DISCECTOMY IN SINGLE LEVEL LUMBAR DISC DISEASE
AbstractBackground: There is a controversy regarding the treatment of lumbar disc herniation. Most ofpatients with lumbar disc herniation and radiculopathy improve with rest and medicine. Lumbar discsurgery gives rapid relief to the patients with severe root pain in legs. This study was conducted to seethe risks and benefits of surgery in single level symptomatic lumbar disc disease. Methods: Thisprospective study was conducted in Department of Neurosurgery, Liaquat University of Medical andHealth Sciences, Jamshoro during 2007–2009. Patients with severe leg pain, positive straight legraising, and confirmed disc extrusion on imaging were included and conventional open discectomywas performed. Patients were followed up for one year after the surgery. Results: Forty-five patientswere operated for lumbar root pain due to a single disc. Most common disc involved was L4–5 anddiscectomy was performed. Recurrence of disc occurred in 4 patients. Conclusion: Proper selection ofpatients is necessary for excellent postoperative results in back surgery. Failed back surgery continuesto rise with high rate of lumbar spine surgery as many patients are selected inappropriately.Keywords: Lumbar disc herniation, open discectomy, backache
Martin MD, Boxell CM, Malone DG. Pathophysiology of lumbar
disc degeneration: a review of the literature. Neurosurg Focus
Gordon SJ, Yang KH, Mayer PJ, Mace AH Jr, Kish VL, Radin
EL. Mechanism of disc rupture. A preliminary report. Spine
Weiner BK, Patel R. The accuracy of MRI in the detection of
Lumbar Disc containment. J Orthop Surg Res 2008;3:46.
Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT,
Malkasian D, Ross JS. Magnetic Resonance Imaging of the
lumbar spine in people without back pain. N Engl J Med
Kayame S, Olmarker K, Larsson K, Sjögren-Jansson E, Lindahl
A, Rydevik B. Cultured autologus neucleus pulposus cells induce
functional changes in spinal Nerve roots. Spine (Phila Pa 1976)
Satosh K, Konno K, Nishyama K, Olmarker K, Kikuchi S.
Presence and distribution of antigen-antibody complexes in the
herniated nucleus pulposus. Spine (Phila Pa 1976)
Nygaard OP, Mellgren SI, Oster B. The inflammatory properties
of contained and non contained lumbar disc herniation. Spine
(Phila Pa 1976) 1997;22:2484–8.
Hadjipavlon AG, Simmons JW, Pope MH, Necessary JT, Goel
VK. Pathomechanics and clinical relevance of disc degeneration
and annular tear: A poait-of-view. Am J orthop 1999;28:561–71.
Hasegawa T, An HS, Infusa Mikawa Y, Watanabe R. The effects
of age on inflammatory responses and nerve root injuries after
lumbar disc herniation: an experimental study in a canine model.
Spine (Phila Pa 1976) 2000;25:937–40.
Videman T, Sama S, Battie MC, Koskinen S, Gill K, Paananen
H, at al. The long term effects of physical loading and excersise
lifestyles on back related symptoms,disability and spinal
pathology among men. Spine (Phila Pa 1976) 1995;20:699–709.
Frymoyer JW, Pope MH, Elements JH, Wilder DG, MacPherson
B, Ashikaga T. Risk factors in low back pain. An
epidemiological survey. J Bone Joint Surg 1983;65:213–8.
Burdorf A. Exposure assessment of risk factors for disorders of
the back in occupational epidemiology. Scand J Work Environ
An HS, Silveri CP, Simpson JM, File P, Simmons C, Simeone
FA, at al. Comparison of smoking habits between patients with
surgically confirmed herniated lumbar and cervical disc disease
and controls. J Spinal Disord 1994;7:369–73.
Battie MC, Videman T, Gibbous LE, Fisher LD, Manninen H, Gill
K. 1995 Volvo Award in Clinical Sciences. Determinants of
lumbar disc degeneration. Spine (Phila Pa 1976) 1995;20:2601–12.
Almeida DB, Prandini MN, Awamura Y, Vitola ML, Simião
MP, Milano JB, at al. Outcome following lumbar disc surgery:
the role of fibrosis. Acta Neurochir 2008;150:1167–76.
Atlas S, Keller R, Wu Y, Deyo R, Singer De. Long-term outcome
of surgical and non surgical management of sciatica secondary to
a lumbar disc herniation: 10 year result from the maine lumbar
spine study. Spine (Phila Pa 1976) 2001;30:927–35.
Raffo CS, Wiesel SW, Lauerman WC. Determining reasons for
failed lumbar spine surgery. In: Frymoyer JW, Wiesel SW, (Eds).
The Adult and Pediatric Spine. 3rd ed. Vol 2. Philadelphia:
Lippincot William & Willkins; 2004. p.945–54.
Matsunaga S, Sakou T, Taketomi E, Ijiri K. Comparison of
operative results of lumbar disc herniation in manual laborers and
athlete. Spine (Phila Pa 1976) 1993;18:2222–6.
Postacchinni F. Results of surgery compared with conservative
management for lumbar disc herniation. Spine (Phila Pa 1976)
vucetic N, Maatanen H, Svensson O. Pain and pathology in
lumbar disc hernia. Clin Orthop 1995;32:65–72.
Siddiq M, Ali N, Jan WA, Dil R. Surgical management of
lumbar disc herniation by standard laminectomy in a periphery
hospital; An experience with 64 patients. J Postgrad Med Institute
Peng C WB, Yco W, Tan SB. Percutaneous lumbar discectomy:
clinical and quality of life outcomes with a minimum 2 year
follow-up. J Orthop Surg Res 2009;4:20.
Singh P, Batish VK, Sarup S, Singh A, Singh AP. Sphincter
involvment in lumbar disc herniation. Med J Armed Forces India
Hakkinen Arja, Ylinen J, Kautiainen H, Tarvainen V, Kiviranta I.
Effects of Home strength Training and Streching versus Streching
alone after lumbar disc surgery: A randomized study with a 1-year
follow-up. Arch Phys Med Rehabil 2005;86:865–70.
Schoeggl A, Maier H, Saringer W, Reddy M, Matula C.
Outcome after chronic sciatica as the only reason for lumbar
micro disectomy. J Spinal Disord Tech 2002;15:415–9.
Law JD, Lehman RW, Kirsch WM. Reoperation after lumbar
intervertebral disc surgery. J Neurosurg 1978;48:251–63.
Gibson JN, Grant IC, Weddel G. The Cochrane review of
surgery for lumbar disc prolapse and degenerative lumbar
spondylosis. Spine (Phila Pa 1976) 1999;24:1820–32.
Jönsson B, Strömqvist B. Neurologic signs in lumbar disc
herniation. Preoperative affliction and postoperative recovery in
cases. Acta Orthop Scand 1996;67:466–9.
Kara B, Başkurt Z, Acar U. One year outcome after surgery for
lumbar disc herniation: a comparison of reoperated and not
reoperated patients. Turk Neurosurg 2007;17:1–6.
Postacchini F. Management of herniation of the lumbar disc. J
Bone Joint Surg (Br) 1999;81(4):567–76.
Postacchini F, Giannicola G, Cinotti G: Recovery of motor
deficits after microdiscectomy for lumbar disc herniation. J Bone
Joint Surg (Br) 2002;84(7):1040–5.
Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K. Long-term
outcomes of standard discectomy for lumbar disc herniation: a
follow-up study of more than 10 years. Spine (Phila Pa 1976)
Swartz KR, Trost GR. Recurrent lumbar disc herniation.
Neurosurg Focus 2003;15(3):E10.