Περίληψη:
Study Design. A retrospective, follow-up study.
Objectives. To assess the effects of conventional surgery for lumbar
disc herniation over an extended period of time and to examine factors
that might correlate with unsatisfactory results.
Summary of Background Data. Although the short; term results of lumbar
discectomy are excellent When there is a proper patient selection, the
reported success; rates in the long-term follow-up studies vary, and few
factors have been implicated for an unsatisfactory outcome.
Methods. One hundred-nine patients with surgically documented herniated
lumbar disc were analyzed, retrospectively, by an independent observer.
Long-term follow-up (mean 12.2 years) was done by a mailed, self-report
questionnaire that included items about pain relief in the back and leg,
satisfaction with the results, need for analgesics, level of activity,
working capacity, and reoperations. Subjective disability was measured
by the Oswestry questionnaire. Radiographic review was carried out in
66% of patients. End results were assessed using the modified
Stauffer-Coventry’s evaluating criteria. Several variables were examined
to assess their influence to the outcome.
Results. The late results were satisfactory in 64% of patients. The
mean Oswestry disability score was 18.9. Of the 101 patients who had
primary procedures, 28% still complained of significant back or leg
pain. Sixty-five percent of patients were very satisfied with their
results, 29% satisfied, and 6% dissatisfied. The reoperation rate was
7.3% (8 patients), about one-third of which was due to recurrent disc
herniation. Sociodemographic factors pre disposing to unsatisfactory
outcome, including female gender, low vocational education, and jobs
requiring significant physical strenuousness. Disc space narrowing was
common at the level of discectomy, but was without prognostic
significance.
Conclusions. The long-term results of standard lumbar discectomy are not
very satisfying. More than one-third of the patients had unsatisfactory
results and more than one quarter complained of significant residual
pain. Heavy manual work, particularly agricultural work, and low
educational level were negative predictors of a good out come. These
indicators should be used preoperatively to identify patients who are at
high risk for an unfavorable long-term result.
Συγγραφείς:
Loupasis, GA
Stamos, K
Katonis, PG
Sapkas, G
Korres, DS
and Hartofilakidis, G
