title: Lumbar microdiscectomy: a clinicoradiological analysis of outcome.
abstract: BACKGROUND
  The long-term outcome after lumbar microdiscectomy (LMD) may be affected by low back pain (LBP) and segmental instability, the determinants of which remain unclear. We sought to analyze the interaction between clinical, functional, and radiological variables and their impact on patient outcome.
  
  
  METHODS
  All patients who underwent LMD in 2004-2005 were invited to participate in this retrospective cohort study. Patients were re-evaluated clinically and radiologically after a three to five year follow-up.
  
  
  RESULTS
  Forty-one of 97 eligible patients were enrolled. Twelve patients (29.3%) reported moderate-to-severe sciatica, 12 (29.3%) had moderate LBP, and 13 (31.7%) exhibited clinical evidence of segmental instability. Thirty-eight patients (92.7%) had minimal disability and 3 (7.3%) had moderate disability. Twenty-three patients (56.1%) were fully satisfied, while 18 (43.9%) had only partial satisfaction, having expected a better outcome. Thirty-three patients (80.5%) returned to full-time work. Median disc space collapse (DSC) was 20% (range 5-66%) and L4-L5 was particularly affected. Prevalence of Modic changes increased from 46.3% to 78% with type 2 predominance. Multivariate logistic regression analysis identified the following negative prognostic factors: female sex, young age, lack of regular exercise, and chronic preoperative LBP. There was no correlation between the course of Modic changes, DSC, and patient outcome.
  
  
  CONCLUSIONS
  Although many patients may be symptomatic following LMD, significant disability and dissatisfaction are uncommon. Female sex, young age, lack of exercise, and chronic preoperative LBP may predict a worse outcome. Disc collapse is a universal finding, particularly at L4-L5. Neither DSC nor Modic changes seem to affect patient outcome.
authors.affiliation: Department of Neurosurgery, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon.
authors.forename: Ralph
authors.initials: R
authors.lastname: Rahme
authors.forename: Ronald
authors.initials: R
authors.lastname: Moussa
authors.forename: Rabih
authors.initials: R
authors.lastname: Bou-Nassif
authors.forename: Joseph
authors.initials: J
authors.lastname: Maarrawi
authors.forename: Tony
authors.initials: T
authors.lastname: Rizk
authors.forename: Georges
authors.initials: G
authors.lastname: Nohra
authors.forename: Elie
authors.initials: E
authors.lastname: Samaha
authors.forename: Nabil
authors.initials: N
authors.lastname: Okais
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000209:etiology*; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D011859:Radiography; D012189:Retrospective Studies; D012585:Sciatica / Q000000981:diagnostic imaging* / Q000209:etiology; D013223:Statistics as Topic; D016896:Treatment Outcome; D055815:Young Adult