Clinical Outcome Study of Different Methods of Unilateral Disc Herniation Surgery

Abstract

Background: To determine the outcome of surgery for lumbar disc herniation and whether any difference is present between clinical results of four different surgical method and also to assess the effect of factors that could predict the outcome of surgery.

Materials and Methods: We retrospectively evaluated 152 patients that were operated for lumbar disc herniation between March 2006- March 2011 with four different surgical techniques by using Japanese Orthopedic Association Back pain Evaluation Questionnaire (JOABPEQ), Return to activities of daily living scale, changes of visual analogue score for low back pain and radicular pain, and our study questionnaire that addressed patient satisfaction with the operation, residual complaints and job resumption.

Four methods of surgery were laminectomy, spinous process osteotomy (muscle sparing technique), MAPN (microscopic assisted percutaneous neucleatomy) and unilateral laminatomy.

Results:  94% of our patients were satisfied with their surgery results. An overall 93.3% success rate with regard to Δ Visual analogue score (postop-preop) for radicular pain was achieved. Laminectomy resulted in better outcome in terms of JOABPEQ Low back pain functional score (p value 0.001), Lumbar function functional score (p value 0.002) and Walking ability functional score (p value 0.004). We had an overall rate 1.98% and 6% of recurrence and surgical complications respectively. 71.1% of cases complained of various residual symptoms. There was a significant statistical relation between age and three upper lumbar level disc herniation (P-value 0.001). When considering the effect of different factors on the outcome of surgery, no relation was found between outcome of different surgical techniques and age, gender, level of education, pre-op motor power, pre-op VAS for back, pre-op VAS for radicular pain, return to previous job (with an overall rate of 94% of patients going back to their job before surgery) and level of herniation.

Conclusion: In this study Laminectomy achieved better outcome in comparison to other methods. From the results of our success rate with each of outcome measures, it is evident that surgery was mostly effective in reducing the radicular pain. It is also worth to mention that success rate with regard to patient overall satisfaction with the operation is almost equal to the success rate with radicular pain, which suggests that the most troublesome symptom for the patient was the radicular pain and its relief brought about satisfaction.