Result of lumbar discectomy for single-level lumbar intervertebral disc herniation：a ten-year report

English Keywords:Lumbar disc herniation  Discectomy  MRI  Long-term  Follow-up

English Abstract:

  【Abstract】 Objective：To investigate the long-term outcome and imaging findings of single-level discectomy for lumbar intervertebral disc herniation.Method：Two hundred and ten patients with single-level lumbar intervertebral disc herniation underwent discectomy from 1990 to 1998，of them，35 patients（10 laminectomy and discectomy，25 mini-laminotomy and discectomy） were followed up for more than 10 years.These 35 patients′ data including demographic record，physical examination，X-ray and MRI findings of lumbar spine as well as ODI assessment were reviewed retrospectively.Result：During follow-up，5 patients presented with no low back pain and sciatica；26 patients complained of transient low back pain and sciatica；while 4 suffered from severe irreducible lowback pain.Lumbar X-ray showed narrowing of intervertebral disc of surgical level in 22 cases（62.9%），and the remaining range of motion of surgical level was 5.0°±3.2°.Functional X-ray showed no instability of lumbar spine.According to UCLA criteria，cephalad adjacent segment degeneration（ASD） occurred in 8 cases（22.9%）.MRI showed recurrence of lumbar disc herniation in 6 patients（17.1%），but only four of them had symptoms and signs of recurrence.According to Pfirrmann intervertebral disc degeneration classification system，cephalad ASD ranked 1-5 in 27 cases，and 6 or more in 8 cases.12 cases including 4 Modic Ⅰ and 8 Modic Ⅱ showed varied signs of end plate degeneration（34.3%）.ODI assessment showed significant difference between disc narrowing and nonnarrowing groups.The ODI score，incidence of ASD and remaining ROM of surgical level between two surgical approaches showed no significant difference.Conclusion：Lumbar discectomy for single-level disc herniation can maintain ROM and spine instability of surgical level to some degree，however disc narrowing and adjacent segment degeneration are more prevalent，which may associate with low back malfunction.