Abstract
Introduction
We aimed to study the following gaps in the literature. (1) Clinical results of spinous process osteotomy for the treatment of LDH is scarce in the literature. (2) Studies comparing clinical outcomes between laminectomy and osteotomy have not been reported. (3) Results of MAPN with open techniques have not been compared.
We sought to study the outcome of surgery for LDH by conducting a comparative study between three different surgical techniques; we aimed to find whether any of these approaches were more efficacious in reducing pain or improving patients' quality of life. In addition, factors that could predict the outcome of LDH surgery were assessed.
Materials and Methods
We evaluated 148 patients who had operations for lumbar disk herniation from March 2006 to March 2011 using three different surgical techniques (laminectomy, microscopically assisted percutaneous nucleotomy, and spinous process osteotomy) by using Japanese Orthopaedic Association (JOA) Back Pain Evaluation Questionnaire, Resumption of Activities of Daily Living scale and changes of visual analog scale (VAS) for low back pain and radicular pain. Our study questionnaire addressed patient subjective satisfaction with the operation, residual complaints, and job resumption.
Results
Ninety-four percent of our patients were satisfied with the results of their surgeries. VAS documented an overall 93.3% success rate for reduction of radicular pain. Laminectomy resulted in better outcome in terms of JOA Back Pain Evaluation Questionnaire. The outcome of surgery did not significantly differ by age, sex, level of education, preoperative VAS for back, preoperative VAS for radicular pain, return to previous job, or level of herniation.
Conclusion
Surgery for lumbar disk herniation is effective in reducing radicular pain (93.4%). All three surgical approaches resulted in significant decrease in preoperative radicular pain and low back pain, but intergroup variation in the outcome was not achieved. As indicated by JOA Back Pain Evaluation Questionnaire–Low Back Pain (JOABPQ-LBP) and lumbar function functional scores, laminectomy achieved significantly better outcome compared with other methods. It is worth mentioning that relief of radicular pain was associated with subjective satisfaction with the surgery among our study population.