title: Microdiscectomy for the treatment of lumbar disc herniation: an evaluation of reoperations and long-term outcomes.
abstract: Design Retrospective case series. Objective The objective of this study was to assess the reoperation rate after microdiscectomy for the treatment of lumbar disc herniation (LDH) in patients with ≥ 5-year follow-up and identify demographic, perioperative, and outcome-related differences between patients with and without a reoperation. Methods The medical records, operative reports, and office notes of patients who had undergone microdiscectomy at a single institution between March 1994 and December 2007 were reviewed and long-term follow-up was assessed via a telephone questionnaire. Results Forty patients (M:24, F:16) with an average age at surgery of 39.9 ± 12.5 years (range: 18-80) underwent microdiscectomy at the levels L5-S1 (n = 28, 70%), L4-L5 (n = 9, 22.5%), L3-L4 (n = 2, 5.0%), and L1-L2 (n = 1, 2.5%). After an average of 40.4 ± 40.1 months (range: 1-128), 25% of patients (10/40) required further spine surgery related to the initial microdiscectomy. At an average postoperative follow-up of 11.1 ± 4.0 years (range: 5-19), additional symptoms apart from back and leg pain were reported more frequently by patients who underwent a reoperation (p = 0.005). Patient satisfaction was significantly higher in patients who did not undergo a reoperation (p = 0.041). For the Oswestry disability index, pain intensity (p = 0.036), and pain-related sleep disturbances (p = 0.006) were reported to be more severe in the reoperation group. Conclusions Microdiscectomy for the treatment of LDH results in a favorable long-term outcome in the majority of cases. The reoperation rate was higher in our series than reported in previous investigations with shorter follow-up. Although there were no statistically significant pre-/perioperative differences between patients with and without reoperation, our findings suggest a difference in self-reported long-term outcome measures.
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Alexander
authors.initials: A
authors.lastname: Aichmair
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Jerry Y
authors.initials: JY
authors.lastname: Du
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shue
authors.affiliation: 1st Orthopaedic Clinic, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors.forename: Gisberto
authors.initials: G
authors.lastname: Evangelisti
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Sama
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Hughes
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Lebl
authors.affiliation: Department of Epidemiology and Biostatistics, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Jayme C
authors.initials: JC
authors.lastname: Burket
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Frank P
authors.initials: FP
authors.lastname: Cammisa
authors.affiliation: Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, United States.
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
keywords: ODI; Oswestry disability index; limited discectomy; long-term outcome; lumbar disc herniation; microdiscectomy; reoperation