eMedicine Specialties > Neurosurgery > Spine

Lumbar Disc Disease: Follow-up

Author: Kamran Sahrakar, MD, FACS, Clinical Professor, Department of Neurosurgery, University of California at San Francisco
Coauthor(s): Martin Melicharek, MD, Assistant Clinical Professor, Department of Neurosurgery, University of California at Davis
Contributor Information and Disclosures

Updated: Nov 4, 2009

Outcome and Prognosis

Almost every study measures the outcome from lumbar disc surgery differently. A good outcome may be defined as the decreased use of narcotics, prompt return to work, or reported reduction in pain. Understandably, outcome studies can be misinterpreted or misrepresented.

Approximately 75% of patients who undergo a microdiscectomy have long-term reduction of sciatic pain and, thus, are considered cured. Reported results vary from 65-95%. Predominance of leg pain is the best determinant of good outcome from surgery for lumbar disc herniation.

Unfortunately, a rather large fraction of individuals who have had surgery for lumbar disc disease have recurrent or residual pain, which can be a significant challenge to treat. A methodical postoperative evaluation is necessary, focusing on symptom clarification, careful examination, and repeat radiographic examinations and MRI with contrast.

Interestingly, a 2006 large multicenter trial found that surgical and nonsurgical outcomes at 2 years were similar, but that the surgical group experienced faster pain relief.5,6 The limitations of this study are outlined in a more recent editorial.7

Also, some patients who are surgically treated are more prone to further problems such as recurrent herniations, arachnoiditis, and vertebral instability.

Future and Controversies

Most areas of controversy are delineated within the above text. The major controversies are outlined in this section.

The duration of conservative management has been debated since the disease was identified. As surgical treatments become less invasive and medications change, the role and duration of conservative management will change as well.

Endoscopic operations are becoming safer and more prevalent. Although many microdiscectomies are now being performed in the outpatient setting, the impetus for even less invasive procedures continues. In fact, the endoscopic approach is even used in the traditionally more technically demanding recurrent cases.8

The role of stabilization in lumbar disc surgery is very unclear. An increasing number of patients are having extensive fusions as the first-line management of lumbar radiculopathy secondary to disc herniations. However, the indications for stabilization need to be better established.

 


More on Lumbar Disc Disease

Overview: Lumbar Disc Disease
Workup: Lumbar Disc Disease
Treatment: Lumbar Disc Disease
Follow-up: Lumbar Disc Disease
Multimedia: Lumbar Disc Disease
References
Further Reading
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References

  1. Nakagawa H, Kamimura M, Takahara K, et al. Optimal duration of conservative treatment for lumbar disc herniation depending on the type of herniation. J Clin Neurosci. Feb 2007;14(2):104-9. [Medline].

  2. Mirzai H, Tekin I, Yaman O, et al. The results of nucleoplasty in patients with lumbar herniated disc: a prospective clinical study of 52 consecutive patients. Spine J. Jan-Feb 2007;7(1):88-92; discussion 92-3. [Medline].

  3. Celik SE, Celik S, Kara A, et al. Lumbar facet joint angle and its importance on joint violation in lumbar microdiscectomy. Neurosurgery. Jan 2008;62(1):168-72; discussion 172-3. [Medline].

  4. Eugene J. Carragee, MD, Anthony O. et al. A Prospective Controlled Study of Limited VersusSubtotal Posterior Discectomy: Short-Term Outcomesin Patients With Herniated Lumbar Intervertebral Discsand Large Posterior Anular Defect. Spine. 2006;31:653-657.

  5. [Best Evidence] Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA. Nov 22 2006;296(20):2441-50. [Medline].

  6. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. Nov 22 2006;296(20):2451-9. [Medline].

  7. Mazanec D, Okereke L. Interpreting the Spine Patient Outcomes Research Trial. Medical vs surgical treatment of lumbar disk herniation: implications for future trials. Cleve Clin J Med. Aug 2007;74(8):577-83. [Medline].

  8. Hoogland T, van den Brekel-Dijkstra K, Schubert M, et al. Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine. Apr 20 2008;33(9):973-8. [Medline].

  9. Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther. Jan 2008;31(1):33-88. [Medline].

  10. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome. J Neurosurg Spine. Jun 2005;2(6):639-46. [Medline].

  11. Ehni BL, Benzel EC. Lumbar Discectomy. Spine Surgery. 1999;1:389-400.

  12. Hardy RW. Extradural Cauda Equina and Nerve Root Compression from Benign Lesions of the Lumbar Spine. Neurological Surgery. 1996;3:2357-2374.

  13. Loupasis GA, Stamos K, Katonis PG, et al. Seven- to 20-year outcome of lumbar discectomy. Spine. Nov 15 1999;24(22):2313-7. [Medline].

  14. Williams RW. Lumbar disc disease. Microdiscectomy. Neurosurg Clin N Am. Jan 1993;4(1):101-8. [Medline].

  15. Woertgen C, Rothoerl RD, Breme K, et al. Variability of outcome after lumbar disc surgery. Spine. Apr 15 1999;24(8):807-11. [Medline].

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Further Reading

Clinical guidelines

Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther 2008 Jan;31(1):33-88. 9

Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, Mummaneni P, Watters WC 3rd, Wang J, Walters BC, Hadley MN, American Association of Neurological Surgeons/Congress of Neurological Surgeons. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome. J Neurosurg Spine 2005 Jun;2(6):639-46. 10

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Keywords

lumbar disc disease, disc herniation, herniated disc, degenerative disc disease, lumbar disc, lumbar degenerative disc disease, lumbar disk disease, degenerative disc, lumbar spine disc disease

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Contributor Information and Disclosures

Author

Kamran Sahrakar, MD, FACS, Clinical Professor, Department of Neurosurgery, University of California at San Francisco
Kamran Sahrakar, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Medical Association, California Medical Association, Florida Medical Association, and Nevada State Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Martin Melicharek, MD, Assistant Clinical Professor, Department of Neurosurgery, University of California at Davis
Martin Melicharek, MD is a member of the following medical societies: American Association of Neurological Surgeons, California Medical Association, and Ohio State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry of New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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