Microdiscectomy for Lumbar Disc Herniation: A Single-Center Observational Study

Vetle Vangen-Lønne; Mattis A Madsbu; Øyvind Salvesen; Øystein P Nygaard; Tore K Solberg; Sasha Gulati

doi:10.1016/j.wneu.2020.02.056

Microdiscectomy for Lumbar Disc Herniation: A Single-Center Observational Study

World Neurosurg. 2020 May:137:e577-e583. doi: 10.1016/j.wneu.2020.02.056. Epub 2020 Feb 17.

Authors

Vetle Vangen-Lønne¹, Mattis A Madsbu², Øyvind Salvesen³, Øystein P Nygaard², Tore K Solberg⁴, Sasha Gulati⁵

Affiliations

¹ Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: vetleva@ntnu.no.
² Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.
³ Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway; Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway.
⁵ Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway.

PMID: 32081830
DOI: 10.1016/j.wneu.2020.02.056

Abstract

Objective: To examine outcomes and complications following first-time lumbar microdiscectomy.

Methods: Prospective data for patients operated on between May 2007 and July 2016 were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in Oswestry Disability Index (ODI) score at 1 year. Secondary endpoints were change in quality of life measured with EuroQol 5 Dimensions, back and leg pain measured with numeric rating scales, and perioperative complications within 3 months of surgery.

Results: For all enrolled patients (N = 1219) enrolled, mean improvement in ODI at 1 year was 33.3 points (95% confidence interval [CI] 31.7 to 34.9, P < 0.001). Mean improvement in EuroQol 5 Dimensions at 1 year of 0.52 point (95% CI 0.49 to 0.55, P < 0.001) represents a large effect size (Cohen's d = 1.6). Mean improvements in back pain and leg pain numeric rating scales were 3.9 points (95% CI 3.6 to 4.1, P < 0.001) and 5.0 points (95% CI 4.8 to 5.2, P < 0.001), respectively. There were 18 surgical complications in 1219 patients and 63 medical complications in 846 patients. The most common complication was micturition problems at 3 months following surgery (n = 25, 2.1%). In multivariate analysis, ODI scores of 21-40 (hazard ratio [HR] 14.5, 95% CI 1.1 to 27.9, P = 0.035), 41-60 (HR 27.5, 95% CI 13.4 to 41.7, P < 0.001), 61-80 (HR 47.4, 95% CI 33.4 to 61.4, P < 0.001) and >81 (HR 66.7, 95% CI 51.1 to 82.2, P < 0.001) were identified as positive predictors for ODI improvement at 1 year, whereas age ≥65 (HR -0.9, 95% CI -0.3 to -1.5, P = 0.004) was identified as a negative predictor for ODI improvement.

Conclusions: Microdiscectomy for lumbar disc herniation is an effective and safe treatment.

Keywords: Lumbar disc herniation; Neurosurgical procedures; Quality of life; Sciatica.

Publication types

Observational Study

MeSH terms

Adult
Back Pain / etiology
Back Pain / surgery*
Diskectomy / methods*
Female
Humans
Intervertebral Disc Displacement / complications
Intervertebral Disc Displacement / surgery*
Lumbar Vertebrae / surgery*
Male
Middle Aged
Pain Measurement
Prospective Studies
Quality of Life
Treatment Outcome