Effect of Preoperative Parameters on Outcomes of Lumbar Microdiscectomy: A Retrospective Analysis

Abstract

Objective The objective of this study was to characterize the effect of preoperative variables on outcomes after minimally invasive lumbar microdiscectomy.

Materials and Methods This study was done from January 2019 to May 2020. This included medical records of all patients who were diagnosed with lumbar disc herniation and treated surgically by microdiscectomy. The medical records of such patients from January 2016 to January 2018 were included in this study. Postoperative outcomes were analyzed by Oswestry Disability Index (ODI), visual analog scale (VAS) leg, and VAS back scores, that were noted at preoperative, immediate postoperative, 6 months postoperative, and 1 year after operation. Difference in each outcomes score was calculated postoperatively with respect to the preoperative readings. Minimal clinically important difference was further calculated for each outcome score.

Results On analyzing the ODI, VAS leg, and VAS back scores across various age groups, genders, body mass indexes, addictions, comorbidities, preoperative epidural steroid injection and physiotherapy, and levels of disc herniation, and it was found that there was no statistically significant difference across these categories. However, the ODI scores (∼ ODI) at all time points showed greater difference in the younger age group, that is, 18 to 30 years, males, nonsmokers, those with symptom duration of less than 6 weeks, and with disc herniation at L3 to L4.

Conclusion The findings of this study will help to properly counsel patients with regard to the factors mentioned above so as to set realistic expectations, to help improve the outcomes, and for appropriate surgical decision making, that is, at which point should a surgical intervention be made.

Keywords

preoperative - lumbar microdiscectomy - ODI - VAS - MCID

Publikationsverlauf

Artikel online veröffentlicht:
24. August 2022

• References

• 1 Goald HJ. Microlumbar discectomy: follow-up of 477 patients. J Microsurg 1980; 2 (02) 95-100
• 2 Andersson GB, Brown MD, Dvorak J. et al. Consensus summary of the diagnosis and treatment of lumbar disc herniation. Spine 1996; 21 (24, Suppl): 75S-78S
• 3 Shrestha D, Shrestha R, Dhoju D, Kayastha S, Jha SC. Study of clinical variables affecting long term outcome after microdiscectomy for lumbar disc herniation. Kathmandu Univ Med J (KUMJ) 2015; 13 (52) 333-340
• 4 Fekete T, Woernle C, Mannion AF. et al; LSOS Working Group. The effect of epidural steroid injection on postoperative outcome in patients from the lumbar spinal stenosis outcome study. Spine 2015; 40 (16) 1303-1310
• 5 Sanden B, Forsth P, Michaelsson K. Smokers show less improvement than nonsmokers two years after surgery for lumbar spinal stenosis: a study of 4555 patients from the Swedish spine register. Spine 2011; 36 (13) 1059-1064
• 6 Appaduray SP, Lo P. Effects of diabetes and smoking on lumbar spinal surgery outcomes. J Clin Neurosci 2013; 20 (12) 1713-1717
• 7 Mannion AF, Fekete TF, Porchet F, Haschtmann D, Jeszenszky D, Kleinstück FS. The influence of comorbidity on the risks and benefits of spine surgery for degenerative lumbar disorders. Eur Spine J 2014; 23 (Suppl. 01) S66-S71
• 8 Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 2008; 8 (06) 968-974
• 9 Peul WC, van Houwelingen HC, van den Hout WB. et al; Leiden-The Hague Spine Intervention Prognostic Study Group. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med 2007; 356 (22) 2245-2256
• 10 Lurie JD, Faucett SC, Hanscom B. et al. Lumbar discectomy outcomes vary by herniation level in the Spine Patient Outcomes Research Trial. J Bone Joint Surg Am 2008; 90 (09) 1811-1819
• 11 Asch HL, Lewis PJ, Moreland DB. et al. Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm?. J Neurosurg 2002; 96 (1, Suppl): 34-44
• 12 Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 1983; 8 (02) 131-140
• 13 Silverplats K, Lind B, Zoëga B. et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J 2010; 19 (09) 1459-1467
• 14 Krutko AV, Sanginov AJ, Baykov ES. Predictors of treatment success following limited discectomy with annular closure for lumbar disc herniation. Int J Spine Surg 2020; 14 (01) 38-45
• 15 Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine 1996; 21 (05) 626-633
• 16 Dewing CB, Provencher MT, Riffenburgh RH, Kerr S, Manos RE. The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine 2008; 33 (01) 33-38
• 17 Basques BA, Haws BE, Khechen B. et al. The effect of preoperative symptom duration on postoperative outcomes after a tubular lumbar microdiscectomy. Clin Spine Surg 2019; 32 (01) E27-E30
• 18 Nygaard ØP, Kloster R, Solberg T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg 2000; 92 (2, Suppl): 131-134
• 19 Schoenfeld AJ, Bono CM. Does surgical timing influence functional recovery after lumbar discectomy? A systematic review. Clin Orthop Relat Res 2015; 473 (06) 1963-1970
• 20 Blazhevski B, Filipche V, Cvetanovski V, Simonovska N. Predictive value of the duration of sciatica for lumbar discectomy. Prilozi 2008; 29 (02) 325-335
• 21 Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine 2002; 27 (03) 313-319
• 22 Shi J, Wang Y, Zhou F, Zhang H, Yang H. Long-term clinical outcomes in patients undergoing lumbar discectomy by fenestration. J Int Med Res 2012; 40 (06) 2355-2361
• 23 Onyia CU, Menon SK. Impact of comorbidities on outcome following revision of recurrent single-level lumbar disc prolapse between revision microdiscectomy and posterior lumbar interbody fusion: a single-institutional analysis. Asian J Neurosurg 2019; 14 (02) 392-398
• 24 Simpson JM, Silveri CP, Balderston RA, Simeone FA, An HS. The results of operations on the lumbar spine in patients who have diabetes mellitus. J Bone Joint Surg Am 1993; 75 (12) 1823-1829
• 25 Mobbs RJ, Newcombe RL, Chandran KN. Lumbar discectomy and the diabetic patient: incidence and outcome. J Clin Neurosci 2001; 8 (01) 10-13
• 26 Sakaura H, Miwa T, Yamashita T, Kuroda Y, Ohwada T. Lifestyle-related diseases affect surgical outcomes after posterior lumbar interbody fusion. Global Spine J 2016; 6 (01) 2-6
• 27 Radcliff K, Kepler C, Hilibrand A. et al. Epidural steroid injections are associated with less improvement in patients with lumbar spinal stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial. Spine 2013; 38 (04) 279-291
• 28 Kennedy DJ, Dreyfuss P, Aprill CN, Bogduk N. Paraplegia following image-guided transforaminal lumbar spine epidural steroid injection: two case reports. Pain Med 2009; 10 (08) 1389-1394
• 29 Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. Pain Physician 2009; 12 (01) 163-188