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Lumbar Microdiscectomy: A Clinicoradiological Analysis of Outcome

Published online by Cambridge University Press:  02 December 2014

Ralph Rahme ,
Ronald Moussa ,
Rabih Bou-Nassif ,
Joseph Maarrawi ,
Tony Rizk ,
Georges Nohra ,
Elie Samaha  and
Nabil Okais
Ralph Rahme
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Ronald Moussa
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Rabih Bou-Nassif
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Joseph Maarrawi
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Tony Rizk
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Georges Nohra
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Elie Samaha
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
Nabil Okais*
Affiliation:
Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
*
Department of Neurosurgery, Hôtel-Dieu de France, Ashrafieh, Beirut, Lebanon
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Abstract

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Background:

The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear. We sought to analyze the interaction between clinical, functional, and radiological variables and their impact on patient outcome.

Methods:

All patients who underwent LMD in 2004-2005 were invited to participate in this retrospective cohort study. Patients were re-evaluated clinically and radiologically after a three to five year follow-up.

Results:

Forty-one of 97 eligible patients were enrolled. Twelve patients (29.3%) reported moderate-to-severe sciatica, 12 (29.3%) had moderate LBP, and 13 (31.7%) exhibited clinical evidence of segmental instability. Thirty-eight patients (92.7%) had minimal disability and 3 (7.3%) had moderate disability. Twenty-three patients (56.1%) were fully satisfied, while 18 (43.9%) had only partial satisfaction, having expected a better outcome. Thirty-three patients (80.5%) returned to full-time work. Median disc space collapse (DSC) was 20% (range 5-66%) and L4-L5 was particularly affected. Prevalence of Modic changes increased from 46.3% to 78% with type 2 predominance. Multivariate logistic regression analysis identified the following negative prognostic factors: female sex, young age, lack of regular exercise, and chronic preoperative LBP. There was no correlation between the course of Modic changes, DSC, and patient outcome.

Conclusion:

Although many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome.

Résumé:

Résumé:Contexte:

Le résultat à long terme de la microdiscectomie lombaire (MDL) peut être influencé par la douleur lombaire (DL) et l’instabilité segmentaire dont les facteurs déterminants sont mal connus. Le but de notre étude était d’analyser l’interaction entre des variables cliniques, fonctionnelles et radiologiques ainsi que leur impact sur le résultat chez le patient.

Méthode:

Tous les patients qui ont subi une MDL en 2004-2005 ont été invités à participer à cette étude rétrospective de cohorte. Tous les patients ont subi une nouvelle évaluation clinique et radiologique après un suivi variant de 3 à 5 ans.

Résultats:

Quarante et un des 97 patients éligibles ont participé à l’étude. Douze patients (29,3%) présentaient une sciatalgie de modérée à sévère, 12 (29,3%) présentaient une DL modérée et 13 (31,7%) présentaient des signes cliniques d’instabilité segmentaire. Trente-huit patients (92,7%) avaient une invalidité minime et 3 (7,3%) avaient une invalidité modérée. Trente-trois patients (56,1%) étaient entièrement satisfaits du résultat et 18 (43,9%) s’étaient attendus à de meilleurs résultats et étaient donc partiellement satisfaits. Trente-trois patients (80,5%) étaient retournés au travail à temps complet. L’affaissement médian de l’espace discal (AED) était de 20% (écart de 5% à 66%) et l’espace L4-L5 était particulièrement touché. La prévalence de changements Modic a augmenté de 46,3% à 78%, avec prédominance de changements de type 2. L’analyse de régression logistique multivariée a identifié les facteurs indiquant un pronostic défavorable : le sexe féminin, le jeune âge, l’absence d’exercice régulier et la présence de DL chronique avant la chirurgie. Il n’existait pas de corrélation entre l’évolution des changements Modic, l’AED et le résultat chez le patient.

Conclusion:

Bien que plusieurs patients éprouvent des symptômes après la MDL, ils présentent rarement une invalidité significative ou de l’insatisfaction. Certains facteurs, tels le sexe féminin, le jeune âge, le manque d’exercice et la DL chronique préopératoire, peuvent prédire un moins bon résultat. L’affaissement de l’espace discal est une constatation universelle, particulièrement au niveau L4-L5. Ni l’AED, ni les changements Modic ne semblent influencer le résultat chez le patient.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 439 - 445
Copyright
Copyright © The Canadian Journal of Neurological 2011

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