Surgical Outcomes of Lumbar Disc Herniation: A Retrospective Analysis
Keywords:
Lumbar disc herniation, microdiscectomy, endoscopic discectomy, surgical outcomes, prognostic factorsAbstract
Background: Lumbar disc herniation (LDH) represents one of the most common spinal disorders requiring surgical intervention. Despite various surgical approaches available, there remains a lack of consensus regarding optimal techniques and their long-term outcomes.
Objective: To evaluate the clinical outcomes, complications, and prognostic factors associated with surgical management of LDH in a large, single-center cohort.
Methods: This retrospective analysis examined 425 consecutive patients who underwent surgical treatment for symptomatic lumbar disc herniation (LDH) between January 2018 and December 2022. Surgical approaches included microdiscectomy, endoscopic discectomy, and open discectomy. The primary outcomes were pain reduction (measured by the Visual Analog Scale), functional improvement (as assessed by the Oswestry Disability Index), and return to work or activities. Secondary outcomes included reoperation rates, complications, and patient satisfaction scores.
Results: At a mean follow-up of 36.7 months, significant improvements were observed in pain scores (mean reduction, 4.2 ± 1.6 points; p < 0.001) and functional capacity (mean ODI improvement, 28.7 ± 11.3 points; p < 0.001) across all surgical modalities. Microdiscectomy demonstrated superior outcomes for selected parameters, including shorter hospital stay, faster return to activities, and lower complication rates compared to open procedures. Recurrent herniation occurred in 7.3% of patients, with higher rates in those with larger disc herniations, obesity, and smoking history. Multiple regression analysis identified younger age, shorter symptom duration, and absence of comorbidities as positive prognostic factors.
Conclusion: Surgical intervention for LDH provides significant and sustained clinical improvement across multiple outcome domains. Minimally invasive approaches appear to offer advantages in terms of early recovery metrics, although long-term functional outcomes were comparable across techniques. Patient selection and consideration of identified prognostic factors may optimize surgical decision-making and outcomes.
References
1. Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. N Engl J Med. 2020;382(12):1093-1102.
2. Carragee EJ, Spinnickie AO, Alamin TF, et al. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine. 2006;31(6):653-657.
3. Choi KC, Shim HK, Kim JS, et al. Cost-effectiveness of microdiscectomy versus endoscopic discectomy for lumbar disc herniation. Spine J. 2019;19(7):1162-1169.
4. Deyo RA, Mirza SK. Clinical practice. Herniated lumbar intervertebral disk. N Engl J Med. 2016;374(18):1763-1772.
5. Fjeld OR, Grøvle L, Helgeland J, et al. Complications, reoperations, readmissions, and length of hospital stay in 34,639 surgical cases of lumbar disc herniation. Bone Joint J. 2019;101-B(4):470-477.
6. Gibson JNA, Subramanian AS, Scott CEH. A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Eur Spine J. 2017;26(3):847-856.
7. Huang W, Han Z, Liu J, et al. Risk Factors for Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016;95(2).
8. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-191.
9. Lurie JD, Tosteson TD, Tosteson AN, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results from the Spine Patient Outcomes Research Trial. Spine. 2014;39(1):3-16.
10. McGirt MJ, Eustacchio S, Varga P, et al. A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine. 2009;34(19):2044-2051.
11. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934;211:210-215.
12. Parker SL, Mendenhall SK, Godil SS, et al. Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res. 2015;473(6):1988-1999.
13. Ruan W, Feng F, Liu Z, et al. Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: a meta-analysis. Int J Surg. 2016;31:86-92.
14. Silverplats K, Lind B, Zoëga B, et al. Clinical factors important for outcome after lumbar disc herniation surgery: a long-term follow-up. Eur Spine J. 2010;19(9):1459-1467.
15. Suri P, Boyko EJ, Goldberg J, et al. Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: A retrospective analysis of data from the Longitudinal Assessment of Imaging and Disability of the Back (LAIDBACK). BMC Musculoskelet Disord. 2014;15:152.
16. Virk SS, Diwan A, Phillips FM, et al. What is the rate of revision discectomies after primary discectomy on a national scale? Clin Orthop Relat Res. 2017;475(11):2752-2762.
17. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006;296(20):2451-2459.
18. Wu X, Zhuang S, Mao Z, et al. Microendoscopic discectomy for lumbar disc herniation: surgical technique and outcome in 873 consecutive cases. Spine. 2006;31(23):2689-2694.
19. Yorimitsu E, Chiba K, Toyama Y, et al. Long-term outcomes of standard discectomy for lumbar disc herniation: A follow-up study of over 10 years. Spine. 2001;26(6):652-657.
20. Zaina F, Tomkins-Lane C, Carragee E, et al. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;(1)
21. Zieger M, Schwarz R, König HH, et al. Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review. Cent Eur Neurosurg. 2010;71(1):26-34.
22. Zou J, Zhang W, Li M, et al. Biportal endoscopic transforaminal lumbar interbody fusion with a single cage and local bone grafts: technical note. World Neurosurg. 2020;138:403-408.
