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Beitragstitel Surgical decompression for foraminal and extraforaminal lumbar disc herniation using the far-lateral approach: patient-rated outcome depends on the involved segment
Beitragscode P019
Autoren
  1. Daniel Haschtmann Schulthess Klinik Zürich Vortragender
  2. Anne F. Mannion Schulthess Klinik
  3. Markus Loibl Schulthess Klinik
  4. Francois Porchet Schulthess Clinic Zurich
  5. Frank Stefan Kleinstück Schulthess Klinik Zürich
  6. Dezsö Jeszenszky Schulthess Klinik Zürich
  7. Tamas F. Fekete Schulthess Clinic Zurich
Präsentationsform Poster
Themengebiete
  • A3 - Wirbelsäule
Abstract Introduction
Decompression for lumbar foraminal to extraforaminal nerve compression is commonly performed using a far-lateral transmuscular approach (FLA), and is typically associated with good patient outcomes. Results are usually reported as the average for all lumbar levels; however, clinical results may be less predictable for surgery at the lumbosacral level, due to its unique anatomic features. This study compared patient-rated outcomes after far-lateral decompression at L5/S1 compared with higher lumbar levels.
Methods
This was a retrospective study of prospectively collected data from 115 consecutive patients (73 m, 42 f; mean age 62±11 yrs) who had undergone surgery at a single level (N=89 at L1 to L5, and N=26 at L5/S1) from 1.1.2005-1.6.2014. 1482 patients from the Spine Tango database, who had undergone removal of disc herniation (non-FLA approach) served as controls. The multidimensional Core Outcome Measures Index (COMI), including scales for leg pain (LP) and back pain (LBP), was completed before surgery, and up to 2 years after surgery.
Results
94% of the patients had completed a baseline COMI, 88% a 2-year; 83% had completed both timepoints. In the FLA group, at the 2-year follow-up, the reduction in LP was significantly (p=0.03) less for those operated at L5/S1 (2.6±2.9 points) than for those operated at L1/2 to L4/5 (4.2±3.4 points) unlike in the control group (4.5±3.2 points for L5/S1 and 4.2±3.3 points for L1/2 to L4/5). A 2-point MCIC score for LP was achieved by 77% patients in the control group, both for those operated at L5/S1 and those operated at higher lumbar levels alike. In the FLA group, the corresponding figures were 63% (L5/S1) and 81% (higher lumbar levels)(p=0.11). The reduction in COMI score showed a similar pattern to that for LP, but without statistical significance: at L5/S1, FLA 3.5±2.4 points vs control 4.6± 3.0 points reduction; at higher lumbar levels, FLA 4.8±3.0 vs control 4.8±2.9 points). There were no significant differences (p>0.05) dependent on group or lumbar level for the improvement in LBP.
Conclusion
Decompression of extra- and intraforaminal nerve root compression using FLA results in good patient-rated outcome at 2 years. However, the improvement in LP was inferior for the L5/S1 level compared with the other levels. This may be due to its unique anatomy. These results are important in decision-making for appropriate surgical treatment and in the management of expectations during the consent process.