title: Long-term clinical outcomes and radiological findings and their correlation with each other after standard open discectomy for lumbar disc herniation.
abstract: OBJECTIVE
  This retrospective study was designed to evaluate the clinical outcomes and radiological findings after open lumbar discectomy (OLD) in patients who were followed up for 10 years or longer.
  
  
  METHODS
  The authors classified 79 patients who had a mean age (±SD) of 53.6±13.6 years (range 30-78 years) into 4 groups according to the length of their follow-up. Patients in Group 1 were followed up for 10-14 years, in Group 2 for 15-19 years, in Group 3 for 20-24 years, and in Group 4 for more than 25 years. In all of these patients, the clinical outcomes were assessed by using patients' self-reported scores on visual analog scales (VASs) measuring back and leg pain and by using scores from the Oswestry Disability Index (ODI). In addition, 10 radiological parameters suggesting degenerative changes or instability at the operated segment were recorded at various time points and used to calculate a numeric radiological finding (NRF) score by rating a presence for each finding of spinal degeneration or instability as 1.
  
  
  RESULTS
  The authors observed that OLD decreased pain and disability scores in all groups. Numeric radiological findings were highest in Group 4, and a significant correlation was detected between NRFs and VAS scores of back pain (p=0.039). In this cohort, the reoperation rate was 13.9% during a mean follow-up period of 15.3 years. Clinical outcomes tended to be most favorable in Group 1, representing patients who had OLD most recently, and they tended to deteriorate in the other 3 groups, indicating some worsening of outcomes over time. Degeneration of the spine at the operated level measured with radiographic methods tended to increase over time, but some stabilization was observed. Although spinal degeneration was stable, clinical outcomes deteriorated over time.
  
  
  CONCLUSIONS
  This cross-sectional assessment of a retrospective cohort indicates that outcomes after OLD deteriorate over time. Increased back pain indicated a worsening of clinical outcomes, and this worsening was correlated with radiological findings of degeneration at the operated segment.
authors.affiliation: Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Il-Nam
authors.initials: IN
authors.lastname: Son
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Kee-Yong
authors.initials: KY
authors.lastname: Ha
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000601:surgery; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D013995:Time; D016896:Treatment Outcome
keywords: ADHR = anterior disc height ratio; LDH = lumbar disc herniation; NRF = numeric radiological finding; ODI = Oswestry Disability Index; OLD = open lumbar discectomy; PDHR = posterior disc height ratio; VAS = visual analog scale; long-term follow-up; lumbar disc herniation; open discectomy; spinal disorders