Is surgery for recurrent lumbar disc herniation worthwhile or futile? A single center observational study with patient reported outcomes

Abstract

Sammendrag

Mål Undersøke resultat og komplikasjonsrate etter mikrodiskektomi for tilbakevendende lumbalprolaps

Metode Prospektive data for pasienter operert ved avdelingen for Nevrokirurgi, St. Olavs Universitetssykehus, Norge, ble hentet fra Norwegian Registry for Spine Surgery fra Mai 2007 til Juli 2016. Alle pasienter gjennomgikk lumbal mikrodiskektomi. Primære endepunkt var ending i Oswestry Disability Index (ODI) etter ett år. Sekundære endepunkt var ending i livskvalitet målt med EuroQol 5 Dimensions (EQ-5D), rygg- og bensmerte målt med numerical rating scales (NRS), komplikasjoner, knivtid og lengde på sykehusoppholdet.

Resultat 276 patienter ble inkludert i studien. Totalt 161 pasienter (58.3%) gjennomførte ett års oppfølging. Gjennomsnittlig bedring i ODI etter ett år var 27.1 poeng (95% CI 23.1 to 31.0, P <0.001). Gjennomsnittlig bedring i EQ-5D etter ett år var 0.47 poeng (95% CI 0.40 – 0.54, P <0.001), noe som representerer en stor effektstørrelse (Cohens D = 1.3). Gjennomsnittlig bedring i rygg- og bensmerte NRS var henholdsvis 4.3 poeng (95% CI 2.2 – 3.2, P <0.001) og 3.8 poeng (95% CI 2.8 – 3.9, P <0.001). Ni pasienter (3.3%) gjennomgikk intraoperative komplikasjoner, og 15 (5.5%9 av 160 pasienter rapporterte komplikasjoner innen tre måneder etter utskrivelse.

Konklusjon Denne studien viser at pasienter som opereres for tilbakevendende prolaps i lumbalcolumna rapporterer signifikant klinisk bedring.

Abstract

Objective To examine outcomes and complications following microdiscectomy for recurrent lumbar disc herniation

Methods Prospective data for patients operated at the Department of Neurosurgery, St. Olavs University Hospital, Norway, were obtained from the Norwegian Registry for Spine Surgery from May 2007 through July 2016. All patients underwent lumbar microdiscectomy. The primary outcome was change in the Oswestry Disability Index (ODI) at one year. Secondary endpoints were change in quality of life measured with EuroQol 5 Dimensions (EQ-5D), back and leg pain measured with numerical rating scales (NRS), complications, and duration of surgery and hospital stays.

Results 276 patients were enrolled in the study. A total of 161 patients (58.3%) completed one-year follow-up. The mean improvement in ODI at one year was 27.1 points (95% CI 23.1 to 31.0, P <0.001). The mean improvement in EQ-5D at one year of 0.47 points (95% CI 0.40 – 0.54, P <0.001), representing a large effect size (Cohens D = 1.3). The mean improvement in back pain and leg pain NRS were 4.3 points (95% CI 2.2 – 3.2, P <0.001) and 3.8 points (95% CI 2.8 – 3.9, P <0.001), respectively. Nine patients (3.3%) experienced intraoperative complications, and 15 (5.5%) out of 160 patients reported complications within three months following hospital discharge.

Conclusions This study shows that patients operated for recurrent lumbar disc herniation in general report significant clinical improvement.