FUSION IN DISC HERNIATION AT L4-L5 LEVEL WITH OR WITHOUT PREVIOUS SURGERY
Abstract
Background. The results of treatment in patients with transpedicular instrumented or interbody cage fusion for lumbar disc extrusions at L4-L5 level were retrospectively analyzed. The goal was to determine whether comparable clinical outcome can be achieved in cases with and without previous surgery.
Methods. Ten patients who had first symptomatic acute massive disc herniation underwent herniotomy, posterior decompression as necessary, and fusion (Group A). Nine patients with recurrent disc herniation treated 6 years (mean, range 4 months to 14 years) earlier for the same disease were reoperated and fused because of worsening of the symptoms (Group B). At final follow-up of at least 2 years the patients were asked to estimate their low back and leg pain as well as their activity level on a visual scale, and to fill-in the Oswestry questionnaire. Clinical and radiological evaluation was performed using modified scoring system of the Japanese Orthopaedic Association (JOA) and score after Tria. Overall clinical results were assessed using the modified Stauffer-Coventry’s evaluating criteria.
Results. Patients in Group A were doing better than those in Group B according to low back pain (p < 0.01), leg pain (p = 0.01), and Oswestry questionnaire (p < 0.05). However, the results were not significantly different if measured by the score of Tria, JOA and activity level (p > 0.05; two-group t-test). 8 patients of Group A and 3 patients in Group B achieved an overall satisfactory result.
Conclusions. Despite the groups were small for statistical analysis, the results of the study suggest that patients undergoing fusion for massive disc herniation at L4-L5 level may do better if being fused at the time of primary procedure.
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References
Kostuik JP, Harrington I, Aleksander D et al. Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg 1986; 68A: 386–91.
Postacchini F. Management of herniation of the lumbar disc. J Bone Joint Surg 1999; 81B: 567–76.
Hanley EN, Shapiro DE. The development of low-back pain after excision of a lumbar disc. J Bone Joint Surg 1989; 71A: 719–21.
Salenius P, Laurent LE. Results of operative treatment of lumbar disc herniation. A survey of 886 patients. Acta Orthop Scand 1977; 48: 630–4.
Loupasis GA, Konstadinos S, Katonis PG, Sapkas G, Korres DS, Hartofilakidis G. Seven- to 20-years outcome of lumbar discectomy. Spine 1999; 24: 2313–7.
Frymoyer JW, Hanley E, Howe J, Kuhlmann D, Materri R. Disc excision and spine fusion in the management of lumbar disc disease. A minimum of ten year follow-up. Spine 1978; 3: 361–5.
Vaughan PA, Malcolm BW, Maistrelli G. Results of L4-L5 disc excision alone versus disc excision and fusion. Spine 1988; 13: 690–5.
O’Sullivan MG, Connolly AE, Buckley TF. Recurrent lumbar disc protrusion. Br J Neurosurg 1990; 4: 319–25.
Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrom: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine 1996; 21: 626–23.
Fairbank JCT, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain questionnaire. Phisiotherapy 1980; 66: 271–3.
Tokuhashy Y, Satoh K, Funami S. A quantitative evaluation of sensory dysfunction in lumbosacral radiculopathy. Spine 1991; 16: 1321–8.
Tria AJ, Williams JM, Harwood D, Zawadsky JP. Laminectomy with and without spinal fusion. Clin Orthop 1987; 224: 134–7.
Stauffer RN, Coventry MB. Anterior interbody lumbar fusion: analysis of Mayo Clinic series. J Bone Joint Surg 1972; 54A: 756–68.
Morgan FP, King T. Primary instability of lumbar vertebrae as a common cause of low back pain. J Bone Joint Surg 1957; 39B: 6–8.
Frymoyer JW. The role of spine fusion. Spine 1981; 6: 289–94.
Farfan HF, Cossette JW, Robertson GH, Wells RV, Kraus H. The effects of torsion on the lumbar intervertebral joints. The role of torsion in the production of disc degeneration. J Bone Joint Surg 1970; 52A: 468–71.
Epstein JA, Epstein BS, Lavine LS, Carras R, Rosenthal AD. Degenerative lumbar spondilolysthesis with an intact neural arch (pseudospondylolysthesis). J Neurosurg 1976; 44: 139–42.
Fokter S, Vengust V. Massive disc herniation at L4-L5 level. In: 5th congress of the European Federation of National Associations of Orthopaedics and Traumatology, Rhodes, June 3–7, 2001. Abstracts of posters. Rhodes; European Federation of National Associations of Orthopaedics and Traumatology, 2001: 51–1.
Nachlas IV. End-result study of treatment of herniated nucleus pulposus by excision with fusion and without fusion. J Bone Joint Surg 1952; 34A: 981–94.
Buttermann GR, Garvey TA, Hunt AF et al. Lumbar fusion results related to diagnosis. Spine 1998; 23: 116–27.
Silvers HR, Lewis PJ, Asch HL, Clabeaux DE. Lumbar diskectomy for recurrent disk herniation. J Spinal Disord 1994; 7: 408–13.
Swank ML. Lumbar fusion is inadequate for the treatment of recurrent lumbar disc herniation: new alternatives need to be found. In: 7th international ARGOS symposium, Paris, January 30–31, 2003. Paris: Scientific book, 2003.
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