Interference of Detection Rate of Lumbar Disc Herniation by Socioeconomic Status

STUDY DESIGN: Retrospective study. PURPOSE: The objective of the study is to evaluate the relationship between the detection rate of lumbar disc herniation and socioeconomic status. OVERVIEW OF LITERATURE: Income is one important determinant of public health. Yet, there are no reports about the relationship between socioeconomic status and the detective rate of disc herniation. METHODS: In this study, 443 cases were checked for lumbar computed tomography for lumbar disc herniation, and they reviewed questionnaires about their socioeconomic status, the presence of back pain or radiating pain and the presence of a medical certificate (to check the medical or surgical treatment for the pain) during the Korean conscription. RESULTS: Without the consideration for the presence of a medical certificate, there was no difference in spinal physical grade according to socioeconomic status (p=0.290). But, with the consideration of the presence of a medical certificate, the significant statistical differences were observed according to socioeconomic status in 249 cases in the presence of a medical certificate (p=0.028). There was a lower detection rate in low economic status individuals than those in the high economic class. The common reason for not submitting a medical certificate is that it is neither necessary for the people of lower socioeconomic status nor is it financially affordable. CONCLUSIONS: The prevalence of lumbar disc herniation is not different according to socioeconomic status, but the detective rate was affected by socioeconomic status. Socioeconomic status is an important factor for detecting lumbar disc herniation.

Adjacent Segment Instability after Posterior Lumbar Fusion: Comparison Between Subtotal Laminectomy and Total Laminectomy

OBJECTIVE: Whereas fusion with pedicle screw fixation has shown satisfactory clinical results, solid fusion has been reported to accelerate degenerative changes in adjacent unfused levels. The purpose of this study was to evaluate the effect of bone/ligament/bone integrity after subtotal or total laminectomies on the development of adjacent segment instability (ASI). The hypothesis that total laminectomy would increase ASI more than would subtotal laminectomy was analyzed. Material and METHODS: This is a retrospective study of 316 patients who were treated with posterior fusion and pedicle screw fixation between 1996 and 2001. After attempts to review all 316 patients and radiologic files, 36 patients who were diagnosed with ASI were carefully reviewed, including follow-up periods of 2-8 years. The medical records were carefully reviewed for recurrence of low back pain or neurologic symptoms after a period of postoperative relief, and the radiologic files were evaluated to determine instability. All patients had undergone single-level or multilevel instrumented posterior lumbar interbody fusion for intractable pain related to degenerative conditions of the spine. RESULTS: Patients over the age of 60 were at a higher risk of developing clinical ASI however,fusion length, level and gender were not associated with ASI. The ASI was noted to occur most commonly in the cranial segment prior to fusion. CONCLUSIONS: This study revealed more frequent ASI after total laminectomy than after subtotal laminectomy, especially in elderly patients. The ideal procedure will be one combining maximal canal and foraminal decompressions with minimal resection of bony structures and supporting ligaments.