A long-term follow-up study of the remote result of lumbar discectomy versus conservative treatment for single-level lumbar disc herniation / 解放军医学杂志

ABSTRACT

Objective To analyze and compare the long-term therapeutic effect and image changes of conservative therapy versus lumbar discectomy for lumbar disc herniation to provide valid reference for its clinical treatment. Methods The clinical data from 182 patients with single-level lumbar disc herniation, who were treated from January 1983 to June 2008 and followed-up for more than 10 years, were analyzed retrospectively. These patients were divided into conservative treatment (CT) group (n=73) with a mean follow-up time of 17.61±3.87 years, and surgery group (n=109) with a mean follow up time of 17.17±3.47 years. In the CT group, 49 patients were male, 24 female; there were 44 patients with L4-L5 disc herniation, and 29 L5-S1 disc herniation. In 109 patients in the surgery group, 71 were male, 38 female; 68 had L4-L5 disc herniation, 41 had L5-S1 disc herniation, and all of them received lumbar discectomy. The long-term therapeutic effects were reviewed and compared retrospectively in the two groups, including clinical manifestations, image changes, neurofunctional evaluation, height of morbid intervertebral space, adjacent segment intervertebral space and the incidence of cephalad adjacent segment degeneration. Results Eight of 73 patients received lumbar spinal canal decompression because of intermittent claudication in the CT group, and 13 in surgery group underwent resurgery for recurrent lumbar disc herniation. At final follow up, the height of morbid intervertebral space (0.62±0.15cm)in surgery group was significantly lower than that in CT group (0.69±0.13cm, P<0.05), the Oswestry score (23.9%±6.3% in surgery group, 23.3%±6.5% in CT group) and height of adjacent segment intervertebral space (0.83±0.11cm in surgery group, and 0.82±0.11cm in CT group) were statistically compared, and no significant difference was found between the two groups. Five patients in CT group and 9 in surgery group were found to have degenerative instability by imaging, however, none of them presented obvious clinical symptoms. According to UCLA criteria, cephalad adjacent segment degeneration occurred in 8 patients (12%) of CT group, and in 23 (22%) of surgery group, and the incidence of cephalad adjacent segment degeneration was significantly higher in surgery group than in CT group (P<0.05). Conclusions The height of morbid intervertebral space is remarkably lower, and less of them trigger clinical symptom from adjacent segment degeneration in patients treated with lumbar discectomy. Both conservative therapy and lumbar discectomy can obtain better long-term results for lumbar disc herniation.