Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm?

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Object. The authors assessed the efficacy and outcomes of lumbar microdiscectomy performed on an outpatient basis by administering six questionnaires before and at five time points after surgery. The results were compared with those reported in literature in which the success rates vary between 70% and 80% and in excess of 90%. The authors use the methodology and data derived from their study to evaluate critically the relevance of these two categories of success rates.

Methods. This is a prospective study of 212 consecutive, eligible patients who underwent outpatient microscopic discectomy for the treatment of lumbar disc herniation; no previous lumbar lesion had been treated. Data were collected from questionnaires given to the patients before and at five time points after surgery, including at a variable final follow-up examination (mean 2 years postoperatively). Data were collated and analyzed independently by individuals other than the operating surgeons.

In both bi- and multivariate analyses, only two preoperative parameters were prognostically significant. The first factor was Workers' Compensation status, which had a negative effect on outcome. The second factor was patient age, which also had a negative effect and was linear with increasing age between 25 years and 56 years—that is, the ages most commonly encountered in cases of herniated disc. Successful outcome rates were as follows: leg pain relief according to a visual analog scale (VAS), 80%; back pain relief (VAS), 77%; Oswestry Low Back Disability Index, 78%; satisfaction with the results of surgery, 76%; return to normal daily activities, 65%; and return to work, 61%.

Conclusions. The findings of this study support the evidence that lumbar microdiscectomy performed on an outpatient basis is a very safe and effective means of treating sciatic pain due to disc herniation. The authors believe that their outcome success rates of 75 to 80% are more realistic than those of 90% or more found in some reports.

Article Information

Address reprint requests to: P. Jeffrey Lewis, M.D., Buffalo Neurosurgery Group, 550 Orchard Park Road, Buffalo, New York 14224. email: bng@buffnet.net.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Bar graph showing distribution of final follow-up times. All patients were canvassed 1 year or longer after surgery. The majority of patients complied with the questionnaires, with a median follow-up time of 25 months (arrow). In cases in which patients did not respond to this query, the outcome data and time after surgery of their last response were used for final follow up. The midpoint for each time range bar is indicated as numbers of months after surgery.

  • View in gallery

    Bar graphs showing leg pain (upper), back pain (center), and Oswestry (lower) scores (mean ± SD) at different time intervals after microdiscectomy. Within each panel, ANOVA was used for comparisons among all time points and the Bonferroni posttest was used for bivariate analyses. Comparisons between pre- and postoperative scores were made using paired patient data.

  • View in gallery

    Bar graphs illustrating time course of outcomes for return to normal ADL (upper), return to work (center), and satisfaction with the results of surgery (lower). Success rates are for each of three outcome parameters at each of three time periods following lumbar microdiscectomy. The probability values (chi-square tests, three time periods × success/failure) were as follows: ADL, p = 0.043; return to work, p = 0.003; satisfaction with surgery, p = 0.091.

  • View in gallery

    Bar graph illustrating the relationship between patient age and leg pain outcome and the percentage of patients in each age group whose final follow-up scores were successes (that is, with VAS Scores ≤ 4). Multivariate analysis of data obtained in all 212 patients showed a linear relationship between the discectomy-related success rate and age (0.06% worse each year than the previous age) in those 25 to 56 years of age. N = the number of cases in each age category.

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