Mid- and long-term results of open discectomy: a clinical study with three to twelve years of follow-up

Abstract Long-term studies on the results of open discectomy (OD) for the treatment of lumbar disc herniation have shown a high percentage of patients complaining of low back or leg pain and obtaining a permanent disability allowance. We evaluated the clinical results of OD in a consecutive series of patients with 3–12 years of follow-up. A standard questionnaire, containing the Oswestry disability questionnaire (ODQ), was administered to 94 patients who had undergone OD at our institute between 1991 and 1999. A total of 85 patients (55.2%) gave complete information for the study; their mean follow-up was 85.9 months. Forty patients (25.9%) consented to a second clinical examination. The overall mean Oswestry disability index (ODI) was 17.43. At clinical follow-up, 29 of 40 patients (72.5%) suffered low back pain (LBP) with a mean ODI of 21.56. The presence of LBP correlated positively with a higher ODI score. Re-operation was performed in 11 of 85 patients: a 2nd OD procedure was done for recurrent disc herniation in 6 cases and posterior lumbar interbody fusion (PLIF) with posterior instrumentation was performed in 5 patients with disabling LBP. ODI scores in these two groups were respectively 37.33 and 13.2 with a significant difference. Long-term studies on OD have shown a deterioration of the clinical results with time. LBP is the complaint most responsible for a patients disability. Our study shows that at the mid- to long-term follow-up, OD still provides good clinical results, but also reveals a high percentage of LBP that is related to the onset of a symptomatic insufficiency of the operated disc. These data seem to be confirmed by the significant improvement of ODI after PLIF.