title: Two-year follow-up after microsurgical discectomy and dynamic percutaneous stabilization in degenerate and herniated lumbar disc: clinical and neuroradiological outcome.
abstract: OBJECTIVE
  Lumbar disc herniation associated with back pain is often related to disc degeneration. Back pain after microdiscectomy often persists, prejudicing clinical outcome and quality of life. To this day, the evolution of disc degeneration after classical microdiscectomy has never been proven. Percutaneous dynamic stabilization after microdiscectomy has been proposed as a novel surgical strategy for treatment of back pain with herniated disc. However, clinical results are still debated and no evidences about the long-term evolution of back pain and relationships between neuroradiological imaging and clinical outcome have been provided. We report our preliminary observations concerning the clinical and neuroradiological outcome of 11 patients treated with microdiscectomy and dynamic percutaneous lumbo-sacral stabilization, after a long-term follow-up (2-years).
  
  
  METHODS
  This was an uncontrolled case series. The study included 11 patients (3 F, 8 M) with L5-S1 discal herniation and degeneration underwent microdiscectomy and percutaneous dynamic stabilization, from December 2008 to November 2009. All the patients were symptomatic with back and leg pain non-responsive to long-term (8-12 months) medical and physical treatments. VAS and Satisfaction Index were used, respectively, for evaluation of clinical outcome and general postoperative patients' satisfaction. Modic and Pfirrmann scores were used for evaluation of neuroradiological outcome. All the patients underwent to microdiscectomy and implantation of the same percutaneous device for dynamic stabilization of the middle vertebral column during the same surgery. Modic, Pfirrmann, VAS and Satisfaction Index scores were collected before surgery and over the follow-up (45 days, 1 and 2 years). MRI and dynamic X-Ray 2 years after surgery were compared to the preoperative imaging.
  
  
  RESULTS
  Motion preservation at the functional spinal unit after surgery was demonstrated in all the cases. All patients reported a reduction or complete resolution of back and leg pain, they were satisfied and came back to normal socio-professional life. No modification of the preoperative Pfirrmann was observed, even in those patients who experienced restoration of back pain. No surgical complications nor device failures were reported.
  
  
  CONCLUSIONS
  Percutaneous minimally invasive lumbo-sacral dynamic stabilization after microdiscectomy seems a reliable and effective technique in order to obtain a resolution of back pain and seems to prevent the Pfirrmann worsening, over a long-term follow-up.
authors.affiliation: Division of Spine Surgery, Department of Surgery, S. Maria Maddalena Hospital, Occhiobello (RO), Italy2 Department of Neuroscience and Rehabilitation Division of Neurosurgery "S. Anna" University-Hospital, Ferrara, Italy - giuma@vodafone.it.
authors.forename: G
authors.initials: G
authors.lastname: Maida
authors.forename: C
authors.initials: C
authors.lastname: Altruda
authors.forename: M
authors.initials: M
authors.lastname: Gatti
authors.forename: A
authors.initials: A
authors.lastname: Saletti
authors.forename: M
authors.initials: M
authors.lastname: Borrelli
authors.forename: S
authors.initials: S
authors.lastname: Sarubbo
mesh_terms: D019643:Arthroplasty, Replacement / Q000295:instrumentation / Q000379:methods*; D001863:Bone Screws; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D017116:Low Back Pain / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D010865:Pilot Projects; D011474:Prosthesis Design; D012447:Sacrum / Q000473:pathology / Q000601:surgery