Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg-Saar, Germany.
Spine (Phila Pa 1976). 2019 Oct 15;44(20):1426-1434. doi: 10.1097/BRS.0000000000003113.
Level 3, cohort study.
The aim of this study was to assess long-term clinical outcome, and rate of reoperation following microsurgical subtotal discectomy (MSD).
Lumbar disc herniation (LDH) is a common cause of discomfort. Studies with >25 years of follow-up are rare and the reported rate of clinical success and reoperation are not well understood.
Retrospectively, files with complete documentation of preoperative and postoperative neurological status, process during hospitalization, detailed report of MSD, outpatient visit notes, and full contact information of patients who underwent MSD for the treatment of LDH with a minimum follow-up of 25 years were reviewed. Patients were contacted for personal follow-up assessment which included Oswestry Disability Index (ODI), EQ-5D, and MacNab criteria, usage of pain medication for leg and back pain, limitations in daily life, and repeated procedures at the lumbar spine.
A total of 355 patients were randomly selected and contacted for final follow-up and 158 patients with a mean follow-up 32 years participated in the study. Clinical success rate was 86.0%, mean ODI was 9% (0-58%), 69.6% of the patients were pain free, 13.9% of patients reported the daily intake of pain medication for back and leg pain. Reoperations were performed in 47 of the patients (29.7%), whereas the rate for recurrent disc herniation at the same level was 8.2%. Reoperation within the first 2 years after initial MSD had negative influence on clinical success. The preoperative physical working status and sex and working status had no influence on the clinical success.
The MSD is an effective technique to achieve a high rate of patient satisfaction, and high rate of functional recovery. The overall reoperation rate is 30% within 30 years but only 8.2% of the patients underwent reoperation because of recurrent disc herniation at the same level.
3 级，队列研究。
本研究旨在评估微创手术治疗腰椎间盘突出症（MSD）后的长期临床结果和再手术率。
腰椎间盘突出症（LDH）是一种常见的不适原因。随访时间超过 25 年的研究很少，报告的临床成功率和再手术率也不明确。
回顾性地，对完整记录术前和术后神经状态、住院期间过程、MSD 详细报告、门诊就诊记录以及接受 MSD 治疗 LDH 且随访时间至少 25 年的患者的全部联系方式的档案进行了审查。联系患者进行个人随访评估，包括 Oswestry 残疾指数（ODI）、EQ-5D 和 MacNab 标准、腿部和背部疼痛的止痛药使用、日常生活受限以及腰椎再次手术。
共随机选择 355 名患者进行最终随访，158 名平均随访 32 年的患者参与了研究。临床成功率为 86.0%，平均 ODI 为 9%（0-58%），69.6%的患者无疼痛，13.9%的患者报告背部和腿部疼痛每日服用止痛药。47 名患者（29.7%）接受了再次手术，而同一水平复发椎间盘突出症的发生率为 8.2%。初始 MSD 后 2 年内的再次手术对临床成功有负面影响。术前的体力工作状态和性别以及工作状态对临床成功没有影响。
MSD 是一种有效技术，可实现高患者满意度和高功能恢复率。30 年内总体再手术率为 30%，但仅 8.2%的患者因同一水平的复发性椎间盘突出症而再次手术。
3 级。
