Outcomes of Lumbar MicrodiscectomyOutcomes involving one hundred eighty-three out of one hundred ninety-seven consecutive subjects in the military who underwent single level lumbar microdiscectomy for either contained disc herniation, disc extrusion, or sequestered discs by the same surgeon were studied over a three year period. The mean age of the subjects was 27.0 years. They were followed for a mean of 26 months. All subjects had failed a period of non-operative care including physical therapy and/or transforaminal epidural steroid injections.
Outcomes that were studied included pain using the Visual Analog Scale, disability using the Oswestry disability index, patient satisfaction, return to military duty, and need for additional surgery.
The authors wanted to investigate these clinical outcomes with type and level of disc herniation in a young, active population.
All subjects were allowed to do activities as tolerated with restrictions only on bending, twisting, lifting greater than 20 pounds from the floor, and high impact activity. They were educated on lumbar stretching and core muscle strengthening. Duty restrictions were lifted and subjects were encouraged to gradually resume running, weightlifting, and other high impact activities.
Eighty-four percent of subjects returned to unrestricted military duty, 16 percent had been medically discharged. 85 percent of subjects were satisfied with the outcome of their surgery. This was a young, motivated group of subjects with preinjury physical condition superior to that of the general public. The subjects were made to feel that this was an injury that could be overcome like most musculoskeletal injuries. The subjects with more elite military jobs had better outcomes than their counterparts in other branches of service.
The authors found that surgical outcomes among those subjects with sequestered discs at all levels demonstrated better VAS and Oswestry scores than extruded or contained disc herniations. Disc herniations at L5-S1 also had greater improvements in the VAS and Oswestry compared to the L4-L5 level. Subjects who had more leg pain than back pain also had better VAS outcomes than those with largely back pain. Preexisting restricted duty status at time of first surgical consultation was associated with poorer outcomes. Smokers had a significantly lower return to full active military duty than non-smokers.
In conclusion, the authors feel that microdiscectomy for symptomatic lumbar disc herniations, especially in those with mostly leg pain and have failed nonoperative treatment has a high success rate among a younger population. Patients with contained disc herniations, mostly back versus leg pain, on restricted duty and who smoke have the potential for less satisfaction and poorer outcomes after microdiscectomy.
C. B. Dewing, et. al. The Outcomes of Lubar Microdiscectomy in a Young, Active Population SPINE. January 2008. Vol. 33, Number 1, Pp. 33-38.
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