[Long-term outcomes of lumbar microdiscectomy in a working class sample]

Abstract

Introduction: In the treatment of the lumbar disc herniaton (LDH) microdiscectomy constitutes one of the standard procedures. In the present study we have analyzed the clinical outcome of the lumbar microdis- cectomy in a series of worker patients who underwent surgery in our service.

Methods: Retrospective analysis and a 5-year follow up, of a series of 142 patients operated on by means of lumbar microdiscectomy in the 2004-2005 period. The clinical outcome was analyzed according to the "Herron and Turner" outline: pain reduction, use of medical treatment, restriction in the ability to perform physical activities, and return to work.

Results: 116 men and 26 women, with an average age of 37.9 and 45.4 years respectively, underwent surgery because of LDH. In the clinical aspect, sciatica was predominant over low back pain in a ratio of three to one. The L5-S1 discal level was operated on in 68.3% of the cases. It was considered that occupational activities gave rise to damage in 107 patients (75.3%). Besides a symptomatic disc, there was an additional injured disc in 44.3% of the cases. An initial unfavourable outcome was seen in 42 patients (33%), 15 of which recovered from in an interval of 3 months, and another fifteen within a one year period. A re-operation was necessa ry in 16 patients because of recurrent lumbar disc herniation (11%). Work reintegration was achieved in 83.3% (119/142) of the cases. After a 5-year follow up, we stated the consistency of the clinical result.

Discussion: We analyzed the intervertebral disc behaviour as regards sex, age, variety of discal herniation, additional disc, outcome and re-operation variables. After the analysis of the type of discal herniation and additional disc we defined three disc injury patterns. We consider microdiscectomy as the technique of choosing for the treatment of recurrence disc herniation.

Conclusions: Between the working class, discal injury predominates in young men, as a consequence of the annulus breakage, or an annulus plus posterior longitudinal ligament breakage (traumatic herniae). Frequently it was observed that more than one disc was involved, and a left lateralization.