Seven- to 20-year outcome of lumbar discectomy

Study Design. A retrospective, follow-up study. Objectives. To assess the effects of conventional surgery for lumbar disc h erniation 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 disc ectomy are excellent When there is a proper patient selection, the reported success; rates in the long-term follow-up studies vary, and few factors ha ve been implicated for an unsatisfactory outcome. Methods. One hundred-nine patients with surgically documented herniated lum bar disc were analyzed, retrospectively, by an independent observer. Long-t erm follow-up (mean 12.2 years) was done by a mailed, self-report questionn aire that included items about pain relief in the back and leg, satisfactio n with the results, need for analgesics, level of activity, working capacit y, and reoperations. Subjective disability was measured by the Oswestry que stionnaire. Radiographic review was carried out in 66% of patients. End res ults were assessed using the modified Stauffer-Coventry's evaluating criter ia. Several variables were examined to assess their influence to the outcom e. Results. The late results were satisfactory in 64% of patients. The mean Os westry disability score was 18.9. Of the 101 patients who had primary proce dures, 28% still complained of significant back or leg pain. Sixty-five per cent of patients were very satisfied with their results, 29% satisfied, and 6% dissatisfied. The reoperation rate was 7.3% (8 patients), about one-thi rd of which was due to recurrent disc herniation. Sociodemographic factors pre disposing to unsatisfactory outcome, including female gender, low vocat ional education, and jobs requiring significant physical strenuousness. Dis c space narrowing was common at the level of discectomy, but was without pr ognostic significance. Conclusions. The long-term results of standard lumbar discectomy are not ve ry satisfying. More than one-third of the patients had unsatisfactory resul ts and more than one quarter complained of significant residual pain. Heavy manual work, particularly agricultural work, and low educational level wer e negative predictors of a good out come. These indicators should be used p reoperatively to identify patients who are at high risk for an unfavorable long-term result.