Chemonucleolysis revisited: a prospective outcome study in symptomatic lumbar disc prolapse

OBJECTIVE: This prospective study was carried out to assess the functional outcome in patients with symptomatic lumbar disc prolapse treated by chemonucleolysis (CNL). METHODS: The Oswestry Low Back Pain Disability Index (ODI) was used to assess the pre- and postprocedure functional status of 112 patients with magnetic resonance (MR) scan-proven lumbar disc prolapse treated by CNL. Follow-up was for at least 5 years. RESULTS: Ninety-three of 112 patients (83%) had excellent/good results, whereas 11 of 112 (10%) were unchanged and 8 of 112 (7%) were worse after the CNL. The younger patients with single-level discs at L5-S1 had the most successful outcome. Seventy percent of our patients (25-45 years of age) were gainfully employed with a mean return to work at 12 weeks. CONCLUSIONS: CNL is a good procedure to bridge the gap between conservative treatment and surgery for lumbar disc prolapse. CNL is beneficial in 80% of patients with significant leg symptoms. After careful selection of candidates using MR scans, it is an effective procedure that does not compromise future open surgery, should it be necessary.     

Comparison of chemonucleolysis and microsurgical discectomy for the treatment of herniated lumbar disc

A series of 126 patients with symptomatic herniated lumbar disc who were treated by either chemonucleolysis (CN) or microsurgical lumbar discectomy (MLD) was reviewed retrospectively. Of the 45 patients who chose chemonucleolysis, 27 (60%) reported a good outcome. The minor morbidity in this group was 52% and the major morbidity (infection) was 2.2%. Of the 81 patients who selected microsurgical discectomy, 72 (89%) reported a good result. The minor morbidity was 5%, and the major morbidity (infection) was 1.2%. The lower incidence of treatment success and higher percentage of patients suffering morbidity in the chemonucleolysis group make this procedure less desirable in the treatment of patients with herniated lumbar disc.     

A prospective randomized trial of chemonucleolysis and conventional disc surgery in single level lumbar disc herniation.

The role of chemonucleolysis as an alternative to disc surgery is still disputed. The authors conducted a prospective randomized controlled trial of chemonucleolysis and conventional disc surgery involving 92 patients with L4-5 or L5-S1 disc herniation who failed to respond to conservative treatment. There were 46 patients in each group, matched for demographic, clinical characteristics, and co-interventions. Independent examiners assessed patients before treatment, at 6 weeks after, 3 months after, and 1 year after treatment. A comprehensive method of outcome assessment involving physiological outcome, functional outcome, cost outcome, and psychological outcome was employed. Nine chemonucleolysis patients and one disc surgery patient required additional surgery for failure of initial treatment (P less than 0.02). The outcomes at 6 weeks and at 3 months were better in the surgical group, but at 1 year the differences were not significant. The authors conclude that chemonucleolysis as a minimally invasive technique produces inferior short-term results and offers no advantage over conventional discectomy.     

Chemonucleolysis versus surgery in lumbar disc herniations: correlation of the results to preoperative clinical pattern and size of the herniation

A prospective study was carried out on the results of chemonucleolysis or surgery in 156 patients who had lumbar disc herniations. All patients were considered as potentially good candidates for chemonucleolysis. Seventy-two received a chymopapain injection and 84 underwent surgery. Based on computerized tomography (CT) scan and/or myelography the herniations were distinguished as small, medium, and large. Also distinguished were three types of preoperative clinical patterns, Type A, Type B and Type C, corresponding to slight, moderate, and severe nerve root compression, respectively. Follow-up evaluations were made 1 month, 3 months, and an average of 2.8 years after treatment. The patients with a small disc herniation, who underwent chemonucleolysis, did slightly better as a group than those treated surgically. At 1 month, the proportions of satisfactory results were 75% in the chemonucleolysis group and 62% in the surgery series. At final follow-up, the proportions were 84% and 82%, respectively, but the ratio of excellent-to-good results was higher in the chemonucleolysis group. In the latter, most patients with satisfactory outcomes had a Type A or Type B clinical pattern. In medium-size herniations the results of surgery were slightly better than those of chemonucleolysis. At 1 month, 55% of patients in the chemonucleolysis group had satisfactory results compared with 74% of those in the surgery series; at final follow-up the proportions were, respectively, 76% and 86%. In the chemonucleolysis group most satisfactory outcomes were found in patients with a Type A or Type B clinical pattern. The results of chemonucleolysis in patients who had large herniations were significantly inferior to those of surgery: at final follow-up the results were satisfactory in 50% of patients in the chemonucleolysis group and 89% of those in the surgery series. Chemonucleolysis appears to be the treatment of choice in most patients with small disc herniations and an effective alternative to surgery in most patients with medium-size herniations when the preoperative clinical pattern indicates a slight or moderate nerve root compression. In all large herniations and in small- or medium-size herniations causing a severe nerve root impingement, surgery should be preferred to chemonucleolysis.     

Long-Term Outcome of Patients who Underwent Percutaneous Nucleotomy for Lumbar Disc Herniation: Results after a Mean Follow-up of 5 Years

Summary A total of 41 patients who had undergone percutaneous nucleotomy for a single level lumbar disc herniation were clinically examined after a mean postoperative follow-up of 5 years (range 4 to 7 years). There were 14 (34%) male and 27 (66%) female patients with a mean age of 49 years. By intra-operative discography, the herniation had been graded as a protrusion in 21 (51%) patients and as a prolapse in 20 (49%) patients. At the time of the investigation, sciatica had completely recovered or markedly diminished in 32 (78%) patients, and 29 (71%) patients had returned to work. Evaluated by a 100 mm visual analog pain scale (VAS), the postoperative pain relief was statistically significant (p<0.0001). Clinical signs and symptoms of segmental instability of the lumbar spine were detected in 10 (24%) patients. Instability was significantly associated with an unsatisfactory long-term outcome in the patients with the occurrence of sciatica (p=0.003) and low back pain (p=0.001) as well as the VAS score (p=0.005) and Oswestry index (p<0.0001). Clinical investigation revealed sensory deficits in the leg in 12 (29%) patients, weakness of the extensor hallucis longus muscle in 5 (12%) patients and a total peroneal paresis in one (2%). The patellar and achilles tendon reflexes were depressed in 2 (5%) and 5 (12%) patients, respectively. During the follow-up period, recurrent disc herniation was detected in 3 (7%) patients who were all re-operated on. In addition, 3 (7%) patients were re-operated on for other back problems. Corroborating earlier findings, the results of this study indicate that percutaneous nucleotomy is an effective and safe alternative to open surgery in the treatment of patients with a small prolapse or a protrusion.     

A critical appraisal of an article comparing the effectiveness of osteopathic manipulation and chemonucleolysis in the management of symptomatic lumbar disc herniation

This single-blind randomised clinical trial compared osteopathic manipulative treatment with chemonucleolysis (used as a control of known efficacy) for symptomatic lumbar disc herniation. Forty patients with sciatica due to this diagnosis (confirmed by imaging) were treated either by chemonucleolysis or manipulation. Outcomes (leg pain, back pain and self-reported disability) were measured at 2 weeks, 6 weeks and 12 months. The mean values for all outcomes improved in both groups. By 12 months, there was no statistically significant difference in outcome between the treatmentments, but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks.A similar number from both groups required additional orthopaedic intervention; there were no serious complications. Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation is warranted.     

Lumbar disc herniations: the predictive value of the Health Attribution Test (HAT) and the Minnesota Multiphasic Personality Inventory (MMPI)

Ninety-one patients who were treated for lumbar disc herniation with chymopapain chemonucleolysis were evaluated preoperatively by means of the Health Attribution Test (HAT) and the Minnesota Multiphasic Personality Inventory (MMPI). There were 54 good, 10 fair, and 27 poor results after chemo-nucleolysis. Nineteen patients subsequently underwent lumbar laminectomy and discectomy and the ultimate outcome for the entire series including these laminectomy patients was 66 good, 10 fair, and 15 poor results. The fair/poor chemonucleolysis outcome patients scored significantly lower than did the good outcome patients on the HAT Powerful Others and significantly higher on the Chance scale. Patients with fair or poor outcomes after chemonucleolysis only scored significantly higher on the Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, and Hypomania scales in preoperative MMPI testing. Good versus fair/poor ultimate outcome patients differed significantly on preoperative MMPI Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia, Hypomania, and Social Introversion scales. These groups also differed significantly on preoperative HAT Internal and Chance scales. Further analyses found the MMPI to be a slightly better predictor of chemonucleolysis outcome and much better predictor of ultimate outcome than the HAT.     

Percutaneous nucleotomy in the treatment of lumbar disc herniation results after a mean follow-up of 2 years

Summary We have evaluated the clinical outcome of 45 consecutive patients who underwent percutaneous nucleotomy for a single-level disc herniation. Included were 28 (62%) woman and 17 (38%) men, with a mean age of 46 years. The mean postoperative follow-up time was 2 years. Intra-operatively, disc herniation was graded as a protrusion in 23 (51%) patients and as a prolapse in 22 (49%) patients. During the follow-up, sciatic pain completely recovered or markedly diminished in 38 (84%) patients and 35 (78%) patients returned to work. The occupational outcome of the patients operated on for a protrusion was inferior to that of the patients operated on for a prolapse: only 22% of the patients who underwent surgery for a protrusion reported to manage their work well, while as many as 41% of those with a prolapse managed well (p=0.04).Pre-operatively, clinical examination revealed segmental instability of the lumbar spine in 11 (24%) patients. There was a significant association between instability and unsatisfactory long-term outcome: of the patients with pre-operative instability, 45% were post-operatively retired or on sick leave because of the back, as compared to 15% of the 34 patients without instability (p=0.03). Furthermore, patients with instability suffered from sciatica and low back pain significantly (p=0.02) more often than those without instability.Surgical complications were infrequent. There were no nerve root lesions and no vascular injuries. Postoperative discitis developed in 2 (4%) patients. Of all patients, only 1 (2%) has been re-operated on for a recurrent disc.     

Does the MMPI predict chemonucleolysis outcome?

Ninety-one patients with lumbar disc herniation were treated by chemonucleolysis with intradiscal chymopapain injection and evaluated at least 1 year after surgery (average, 18 months). There were 54 good, 10 fair, and 27 poor results after chemonucleolysis. Good versus fair/poor outcome groups differed preoperatively on the Minnesota Multiphasic Personality Inventory (MMPI) Hypochondriasis (Hs), Hysteria (Hy), Psychopathic Deviate (Pd), Paranoia (Pa), Hypomania (Ma), and Social Introversion (Si) scales. Presence of compensation issues at the time of surgery was significantly related to outcome, and the MMPI scales provided additional predictive power. Nineteen patients who did not show improvement with chemonucleolysis subsequently underwent lumbar laminectomy and discectomy, and the ultimate outcome for the entire series including these laminectomy patients was 66 good, 10 fair, and 15 poor results. Good versus fair/poor ultimate outcome patients differed significantly on preoperative MMPI Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia, Hypomania, and Social Introversion scales. After controlling for the effects of compensation issues, MMPI scales added significantly to the ability to predict ultimate surgical outcome. However, the MMPI could not be used with confidence to predict the outcome for a given patient and should serve only to alert the surgeon to the presence of psychological risk factors and the possible need for referral for psychological evaluation and treatment.     

Cost effectiveness of chemonucleolysis versus laminectomy in the treatment of herniated nucleus pulposus

The hospital and professional charges for 40 consecutive patients who underwent chymopapain chemonucleolysis in 1982-83 at the University of Wisconsin for single-level lumbar disc disease were compared with the charges incurred by 40 consecutive patients who underwent lumbar laminectomy for single-level disc disease during the same period. The average cost per patient was $4,163 for chemonucleolysis and $6,124 for laminectomy. Three chemonucleolysis patients reported poor results, and all subsequently underwent reoperation by laminectomy. Four laminectomy patients reported poor results, and two of these subsequently underwent reoperation. The costs of chemonucleolysis and lumbar laminectomy were calculated to reflect reoperation costs, and we found that the average cost per patient was $1,808 less for chemonucleolysis. The implications of this saving for national cost containment of lumbar disc surgery are discussed.     

Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation

This single-blind randomised clinical trial compared osteopathic manipulative treatment with chemonucleolysis (used as a control of known efficacy) for symptomatic lumbar disc herniation. Forty patients with sciatica due to this diagnosis (confirmed by imaging) were treated either by chemonucleolysis or manipulation. Outcomes (leg pain, back pain and self-reported disability) were measured at 2 weeks, 6 weeks and 12 months. The mean values for all outcomes improved in both groups. By 12 months, there was no statistically significant difference in outcome between the treatments, but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks. A similar number from both groups required additional orthopaedic intervention; there were no serious complications. Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation at a more acute stage is warranted. Received: 10 June 1999 Revised: 24 November 1999 Accepted: 24 November 1999     

Magnetic resonance imaging before chemonucleolysis for lumbar disc prolapse

Summary Chemonucleolysis is an established non-operative treatment of a prolapsed symptomatic lumbar disc. It was introduced as a form of treatment in the early 1960s by Smith [18]. One of the main causes of failure is the difficulty in pre-operative assessment of a contained disc prolapse. Reducing failure rates is very important for the morale of surgeon and patient alike. We investigated 58 patients with magnetic resonance imaging (MRI) to select those with a contained protrusion prior to chemonucleolysis. Per-operative discography confirmed contained protrusion in 96.5% (56/58) of cases, increasing the specificity of selection. At 6 months post chemonucleolysis 86% of our patients were asymptomatic. We would commend MRI as the investigation method of choice prior to chemonucleolysis for a prolapsed symptomatic lumbar disc, thus avoiding separate diagnostic discography, thereby reducing inconvenience to the patient and wastage of prepared chymopapain.     

Adolescent disc protrusions

Summary The management of adolescent disc protrusions by chemonucleolysis has received little attention in the literature, and reports of the long-term outcome are lacking. Between May 1978 and July 1986 42 patients between the ages of 13 and 19 years with radiologically proven lumbar disc protrusions were treated at this institution with chymopapain. They were followed prospectively for 1 year, and the procedure was successful in 27 patients (64%). Of the 15 patients in whom the treatment failed, 11 underwent subsequent surgical discectomy, successful in 10, giving an overall treatment success rate of 37/42 (88%) at 1 year. The patients were contacted by telephone and questionnaire at a minimum of 5 years after treatment (mean 8.5 years), and full replies were obtained from 39/42 (93%). The long-term outcome was good or excellent in 82%. A history of injury, and the demonstration by MRI or discography of disc degeneration at more than one level was associated with a reduced success rate both at 1 year and in the long term. We conclude that there are no long-term ill effects of chemonucleolysis with chymopapain on the adolescent disc. It is a useful procedure that is well tolerated and we have no reservations about its use.     

Comparison of intervertebral disc disease treatment by chymopapain injection and open surgery.

Chymopapain chemonucleolysis was performed on 100 patients with primary lumbar intervertebral disc disease. The results were compared with those of 174 patients who underwent laminotomy, foraminotomy, and discectomy. Primary lumbar intervertebral disc disease was arbitrarily divided into degenerative, complex, previous surgical, and simple disc syndromes. No difference was seen between chemonucleolysis and surgery in the first three divisions; between 55 percent and 60 per cent of patients responded successfully to treatment. In the simple disc division 89 per cent of the surgical and 60 per cent of the chemonucleolysis patients had successful results.     

Inadequacies and hazards of chymopapain injections as treatment for intervertebral disc disease.

Chymopapain chemonucleolysis was performed on 100 patients with primary lumbar intervertebral disc disease. The results were compared with those of 174 patients who underwent laminotomy, foraminotomy, and discectomy. Primary lumbar intervertebral disc disease was arbitrarily divided into degenerative, complex, previous surgical, and simple disc syndromes. No difference was seen between chemonucleolysis and surgery in the first three divisions; between 55 percent and 60 per cent of patients responded successfully to treatment. In the simple disc division 89 per cent of the surgical and 60 per cent of the chemonucleolysis patients had successful results.     

The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis.

STUDY DESIGN: A Cochrane review of randomized controlled trials. OBJECTIVES: To collate the scientific evidence on surgical management for lumbar-disc prolapse and degenerative lumbar spondylosis. SUMMARY OF BACKGROUND DATA: Surgical investigations and interventions account for as much as one third of the health care costs for spinal disorders, but the scientific evidence for most procedures still is unclear. METHODS: A highly sensitive search strategy identified all published randomized controlled trials. Cochrane methodology was used for meta-analysis of the results. RESULTS: Twenty-six randomized controlled trials of surgery for lumbar disc prolapse and 14 trials of surgery for degenerative lumbar spondylosis were identified. Methodologic weaknesses were found in many of the trials. Only one trial directly compared discectomy and conservative management. Meta-analyses showed that surgical discectomy produces better clinical outcomes than chemonucleolysis, which is better than placebo. Three trials showed no difference in clinical outcomes between microdiscectomy and standard discectomy, but in three other studies, both produced better results than percutaneous discectomy. Three trials showed that inserting an interposition membrane after discectomy does not significantly reduce scar formation or alter clinical outcomes. Five heterogeneous trials on spinal stenosis and degenerative spondylolisthesis permit very limited conclusions. There were nine trials of instrumented versus noninstrumented fusion: Meta-analysis showed that instrumentation may facilitate fusion but does not improve clinical outcomes. CONCLUSIONS: There is now strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is considerable evidence on the clinical effectiveness of discectomy for carefully selected patients with sciatica caused by lumbar disc prolapse that fails to resolve with conservative management. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative management. The Cochrane reviews will be updated continuously as other trials become available.     

Caudal epidural injection for L4-5 versus L5-S1 disc prolapse: is there any difference in the outcome?

One hundred seventy-seven patients with radicular pain due to disc prolapse treated with caudal epidural injection were included in our study. All the injections were carried out between January 2000 and December 2004. Inclusion criteria include symptomatic disc prolapse diagnosed with magnetic resonance imaging scan, disc prolapse of 1 level only either L4-5 or L5-S1, leg pain for more than 4 wk and age more than 18. Exclusion criteria include multiple disc levels, spondylolithesis, spinal stenosis, cauda equina, and progressive neurologic deficits. Outcome Measures include Oswestry score and patient satisfaction and final outcome patient satisfaction either excellent (complete pain relief), good (minimal symptoms), moderate (some symptoms), no relief (symptoms unchanged), and worse (symptoms deteriorated). The final outcome is excellent (more than 6 mo pain relief), very good (3 to 6 mo pain relief), good (6 wk to 3 mo pain relief), fair (4 to 6 wk pain relief), brief (less than 4 wk pain relief), and no relief postal questionnaire sent and telephone interview done with the nonresponders. Ninety-six answered the postal questionnaire and this number increased to 136 after telephone interview. Forty-nine percent females and 51% males. Eighty-nine with L5-S1 disc prolapse and 47 with L4-5 disc prolapse. Caudal epidural not only relieve leg pain but also relieve back pain. There is no significant difference in the Oswestry disability index nor in the patient satisfaction nor the final outcome after caudal epidural injections for patients with disc prolapse L5-S1 and L4-5 ones. The number of patients who required surgery were much less than the literature figures 3.05%. There is no significant difference in the response after caudal epidural injection considering the sex only. The longest the back pain before injection is associated with the worst Oswestry disability index.     

Assessing outcome in lumbar disc surgery using patient completed measures

Measuring outcome after spinal surgery is difficult. The objective of this study was to assess the use of four measures in establishing outcome in patients undergoing lumbar discectomy. Forty-six consecutive patients who had undergone two operations for lumbar disc prolapse and 54 patients who had undergone one operation for the same condition over the same period were identified. The SF-36 questionnaire was used to assess general health. The Roland-Morris questionnaire and a simple modification of the Roland-Morris questionnaire were used to assess back and leg related disability, respectively. Analogue pain scales were used to measure back pain and sciatica. The SF-36 scores revealed significantly worse health status in the two operation compared with the one operation patients and in all patients compared with the normal population. Using the Roland-Morris and the leg disability questionnaires, patients who had undergone two operations reported significantly worse disability (Roland-Morris, 53%, poor outcome) than those who had undergone one operation (Roland-Morris, 19%, poor outcome). There was significantly greater back disability than leg disability in both groups of patients and this was confirmed by the analogue pain scales. In patients who had undergone two operations, 25% classified their back pain as very bad or unbearable, and 22.5% described very bad or unbearable leg pain. For the one operation patients these figures were 9.5 and 2.4%, respectively. The results demonstrate that both generic and condition specific patient completed measures have the potential to detect differences in outcome between patients who have undergone either one or two lumbar disc operations. The study provides support for the use of these patient completed measures in assessing outcome in lumbar disc surgery.     

The long-term results of chymopapain. Ten-year follow-up of 268 patients after chemonucleolysis

The effect of chymopapain injection was investigated in myelographically confirmed intervertebral disc herniation in 268 patients after ten years. Mean age is 39.4 years, 178 males and 90 females. Sixty-two patients had compensation or litigation and 12 had prior lumbar spine surgery. Discography was performed in 223 patients, resulting in 134 one-level injections, 124 two-level injections, and ten three-level injections. Forty percent of the patients experienced postoperative muscle spasm for several days. No complications were seen in 241 patients (92%) who were available for follow-up examination at ten years; 86% had less leg pain, 82% were employed at a capacity equal to or greater than before injection, 9% were at a less strenuous job, 1% were disabled, and 8% had retired. In 22 patients treated surgically within one year of chemonucleolysis, disc-related pathology was present in 14 cases and spondylosis or spinal stenosis was present in seven cases. One had a negative exploration and continued to be disabled. Eight patients came to surgical intervention after one year because of persisting symptoms: four patients had disc protrusion, three had laminectomy and spinal fusion, and one had a decompressive laminectomy secondary to spondylotic change. Chemonucleolysis did not prejudice the outcome of subsequent surgical treatment with good results following this intervention. One tumor, a neurofibroma, was found in this study. Chemonucleolysis with chymopapain was a safe and effective treatment of radicular complaints caused by well-documented intervertebral disc herniation.     

Mid- to long-term outcome of disc excision in adolescent disc herniation.

BACKGROUND CONTEXT: Adolescent disc herniation and its surgical treatment have been the subjects of many published clinical series. The majority of these series were heterogeneous; the number of adolescent patients (12-17 years) as opposed to young adults (18-20 years) was generally small and the length of follow-up varied greatly. Although the short-term outcome of disc excision in adolescents was mostly favorable, their long-term outcome is unknown. OBJECTIVES: To evaluate the mid- and long-term results of discectomy in patients younger than 17 years of age. STUDY DESIGN: Retrospective examination of a series of adolescent patients under the age of 17 years who underwent surgery for lumbar intervertebral disc herniation. PATIENT SAMPLE: The medical records of 26 patients (15 males, 11 females, 12-17 years old [average 14.6]) who were operated for lumbar intervertebral disc herniation in three spine centers between 1984 and 2002 were reviewed. These subjects represented the total number of patients meeting the criteria of adolescents undergoing discectomy for lumbar disc herniation in these institutions during the study period. All patients were located and contacted by an independent observer not involved in the care of these patients. Low back pain associated with leg pain was the main clinical symptom in 20 patients (77%), leg pain in 4 (15%), and back pain in 2 (8%). They all underwent posterior disc excision: 23 (88%) patients had one level discectomy, and 3 (12%) had simultaneous discectomy at two levels. The L4-L5 interspace was involved 19 times, and the L5-S1 interspace 10 times. Slipped vertebral apophysis was diagnosed in 4 patients (15%). Twelve of the 26 patients (46%) had a first-degree relative with a history of lumbar disc herniation. OUTCOME MEASURES: Telephone interviews provided follow-up data for 26 patients. Results were classified as excellent, good, moderate, or poor according to current symptom status, the need for additional surgery, the Oswestry Disability Index, and back and leg pain scores. RESULTS: The average time from surgery to follow-up was 8.9 years (range 3-21 years). At follow-up, the clinical results were excellent in 13 patients (50%), good in 4 (15%), moderate in 8 (31%), and poor in 1 (4%). Four subjects (15%) underwent a subsequent disc excision in the lumbar region, and one of them later underwent fusion. CONCLUSIONS: Discectomy provides satisfactory clinical results in young patients with disc herniation. The rate of reintervention (15%) is comparable to that in adults, indicating that discectomy for young patients should be approached similarly to that in adults.