Lumbar Herniated Degenerated Disc: Simple Discectomy or Fusion?

Abstract

Background Data: Low back pain is estimated to occur in 84% of individuals at some point of their life. Lumbar disc degeneration is one of the most common finding in the work up of low back pain. Mechanical, nutritional, and genetic factors may play a role in the pathogenesis of disc degeneration. The etiology of back pain in degenerated disc is a complex process, and appears to be a combination of mechanical deformation and the release of inflammatory mediators. Being a recently highlighted illness, still there is a great controversy concerning the surgical treatment of degenerated lumbar disc hernia. Study Design: Prospective comparative clinical case study. Purpose: To compare the clinical outcome of patients presented with single degenerated lumbar disc hernia treated with fusion to those treated only with simple discectomy. Patients and Methods: Two groups of patients were recruited for this study included 20 patients each. Group A; patients treated with fusion and instrumental fixation. Group B; patients treated with simple discectomy. Both groups were homogeneous in terms of clinical presentation and imaging data. The VAS was used to evaluate leg and back pain, while ODI was used to evaluate the functional status both pre and post operatively. Results: Preoperatively, all patients suffered back pain, where 16 had moderate and 4 had severe pain in group A, and 14 had moderate and 6 had severe pain in group B. The ODI showed that, 16 and 17 patients had moderate disability in group A and B respectively. According to VAS, 12 patients had moderate and 8 had severe sciatica in group A, and 15 patients had moderate and 5 had severe sciatica in group B. With follow-up, back pain improved according to VAS, where 14 patients had no pain, 3 had mild and 3 had moderate pain in group A, and 18 (90%) patients had severe pain in group B. the ODI showed that 17 (85%) patients had minimal disability and 18 (90%) patients had moderate disability in group A and B respectively. According to VAS, 18 (90%) patients were pain free while 2 had mild sciatica in group A, and 17 patients became pain free in group B, however, 4 patients re-experienced moderate and 2 complained of severe pain due to recurrent disc. Conclusion: Despite the controversies regarding its ideal management, the results of discectomy and fusion stand better when compared with simple discectomy. However the disease needs more study to understand its pathogenesis. (2012ESJ034)

Keywords

• degenerative disc disease
• disc hernia
• simple discectomy
• lumbar fusion