fusion in disc herniation at l4-l5 level with or without previous surgery

Background. The results of treatment in patients with transpedicular instrumented or interbody cage fusion for lumbar disc extrusions at L4-L5 level were retrospectively analyzed. The goal was to determine whether comparable clinical outcome can be achieved in cases with and without previous surgery.

Methods. Ten patients who had first symptomatic acute massive disc herniation underwent herniotomy, posterior decompression as necessary, and fusion (Group A). Nine patients with recurrent disc herniation treated 6 years (mean, range 4 months to 14 years) earlier for the same disease were reoperated and fused because of worsening of the symptoms (Group B). At final follow-up of at least 2 years the patients were asked to estimate their low back and leg pain as well as their activity level on a visual scale, and to fill-in the Oswestry questionnaire. Clinical and radiological evaluation was performed using modified scoring system of the Japanese Orthopaedic Association (JOA) and score after Tria. Overall clinical results were assessed using the modified Stauffer-Coventry’s evaluating criteria.

Results. Patients in Group A were doing better than those in Group B according to low back pain (p < 0.01), leg pain (p = 0.01), and Oswestry questionnaire (p < 0.05). However, the results were not significantly different if measured by the score of Tria, JOA and activity level (p > 0.05; two-group t-test). 8 patients of Group A and 3 patients in Group B achieved an overall satisfactory result.

Conclusions. Despite the groups were small for statistical analysis, the results of the study suggest that patients undergoing fusion for massive disc herniation at L4-L5 level may do better if being fused at the time of primary procedure.