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Lumbar disc herniation treated by microendoscopic discectomy

Prognostic predictors of long-term postoperative outcome

Behandlung eines Bandscheibenvorfalls der Lendenwirbelsäule mittels endoskopischer Mikrodiskektomie

Prognostische Prädiktoren für das postoperative Langzeitergebnis

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Abstract

Purpose

Microendoscopic discectomy (MED) is becoming an established and effective minimally invasive surgical method for the treatment of lumbar disc herniation (LDH); however, the absence of prognostic factors for long-term outcomes after MED results in a lack of specific criteria for appropriate patient selection. Therefore, we evaluated the long-term outcomes and associated predictors in patients who underwent MED for LDH.

Material and methods

Baseline and follow-up data for 664 LDH patients who suffered from sciatica and underwent primary MED were reviewed retrospectively. Variables at baseline that were analyzed as potential prognostic factors included sociodemographic characteristics, clinical findings, and imaging features. Follow-up data including improvements in the Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI), postoperative low back pain (LBP), reoperation, and excellent/good results according to the modified MacNab criteria were set as outcome variables for univariate and further multivariate logistic regression analyses.

Results

The mean follow-up period was 63.8 ± 20.0 months (range 24–96 months). On average, sufficient improvements in both the VAS score (72.8%) and ODI (63.4%) were observed. In addition, a low postoperative LBP rate (23.9%), low reoperation rate (7.1%), and high rate of excellent/good clinical outcomes (89.9%) were achieved. A multivariate analysis indicated that older age, shorter disease duration, higher preoperative VAS score, lower preoperative ODI, shorter surgical time, lower severity of disc and adjacent disc degeneration, and lower severity of lumbar multifidus atrophy contributed to superior clinical outcomes.

Conclusion

Excellent long-term outcomes after primary MED were achieved and specific sociodemographic, clinical, and imaging variables were identified as prognostic factors that can be used to guide patient selection and clinical decision making.

Zusammenfassung

Zweck

Die endoskopische Mikrodiskektomie (MED) entwickelt sich zu einer etablierten minimalinvasiven Operationsmethode zur Behandlung eines Bandscheibenvorfalls der Lendenwirbelsäule (LDH). Die Abwesenheit prognostischer Faktoren für Langzeitergebnisse nach MED resultiert jedoch in einem Mangel an spezifischen Kriterien für eine entsprechende Patientenselektion. Daher evaluierten wir die Langzeitergebnisse und die damit assoziierten Prädiktoren bei Patienten, die sich aufgrund eines LDH einer MED unterzogen.

Material und Methoden

Baseline- und Follow-up-Daten für 664 LDH-Patienten, die an Ischialgie litten und sich einer primären MED unterzogen, wurden retrospektiv beurteilt. Die Baseline-Variablen, die als potenzielle prognostische Faktoren analysiert wurden, umfassten soziodemographische Charakteristika, klinische Befunde sowie Bildgebungsmerkmale. Die Follow-up-Daten, einschließlich Verbesserung des Scores der visuellen Analogskala (VAS) und Oswestry-Disability-Index (ODI), postoperative untere Rückenschmerzen (LBP), Reoperation und exzellente/gute Ergebnisse nach den modifizierten MacNab-Kriterien, wurden als Outcome-Variablen für die univariaten und multivariaten logistische Regressionsanalysen festgelegt.

Ergebnisse

Der mittlere Follow-up-Zeitraum betrug 63,8 ± 20,0 Monate (Range: 24–96 Monate). Im Durchschnitt wurden ausreichende Verbesserungen sowohl bei den VAS-Scores (72,8 %) als auch den ODI-Werten (63,4 %) beobachtet. Zudem wurden eine niedrige postoperative LBP-Rate (23,9 %), eine niedrige Reoperationsrate (7,1 %) sowie eine hohe Rate an exzellenten/guten klinischen Ergebnissen (89,9 %) erreicht. Eine multivariate Analyse zeigte, dass ein fortgeschrittenes Alter, eine kurze Krankheitsdauer, höhere präoperative VAS-Scores, geringere präoperative ODI-Werte, eine kürzere Operationszeit, ein geringerer Degenerationsgrad der Bandscheibe und benachbarten Bandscheiben sowie eine geringere Schwere einer Musculi-multifidi-Atrophie der Lendenwirbelsäule zu den überragenden klinischen Ergebnissen beitrugen.

Schlussfolgerung

Exzellente Langzeitergebnisse nach primärer MED wurden erreicht. Spezifische soziodemographische klinische und Bildgebungsvariablen wurden als prognostische Faktoren identifiziert, welche für die Patientenselektion und die klinische Entscheidungsfindung verwendet werden können.

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Abbreviations

CI:

Confidence interval

IMMPACT:

Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials

LBP:

Low back pain

LDH:

Lumbar disc herniation

LM:

Lumbar multifidus

MRI:

Magnetic resonance imaging

MED:

Microendoscopic discectomy

ODI:

Oswestry disability index

OR:

Odds ratio

VAS:

Visual analog scale

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Acknowledgements

This work was supported by grants from the National Natural Science Foundation of China (Grant No. 81702201, 81272035, 81071493, 31070876, 81572190 and 81572170) and the Natural Science Foundation of Jiangsu Province (CN): Grant No. BK20170701.

Funding

Natural Science Foundation of Jiangsu, Province (CN), (BK20170701) and National Natural Science Foundation of China (CN), (81702201) Dr. Rui Shi; National Natural Science Foundation of China (CN), (81272035) and National Natural Science Foundation of China (CN), (81071493), Dr Xiao-Tao Wu; National Natural Science Foundation of China (CN), (31070876), Dr. Yun-Tao Wang; National Natural Science Foundation of China (CN), (81572190), Dr. Xin Hong; National Natural Science Foundation of China (CN), (81572170), Dr. Xiao-Tao Wu; Research Funds of Jiangsu Provincial Commission of Health and Family Planning (H201533), Dr. Xin Hong

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Authors and Affiliations

  1. Spine Surgery Center, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao, 210009, Nanjing, Jiangsu, China

    Xin Hong,  Rui Shi,  Yun-Tao Wang,  Lei Liu,  Jun-Ping Bao &  Xiao-Tao Wu

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  1. Xin Hong
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  2. Rui Shi
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  3. Yun-Tao Wang
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Correspondence to Xiao-Tao Wu.

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Conflict of interest

X. Hong, R. Shi, Y.-T. Wang, L. Liu, J.-P. Bao and X.-T. Wu declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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X. Hong and R. Shi contributed equally to this article.

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Hong, X., Shi, R., Wang, YT. et al. Lumbar disc herniation treated by microendoscopic discectomy. Orthopäde 47, 993–1002 (2018). https://doi.org/10.1007/s00132-018-3624-6

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