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      Lumbar Disk Herniation Surgery: Outcome and Predictors

      research-article
      1 , 1 , 2
      Global Spine Journal
      Georg Thieme Verlag KG
      lumbar disk herniation, surgery, outcome, predictors

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          Abstract

          Study Design A retrospective cohort study.

          Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar disk herniation and to assess the effect of factors that could predict the outcome of surgery.

          Methods We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis.

          Results Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation.

          Conclusion Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population. Predictive factors for ineffective surgical treatment for lumbar disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for low back pain were other factors that showed prediction power.

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          Most cited references77

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          The economic burden of low back pain: a review of studies published between 1996 and 2001.

          Low back pain (LBP) poses an economic burden to society, mainly in terms of the large number of work days lost by a small percentage of patients who develop chronic LBP. The object of this review is to gain a better understanding of the societal costs of LBP and to see whether current clinical management follows evidence-based guidelines and is economically attractive, by reviewing studies on LBP with economic implications. To this end, the Medline database was searched between 1996 and 2001 using appropriate keywords, broadly defined. A total of 372 abstracts were screened and paper copies of 73 potentially relevant articles were obtained. It was found that the cost of LBP illness was high and was comparable to other disorders such as headache, heart disease, depression or diabetes, but actual cost estimates varied depending on the costing methodology employed. A small percentage of patients with chronic LBP accounts for a large fraction of the costs. Excessive and inappropriate use of diagnostic or therapeutic services can be documented but varied by region and provider type. Management according to evidence-based guidelines was not necessarily economically attractive. Interventions for acute or chronic LBP failed to show economic benefits, but demonstrated modest clinical benefits, which suggested a weak relationship between clinical and economic outcomes. The conclusion was that common definitions and costing methodologies need to be found to gain a better understanding of the true costs to society and to make studies comparable. A better definition is needed for the type for patient with LBP for whom therapeutic management is most likely to have a long-lasting economic benefit.
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            Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years.

            A retrospective analysis of the long-term outcomes of standard discectomy for lumbar disc herniation. To investigate the long-term outcomes of standard discectomy to address postoperative problems, including residual low back pain and recurrent herniation. Most previous investigators found that favorable outcomes of standard discectomy were maintained for the long-term postoperative period. Although they observed postoperative complications such as residual low back pain and recurrent herniation, detailed analyses of these results have not been conducted. The long-term follow-up results in patients who were observed for a minimum of 10 years after standard discectomy were evaluated by using the Japanese Orthopedic Association scoring system through direct examinations and questionnaires. Radiography also was used in patients who agreed to visit the hospital, and findings were compared with those on preoperative radiographs. The average recovery rate calculated by using Japanese Orthopedic Association scores was 73.5 +/- 21.7%. Even though residual low back pain was found in 74.6% of the patients, only 12.7% had severe low back pain. The majority of the patients with severe low back pain were under 35 years of age at the time of operation, with preoperative advanced disc degeneration. The final Japanese Orthopedic Association scores in the patients with decreased disc height were significantly lower than those in patients with no decrease. However, the disc height of patients with a recurrent herniation was preserved. The long-term outcome of standard discectomy in this series was favorable. Although patients with preserved disc height generally had favorable results, the risk of recurrent disc herniation was high in this population.
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              JOA Back Pain Evaluation Questionnaire (JOABPEQ)/JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The report on the development of revised versions. April 16, 2007. The Subcommittee of the Clinical Outcome Committee of the Japanese Orthopaedic Association on Low Back Pain and Cervical Myelopathy Evaluation.

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                Author and article information

                Journal
                Global Spine J
                Global Spine J
                10.1055/s-00000177
                Global Spine Journal
                Georg Thieme Verlag KG (Stuttgart · New York )
                2192-5682
                2192-5690
                26 September 2014
                December 2014
                : 4
                : 4
                : 233-244
                Affiliations
                [1 ]Department of Neurosurgery, Neurospine Section, Chamran Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
                [2 ]Department of Trauma Research Center (TRC), Rajaee Hospital, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
                Author notes
                Address for correspondence Ali Haghnegahdar, MD P.O. Box 71345-1536 ShirazIran haghnegahdar.ali@ 123456gmail.com
                Article
                1400034
                10.1055/s-0034-1390010
                4229371
                25396104
                186d9a69-22e7-4fe6-aee0-4ffaa8b77349
                © Thieme Medical Publishers
                Categories
                Article

                lumbar disk herniation,surgery,outcome,predictors
                lumbar disk herniation, surgery, outcome, predictors

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