Publication: Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation
Date
2015
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Outcome of lumbar disc herniation are influenced by various clinical, socioeconomic
and psychological factors. In the absence of provision of medical insurances, worker’s
compensation and sick leave, predictors for outcome after lumbar disc herniation
surgery will be different in Nepalese population.
Objective
To evaluate different clinical variables that can affect outcome after lumbar disc
herniation surgery.
Method
Among 88 patients who underwent microdisectomy for lumbar disc herniation, 63
patients (43 male, 20 female) with follow up at least six months were retrospectively
evaluated for clinical variables which can affect Oswestry disability index (ODI) score,
its interpretation and Mcnab classification of post operative outcome.
Result
Average age of patients was 42.54±8.60 years. Mean follow up period was
34.89±23.80 months (range 6 -111 months). Thirty four patients had follow up period
> 24 months. Mean ODI score before surgery and at final follow up was 37.87±8.76
vs 7.78±7.7; (p=0.00). Success rate was 90.47% (change in ODI score at least by 10),
93.65% (ODI score interpretation <40%), and 85.71%. (Mcnab outcome excellent
and good). Significant correlation was found between age and ODI at final follow
up but not with duration of symptoms. Male, non alcoholic, low level of education,
numbness as a predominant symptom, disc at L4-L5 were significantly associated
with better ODI at final follow up. For ODI score interpretation, gender, smoking
habit, presence of leg pain as a predominant symptom were statistically significant
factors whereas smoking and drinking habit, level of education, occupation, back
pain and numbness as predominant pre-operative symptom, types of disc in MRI
were significantly related to Mcnab outcome. There was 9.5% peri- or post-operative
complications and recurrence in seven patients.
Conclusion
Age, gender, smoking and drinking habit, level of education, occupation, types of disc
in MRI are important variables for ODI score, ODI score interpretation and Mcnab
outcome.
KEY WORDS
Lumbar disc herniation, microdisectomy, oswestry disability index, sciatica
Description
Shrestha D, Shrestha R, Dhoju D, Kayastha SR, Jha SC
Department of Orthopedic and Truamatology
Dhulikhel Hospital, Kathmandu University Hospital
School of Medical Sciences
Dhulikhel, Kavre, Nepal
Keywords
Lumbar disc herniation, Microdisectomy, Oswestry disability index, Sciatica