Article
Reoperation rate after microsurgical operations performed at the upper lumbar disc levels
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Published: | May 20, 2009 |
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Objective: Disc herniations of the upper lumbar spine (L 1-2 and L 2-3) have a frequency of 1 to 2 % of all lumbar disc herniations. In this study we compare outcome, recurrence, and frequency of instability after sequestrectomy or microdiscectomy.
Methods: A retrospective assessment of 141 patients (59 women and 82 men) operated between 1995 and 2007 was performed. The following clinical data were collected: age, femoral stretch test, motor strength, sensory disturbance, autonomic disturbances and tendon reflexes. Intraoperative parameters as well as pre- and postoperative symptoms were documented. Long-term outcome (range 7-144 months, mean follow-up 62 months) was characterized using the Oswestry Disability Index (ODI Version 2.0) and the modified Prolo Economic Rating system in comparison to literature.
Results: Mean age at time of operation was 61.8 years (SD ±10.3, range 30-83). Foraminal and far lateral disc herniation occurred in 18 patients (11.5%). The median operation time was 86.97 (SD ±34.37) minutes. Complications including epidural hematoma, dural lacerations and thromboembolic complications were observed in 6.4%. Reherniation occurred in 10 patients after discectomy (6.4%), but none after sequestrectomy. Long-term follow-up was available in 107 patients (68.1%). 8 patients (5.7%) died in the follow-up period. 1 patient (0.7%) needed a fusion procedure due to instability. 14.4% were able to work in their previous profession without restrictions. 17.5% were able to work part-time in their previous occupation or with limited assignment. 11.3% had to change their profession, while 39% were not able to gain any occupation postoperatively and retired. With longer follow-up periods the ODI score was better.
Conclusions: There is only a small rate of postoperative instability after microsurgical disc surgery performed at the L1-L2 and L2-L3 levels. The reoperation rate of upper disc levels is comparable to lower disc levels according to literature. Microdiscectomy entails a higher rate of recurrence compared to sequestrectomy.