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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 August;59(4):233-40
Influence of surgical technique on lumbar discectomy outcome
Radziszewski K. 1,2, Szolna A. 1,2
1 Department of Clinical Basis of Physiotherapy Collegium Medicum, Bydgoszcz Nicolas Copernicus University, Toruƒ, Poland
2 Clinic of Neurosurgery Military Hospital, Bydgoszcz, Poland
Aim. Lumbar disc herniation is complex illness, therefore accurate choice and application of treatment is an extensive medical problem. Moreover, one of the most important factors which could influence the outcome of treatment is the surgical technique. The aim of the study was to determine the influence that a kind of surgical intervention might have on the long-term outcome in patients with lumbar disc herniation.
Methods. The research was conducted on 215 patients (113 females and 102 males) from 16 to 76 years of age, with disc herniation of L4-L5 and L5-S1 segments, treated surgically by standard open lumbar diskectomy by fenestration, hemilaminectomy or laminectomy. The complications and outcome were assessed within 10-year period following the operating intervention. The gathered material was divided into three surgery and three age groups. The surgery groups were determined as following: F (fenestration), H (hemilaminectomy), and L (laminectomy), and age groups as: Y (the young, up to 30 years of age), M (middle aged, 31 – 50 years of age), S (as well as seniors, over 50 years of age). The assessment comprised the most important aspects of the illness: pain, neurological condition, mental condition, professional activity, the standard of living, reoperations. The final assessment of the outcome of surgical treatment in the said groups was based on the following results: neurological status, physical impairment, level of pain, quality of live (Oswestry Low Back Pain Disability Questionnaire [OLBPDQ]), professional activity (Functional-Economic Outcome Rating Scale of Prolo [F-EORS]), and the level of depression (Self-Rating Depression Scale [SRDS]).
Results. The best results in relation to functional outcome, the level of physical impairment, the acuteness of pain, the length of hospitalization and involvement in professional activity were obtained after the procedure of fenestration. No significant influence on neurological condition and the level of depression in patients was observed. The percentage of reoperated patients within the period of 10 years was 19.1%. The commonest cause for reoperation was the presence of adhesions around nerve roots.
Conclusion. The extent of surgical intervention may influence the treatment outcome. The conducted research points to the advantage of fenestration as a sparing operation over hemilaminectomy and laminectomy. The fenestration should be considered as a treatment of choice among other standard open aproaches to diskectomy.