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European Spine Journal
Published in: European Spine Journal 4/2012

01-04-2012 | Original Article

Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series

Authors: Gerhard Marquardt, Markus Bruder, Stephanie Theuss, Matthias Setzer, Volker Seifert

Published in: European Spine Journal | Issue 4/2012

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Abstract

Purpose

Far-lateral extraforaminal lumbar disc herniation is an uncommon cause of nerve root entrapment, and studies addressing the long-term outcome of surgically treated patients are few. The purpose of this study was to analyze the ultra-long-term outcome of patients who were treated via a lateral approach.

Methods

The medical reports of 138 consecutive patients were analyzed with regard to signs and symptoms, operative findings, complications, and short-term outcome (6 weeks). To assess long-term results, standardized telephone interviews were performed using a structured questionnaire. The patients were questioned about pain using the verbal rating scale and persisting symptoms, if any. Other queries were related to the Oswestry Disability Index. Subjective satisfaction with the result of surgery was classified as excellent (no pain), good (some pain), fair (moderate pain), and poor (unchanged or worse) based on MacNab classification.

Results

At short-term follow-up, major and moderate leg pain had decreased from 99.3 to 5.1% and low back pain from 97.8 to 2.8%. Sensory and motor deficits, however, were still present in the majority of patients. A total of 87 telephone interviews were conducted, and the mean follow-up was 146 months. As many as 49 patients (56.3%) reported complete relief of symptoms, 14 patients (16.1%) had minor ailments under physical stress, and 24 patients (27.6%) had permanent residual symptoms. The most common complaint was remaining sensory disturbance. Despite residual symptoms, the vast majority of patients expressed satisfaction with the result of surgery. The outcome was subjectively rated as follows: 75.9% excellent (66 patients), 18.4% good (16 patients), 4.6% fair (4 patients), and 1.1% poor (1 patient).

Conclusions

The lateral approach is a minimally invasive and safe procedure with low complication rates. The profit from surgery is maintained beyond the usual postoperative observation periods. Thus, ultimate outcome at ultra-long-term follow-up is very gratifying in the vast majority of patients.
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Metadata
Title
Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series
Authors
Gerhard Marquardt
Markus Bruder
Stephanie Theuss
Matthias Setzer
Volker Seifert
Publication date
01-04-2012
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 4/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-2123-9

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Reviewer's Comment

Reviewer’s comment concerning “Posterior transdural discectomy: a new approach for the removal of a central thoracic disc herniation.” (doi:10.1007/s00586-011-1990-4 by H.M. Coppes et al.)