[Results of lumbar diskectomy].

PURPOSE OF THE STUDY: We evaluated the outcomes of lumbar discectomies in relation to the presence or absence of degenerative spinal lesions and the surgical treatment used in order to determine the extent to which these factors influence the result of treatment.

MATERIAL: Patients who were treated by discectomy in the period from January 1, 1994, to July 7, 1998, were contacted. A total of 132 subjects received the Oswestry questionnaire (in two copies) in February 2002 and 100 of them, 62 men and 38 women, were included in the final evaluation. The average age of the patients at the time of surgery was 42.86 years (range, 15 to 69 years). The average follow-up period was 3.22 years. All patients underwent preoperative neurological check-up and examination by X-ray, contrast perimyelography, magnetic resonance imaging or computer tomography. The surgical procedure involved either microdiscectomy according to Caspar or conventional open discectomy.

METHODS: The patients were allocated to four groups on the basis of the presence or absence of degenerative lesions shown by pre-operative or intra-operative findings and of the surgical treatment used. Each group was evaluated individually. Group 1 comprised 15 patients without degenerative lesions and group 2 included 19 patients with degenerative lesions; both groups were treated by the Caspar method. Groups 3 and 4 were treated by open discectomy and consisted of 32 patients without and 34 patients with degenerative lesions, respectively. The patients reported their pre- and post-operative complaints retrospectively, using a separate copy of the Oswestry Low Back Pain Disability Quiestionnaire, Version 1.0, for each period.

RESULTS: In the whole sample, the average improvement estimated by the Oswestry Disability Index (ODI) was 30.32% in the year 2002, as compared with 54.15% before surgical treatment. The best outcome, improvement by 45.87%, was in group 1. Groups 2, 3 and 4 showed improvements by 31.95%, 30.35% and 22.38%, respectively.

DISCUSSION: The Oswestry questionnaire has become a widely-used instrument for evaluation of complaints in patients with spinal disorders. Its universal application enabled us to compare the results of different studies. The presence of degenerative lesions was responsible for less successful outcomes of both the Caspar microdiscectomy and open discectomy. It remains to be answered to what extent these poorer outcomes in spines with degenerative lesions are related to the instability of the segments treated. However, it is apparent that the Caspar microdiscectomy improved the patients' conditions more than open discectomy.

CONCLUSIONS: The average 30.32% decrease in ODI score from 54.15% before the surgical tree of intervertebral discs herniation, as evaluated at an average of 3.22 years after surgery, is regarded as a good outcome. The Oswestry questionnaire generally permits a reliable assessment of patient complaints. In this study, a Czech translation of Version 2.0 of this questionnaire is presented and recommended for use. The presence of serious degenerative spinal lesions makes the outcomes of discectomy less satisfactory. Prospects for the approach that combines discectomy with fusion can be assessed in patients whose indications are well defined and complaints exactly evaluated.