Surgery for extraforaminal lumbar disc herniation: a single center comparative observational study

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Abstract

Background

Surgery on extraforaminal lumbar disc herniation (ELDH) is a commonly performed procedure. Operating on this type of herniation is known to come with more difficulties than on the frequently seen paramedian lumbar disc herniation (PLDH). However, no comparative data are available on the effectiveness and safety of this operation. We sought out to compare clinical outcomes at 1 year following surgery for ELDH and PLDH.

Methods

Data were collected through the Norwegian Registry for Spine Surgery (NORspine). The primary outcome measure was change at 1 year in the Oswestry Disability Index (ODI). Secondary outcome measures were quality of life measured with EuroQol 5 dimensions (EQ-5D); and numeric rating scales (NRSs).

Results

Data of a total of 1750 patients were evaluated in this study, including 72 ELDH patients (4.1%). One year after surgery, there were no differences in any of the patient reported outcome measurements (PROMs) between the two groups. PLDH and ELDH patients experienced similar changes in ODI (− 30.92 vs. − 34.00, P = 0.325); EQ-5D (0.50 vs. 0.51, P = 0.859); NRS back (− 3.69 vs. − 3.83, P = 0.745); and NRS leg (− 4.69 vs. − 4.46, P = 0.607) after 1 year. The proportion of patients achieving a clinical success (defined as an ODI score of less than 20 points) at 1 year was similar in both groups (61.5% vs. 52.7%, P = 0.204).

Conclusions

Patients operated for ELDH reported similar improvement after 1 year compared with patients operated for PLDH.

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Most cited references 21

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Herniated Lumbar Intervertebral Disk

Caren G. Solomon, Richard A Deyo, Sohail K Mirza (2016)

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Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

Johannes van Goudoever, , Wilco Peul … (2008)

To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Randomised controlled trial. Nine Dutch hospitals. 283 patients with 6-12 weeks of sciatica. Early surgery or an intended six months of continued conservative treatment, with delayed surgery if needed. Scores from Roland disability questionnaire for sciatica, visual analogue scale for leg pain, and Likert self rating scale of global perceived recovery. Of the 141 patients assigned to undergo early surgery, 125 (89%) underwent microdiscectomy. Of the 142 patients assigned to conservative treatment, 62 (44%) eventually required surgery, seven doing so in the second year of follow-up. There was no significant overall difference between treatment arms in disability scores during the first two years (P=0.25). Improvement in leg pain was faster for patients randomised to early surgery, with a significant difference between "areas under the curves" over two years (P=0.05). This short term benefit of early surgery was no longer significant by six months and continued to narrow between six months and 24 months. Patient satisfaction decreased slightly between one and two years for both groups. At two years 20% of all patients reported an unsatisfactory outcome. Early surgery achieved more rapid relief of sciatica than conservative care, but outcomes were similar by one year and these did not change during the second year. ISRCT No 26872154.

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Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery.

Jan Olsen, Dag Hofoss, Tor Ingebrigtsen … (2005)

There is limited data on the cost-utility of low-back surgical procedures. The EuroQol-5D (EQ-5D) is a generic health-related quality of life (HRQL) instrument, which was designed for cost-utility analyses and for comparisons of therapeutic effects across different diseases. Disease-specific (HRQL) instruments cannot be used for such purposes. However, there is little evidence of the usefulness of the EQ-5D in the field of low-back surgery, and it might be too general to assess specific conditions. We therefore tested its validity and responsiveness against a widely used disease-specific HRQL instrument [the Oswestry disability index (ODI)], in a prospective study on 326 patients operated for degenerative disorders in the lumbar spine. The reliability of the EQ-5D was also evaluated. Follow-up time was 12 months. Cross-sectional construct validity of the EQ-5D and ODI in the assessments of pain, functional status, health state and employment status were equal. The ODI performed better only in the assessment of walking capability. Only small differences in responsiveness were found. The reliability of the EQ-5D was solid. Our results indicate that the EQ-5D is useful for estimating health state values and for monitoring outcome of patients undergoing low-back surgery. Hence, this instrument would provide valid data for cost-utility analyses.

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Author and article information

Contributors

Samuel B. Polak: s.b.polak@lumc.nl

Mattis A. Madsbu: mattis.madsbu@gmail.com

Vetle Vangen-Lønne: vetle_vl@hotmail.no

Øyvind Salvesen: oyvind.salvesen@ntnu.no

Øystein Nygaard: oystein.nygaard@ntnu.no

Tore K. Solberg: tore.solberg@unn.no

Carmen L. A. M. Vleggeert-Lankamp: c.l.a.vleggeert-lankamp@lumc.nl

Sasha Gulati: sasha.gulati@ntnu.no

Journal

Journal ID (nlm-ta): Acta Neurochir (Wien)

Journal ID (iso-abbrev): Acta Neurochir (Wien)

Title: Acta Neurochirurgica

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0001-6268

ISSN (Electronic): 0942-0940

Publication date (Electronic): 13 April 2020

Publication date PMC-release: 13 April 2020

Publication date (Print): 2020

Volume: 162

Issue: 6

Pages: 1409-1415

Affiliations

[1 ]GRID grid.10419.3d, ISNI 0000000089452978, Department of Neurosurgery, , Leiden University Medical Center, ; Leiden, Netherlands

[2 ]GRID grid.52522.32, ISNI 0000 0004 0627 3560, Department of Neurosurgery, , St. Olavs University Hospital, ; Trondheim, Norway

[3 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Neuroscience, , Norwegian University of Science and Technology (NTNU), ; Trondheim, Norway

[4 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Public Health and General Practice, , Norwegian University of Science and Technology (NTNU), ; Trondheim, Norway

[5 ]GRID grid.412244.5, ISNI 0000 0004 4689 5540, The Norwegian National Registry for Spine Surgery, , University Hospital of Northern Norway (UNN), ; Tromsø, Norway

[6 ]GRID grid.412244.5, ISNI 0000 0004 4689 5540, Department of Neurosurgery, , University Hospital of Northern Norway (UNN), ; Tromsø, Norway

[7 ]GRID grid.52522.32, ISNI 0000 0004 0627 3560, National Advisory Unit on Spinal Surgery, , St. Olavs University Hospital, ; Trondheim, Norway

Article

Publisher ID: 4313

DOI: 10.1007/s00701-020-04313-w

PMC ID: 7235055

PubMed ID: 32285191

SO-VID: e50126a3-eeb7-4fe2-bd63-ba61889eae88

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 10 January 2020

Date accepted : 29 March 2020

Funding

Funded by: NTNU Norwegian University of Science and Technology (incl St. Olavs Hospital - Trondheim University Hospital)

Open Access :

Open Access funding provided by NTNU Norwegian University of Science and Technology (incl St. Olavs Hospital - Trondheim University Hospital)

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: intervertebral disc displacement,neurosurgery,orthopedics,sciatica

Data availability:

ScienceOpen disciplines: Surgery

Keywords: intervertebral disc displacement, neurosurgery, orthopedics, sciatica

Surgery for extraforaminal lumbar disc herniation: a single center comparative observational study

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 21

Herniated Lumbar Intervertebral Disk

Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery.

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