH, underwent single-level lumbar microdiscectomy between January 2007 and May 2014, and were between 13 and 50 years old at time of surgery. The primary endpoint was change in Oswestry Disability Index (ODI) 1 year after surgery. Secondary endpoints were generic quality of life (EuroQol five dimensions [EQ-5D]), back pain numerical rating scale (NRS), leg pain NRS and complications.ResultsA total of 3,245 patients were included (97 patients 13–19 years old and 3,148 patients 20–50 years old). A significant improvement in ODI was observed for the whole population, but there was no difference between groups (0.6; 95% CI, −4.5 to 5.8; p = 0.811). There were no differences between groups concerning EQ-5D (−0.04; 95% CI, −0.15 to 0.07; p = 0.442), back pain NRS (−0.4; 95% CI, −1.2 to 0.4; p = 0.279), leg pain NRS (−0.4; 95% CI, −1.2 to 0.5; p = 0.374) or perioperative complications (1.0% for adolescents, 5.1% for adults, p = 0.072).ConclusionsThe effectiveness and safety of single-level microdiscectomy are similar in adolescents and the adult population at 1-year follow-up.

249 - Determining the Drivers of Variability in 90-Day Cost for Primary Single-Level Microdiscectomy

249 - Determining the Drivers of Variability in 90-Day Cost for Primary Single-Level Microdiscectomy

Liposomal bupivacaine incisional injection in single-level lumbar spine surgery

Background ContextPostsurgical pain control is important in spine surgery as it can lead to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications, and improved patient satisfaction. Liposomal bupivacaine (LB) is an injectable formulation of bupivacaine, providing prolonged local anesthesia, up to 72 hours postinjection. Although, LB has been used with increasing frequency following other musculoskeletal procedures, specifically total joint replacements, its pre-emptive analgesic effect following lumbar microdiscectomy has hitherto not been reported. If administration of LB as a pre-emptive analgesic agent at the end of microdiscectomy resulted in reduced postoperative pain, then this could minimize adverse events related to narcotic pain medication use and improve acute clinical outcomes. PurposeThe aim of the present study was to determine the comparative efficacy of infiltration of a standard dose and volume of LB in a comparative cohort analysis of single-level microdiscectomy procedures. DesignThe present study made use of mixed prospective/retrospective observational cohort analysis. Patient SampleAdult patients presenting with lumbar or sacral compressive disc disease treated with single-level microdiscectomy, at one institution utilizing a standard surgical technique. Outcome MeasuresTime spent on intravenous (IV) narcotics postoperatively (primary outcome), postoperative visual analog score (VAS), total morphine equivalent dose of narcotic pain medications, and 30-day emergency room visits for pain control were measured. MethodsUnder an approved process improvement project, immediate outcome and process measures for a prospective cohort of 40 patients who received LB field blocks following single-level lumbar microdiscectomy were compared with a historical cohort of 40 patients who underwent the same surgical procedure but did not receive postsurgical infiltration of local anesthetic. All patients received a standard open surgical technique and postoperative convalescence protocol, which included overnight admission, oral narcotic pain medication as needed, scheduled IV ketorolac and IV narcotic pain medication for breakthrough. ResultsData from 80 subjects (67 males) operated on between January 2014 and 2015 were compared, including 40 cases, which occurred prior to using LB, and 40 cases after. There was no significant difference between mean age or body mass index (BMI) between groups. Patients who received LB infiltration spent significantly less time using IV narcotics in the postoperative period (LB patients 13.0±2.1 hours vs. non-LB patients 23.3±2.1 hours, p<.001). There was no significant difference noted between VAS at any point in the postoperative period, total injectable morphine equivalent doses, or 30-day emergency room visits for pain. ConclusionsWe found that patients who received LB field blocks required IV narcotic pain medication for a significantly decreased length of time (average delta=10.3 hours). Although this is a surrogate for earlier discharge, within the numbers studied, this did not translate into a significantdifference in VAS scores or total morphine equivalents. It is uncertain, if the independent effect of LB may have been masked by the multimodal postoperative pain control protocol in use. Further study is required to best understand the potential benefit of pre-emptive analgesia in elective spine surgery. Its impact would likely be more significant in more invasive procedures.

Microsurgical Annular Restoration with a Z-Suture following Lumbar Microdiscectomy: A Retrospective Comparative Study on 763 Patients with a Mean Follow-up of 12.5 Years

Background: Microdiscectomy for lumbar disc herniation (LDH) is one of the most common procedures performed by spine surgeons worldwide. It usually significantly reduces pain and restores both functional disability and health-related quality of life. The incidence of a postoperative recurrence, however, is encountered in 10 to 25%. A large annular defect is known to increase the risk of recurrence. A perioperative annular restoration may thus decrease the risk of recurrence. Methods: A retrospective study was performed comparing the risk of recurrence after lumbar single-level microdiscectomy with (study group) or without (control group) annular restoration using a Z-suture. Included patients were consecutively operated between May 1990 and April 1994 (control group) and September 1998 and December 1998 (study group). Subsequent LDH recurrence was recorded analyzing the patients' records and rereferrals until a mean follow-up of 12.5 years. Results: A total of n = 763 patients were included, of which 374 patients received a Z-suture (study group) and 389 patients served as controls (control group). The study groups did not differ in age (mean: 44.8 vs. 45.1 years; p = 0.86), gender (54.8 and 51.7% males; p = 0.38), or distribution of the lumbar segments (p = 0.46). Surgical time was significantly longer in the study group (81.6 vs. 69.3 minutes, p < 0.0001). The rate of reoperation for a local LDH recurrence was significantly lower in the study group at 3 months (0 vs. 1.8%, p = 0.02) and remained to show a clear trend at 12 months postoperative (2.1 vs. 4.6%, p = 0.07). At the time of last follow-up (mean: 8.3 vs. 16.6 years, p < 0.0001), local recurrence was observed in 21 out of 374 (5.6%) in the study group compared with 36 out of 389 (9.3%) in the control group (p = 0.06). The subsequent risk reduction of reoperation for local recurrence was 100, 54.3, and 39.8% after 3 months, 12 months, and at long-term follow-up using a Z-suture. There were no complications associated with the Z-suture in this series. Conclusions: Our data indicate that a Z-suture as annular restoration is safe and prolongs the surgery by ∼12 minutes. It reduces the recurrence rate at 3 and 12 months after microdiscectomy, while its impact on the long-term follow-up has to be interpreted with caution due to the longer follow-up of our control group. Therefore, annular defect restoration should be considered as an option to reduce the local recurrence rate for patients undergoing lumbar microdiscectomy.

Time Courses of Adaptation in Lumbar Extensor Performance of Patients With a Single-Level Microdiscectomy During a Physical Therapy Exercise Program

Longitudinal single-cohort study. To characterize the time course of performance adaptations during a postsurgical exercise intervention following a single-level microdiscectomy. Patients with a recent history of lumbar microdiscectomy are functionally limited, weak, have compromised paraspinal musculature, and benefit from an exercise program. Patients (n = 48) with a single-level microdiscectomy participated in a 12-week (36 sessions) comprehensive strength and endurance exercise program starting 4 to 6 weeks postsurgery. Lumbar extensor strength was quantified as the degree from horizontal on a modified Sorensen test procedure. Patients unable to assume the horizontal position were assumed to have strength deficits. Lumbar muscular endurance performance was quantified by the amount of time patients could hold the Sorensen test position at the horizontal. The time rate of lumbar muscular endurance adaptations were analyzed using longitudinal growth curve modeling. The adherence rate of this program was low (67%). Twenty percent of the patients were identified as having strength deficits. These deficits were corrected in all patients within 3 to 9 weeks. Linear mixed-model results suggest an improvement of 5.6 seconds in hold time per week of exercise. Both the initial level of endurance and the rates of improvements were highly individualized. The time course of musculoskeletal performance adaptations in persons with a history of lumbar surgery is highly individualized. When compared to normative endurance times, the results of this study indicate that the number of sessions and duration of therapy needed to generate meaningful adaptations of the paraspinal musculature is longer than what is typically provided in the clinic postsurgery. Therapy, level 4.J Orthop Sports Phys Ther 2010;40(6):336-344, Epub 13 May 2010. doi:10.2519/jospt.2010.3141.

Sport nach lumbaler Bandscheibenoperation: Eine prospektive Beobachtungsstudie

Lumbar discectomy is the most frequent spinal surgical procedure in Germany. Surgeons vary widely in their preferences with regard to patients' return to sports after spinal surgery. The self-reported sporting activity before and after microdiscectomy was evaluated in a prospective observational study with 5 year follow-up. One hundred and five patients (mean age 45.4 years) with self-reported sporting activity before lumbar single-level discectomy were re-evaluated after 5 years. The clinical outcome was graded using a modified Prolo scale (pain and medication). Based on the Prolo scale, an excellent (n = 80) or good (n = 17) outcome was achieved in 92.4% of patients. Altogether, 91.4% of patients (n = 96) resumed sporting activities: 87 patients returned to their previous sport. Only 8.6% of the patients (n = 9) were unable to return to sports, for various reasons (e.g., poor general health, lumbar pain, or lack of time). The mean time until return to sports after operation was 5.8 months (range 6 weeks to 24 months).The recurrence rate was 5.7% (n = 6), with 3 of the herniations occurring before the return to sporting activities (after 1, 2 and 7 months). The success rate of single-level microdiscectomy in athletes was frequently good or excellent, with over 90% of patients able to return to sports. The reherniation rate after postoperative athletic activity was comparable with results reported in the literature.

Assessing Musculoskeletal Performance of the Back Extensors Following a Single-Level Microdiscectomy

A descriptive and exploratory investigation of lumbar extensor performance in persons with a recent history of single-level microdiscectomy. To provide a justification for and outline the procedure of assessing lumbar extensor musculature performance. The time of holding an unsupported trunk horizontally, also called the Sorensen test (ST), is often used to test the lumbar extensor endurance of healthy and patient populations, but may need to be modified for some patients. Sixty-eight participants completed a modified ST procedure, along with several questionnaires and performance measures, approximately 4 to 6 weeks after a single-level microdiscectomy. Participants were classified as either able to complete or unable to complete the final position of the modified ST procedure (trunk horizontal). Fifty-one point five percent of the participants could not attain the final position of the modified ST procedure due to either pain or perceived exertion. Those who could not attain the final position of the modified ST procedure had significantly lower scores (compared to those who could) on most measures. A majority (78.8%) of the participants in this study who were unable to complete the ST were correctly classified using the Fear-Avoidance Belief Questionnaire Work Subscale and a 24-hour activity questionnaire. The ability to attain the final position of the modified ST procedure was closely associated with fear-avoidance beliefs and physical activity level, suggesting that this test may be too intense (either real or perceived) for many patients within 4 to 6 weeks following a single-level microdiscectomy.

The immediate and long-term effects of exercise and patient education on physical, functional, and quality-of-life outcome measures after single-level lumbar microdiscectomy: a randomized controlled trial protocol

BackgroundLow back pain remains a costly quality-of-life-related health problem. Microdiscectomy is often the surgical procedure of choice for a symptomatic, single-level, lumbar disc herniation in younger and middle-aged adults. The question of whether a post-microdiscectomy exercise program enhances function, quality of life, and disability status has not been systematically explored. Thus, the overall purpose of this study is to assess immediate and long-term outcomes of an exercise program, developed at University of Southern California (USC), targeting the trunk and lower extremities (USC Spine Exercise Program) for persons who have undergone a single-level microdiscectomy for the first time.Methods/designOne hundred individuals between the ages of 18 and 60 who consent to undergo lumbar microdiscectomy will be recruited to participate in this study. Subjects will be randomly assigned to one of two groups: 1) one session of back care education, or 2) a back care education session followed by the 12-week USC Spine Exercise Program. The outcome examiners (evaluators), as well as the data managers, will be blinded to group allocation.Education will consist of a one-hour "one-on-one" session with the intervention therapist, guided by an educational booklet specifically designed for post-microdiscectomy care. This session will occur four to six weeks after surgery. The USC Spine Exercise Program consists of two parts: back extensor strength and endurance, and mat and upright therapeutic exercises. This exercise program is goal-oriented, performance-based, and periodized. It will begin two to three days after the education session, and will occur three times a week for 12 weeks.Primary outcome measures include the Oswestry Disability Questionnaire, Roland-Morris Disability Questionnaire, SF-36® quality of life assessment, Subjective Quality of Life Scale, 50-foot Walk, Repeated Sit-to-Stand, and a modified Sorensen test. The outcome measures in the study will be assessed before and after the 12-week post-surgical intervention program. Long-term follow up assessments will occur every six months beginning one year after surgery and ending five years after surgery.Immediate and long-term effects will be assessed using repeated measures multivariate analysis of variance (MANOVA). If significant interactions are found, one-way ANOVAs will be performed followed by post-hoc testing to determine statistically significant pairwise comparisons.DiscussionWe have presented the rationale and design for a randomized controlled trial evaluating the effectiveness of a treatment regimen for people who have undergone a single-level lumbar microdiscectomy.