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. 2021 Jun;11(5):690-696.
doi: 10.1177/2192568220921829. Epub 2020 May 19.

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

Anuj Gupta  1 , H S Chhabra  2 , D Nagarjuna  3 , Mohit Arora  4
Affiliations

Comparison of Functional Outcomes Between Lumbar Interbody Fusion Surgery and Discectomy in Massive Lumbar Disc Herniation: A Retrospective Analysis

Anuj Gupta et al. Global Spine J. 2021 Jun.

Abstract

Study design: Retrospective analysis.

Objective: Lumbar disc herniation is one the most common condition responsible for low back and radicular pain. Although the symptoms are not proportional to the size of disc prolapse but massive disc herniation frequently needs surgical management. According to literature, the incidence of low back pain, recurrent disc herniation and segmental instability are more in discectomy whereas incidence of adjacent segment degeneration (ASD) is more after fusion surgery. There are very few studies that directly compare long-term functional outcome of both these procedures. We compared the functional outcome of both the procedures in this study.

Methods: All patients of massive disc prolapse, operated at our center between 2011 to 2017, were contacted. All the patients underwent either discectomy or transforaminal lumbar interbody fusion (TLIF). Functional outcomes of all the patients were collected using visual analogue scale (VAS) (back), VAS (leg), modified Oswestry Disability Index (mODI), Sciatica Bothersomeness Index (SBI), and McNab's criterion. Various complications were also analyzed.

Results: There were 144 patients in the discectomy group and 123 patients in the TLIF group. Mean duration of follow-up was 55.07 months and 51.86 months, respectively. Both the groups show no significant difference in VAS. Significant difference was seen in mODI and SBI favoring discectomy. McNab's criterion showed excellent result in 80% of patients of discectomy compared with 68% patients of TLIF. Overall complication rate in discectomy group was 11% whereas 13% in TLIF group.

Conclusion: Both show good functional outcome but better in discectomy. Recurrent herniation and instability were noticed more with discectomy and ASD was more common after fusion surgeries. The choice of procedure should be individualized, and it also depends on surgical expertise, but in developing countries where resources are constrained, discectomy should be preferred.

Keywords: TLIF; disc; discectomy; fusion; lumbar; massive disc herniation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A case of massive disc prolapse managed with discectomy alone.
Figure 2.
Figure 2.
A case of massive disc prolapse managed with transforaminal lumbar interbody fusion (TLIF).
Figure 3.
Figure 3.
Visual analogue scale (VAS) scores comparison of the patients between the groups. An unpaired t test is applied, which resulted in a 2-tailed P value of .0693 (VAS back pain) and .438 (VAS leg pain), which is statistically nonsignificant.
Figure 4.
Figure 4.
Modified Oswestry Disability Index (mODI) and Sciatica Bothersomeness Index (SBI) scores: comparison of the patients between the groups. An unpaired t test is applied, which resulted in a 2-tailed P value of .002 (mODI), which is statistically significant and the P value of .58 (SBI), which is statistically nonsignificant.
Figure 5.
Figure 5.
Graphical representation of McNab’s score comparing patients in the discectomy and transforaminal lumbar interbody fusion groups (TLIF).
See this image and copyright information in PMC

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