Abstract
We measured the effects of lumbar discectomy on segmental motion over a period of 5 years. Twenty-four patients with lumbar disc herniation were treated by standard lumbar discectomy at the L4–L5 or L5–S1 level. Peroperatively, tantalum markers were inserted into L4, L5, and the sacrum. Radiostereometric analysis was performed at discharge from hospital and 5 years postoperatively. The treated level was compared with the corresponding untreated level. Thus, patients who had discectomy at the L4–L5 level served as controls for patients with L5–S1 lesions and vice versa. The relative rotation and translation in relation to the three cardinal axes were calculated. Inducible displacements over the two discs were calculated between the supine and standing positions. At the L4–L5 level, there were no differences in inducible displacements between the operated and control levels at discharge or 5 years postoperatively. At the L5–S1 level we found decreasing inducible movement in the sagittal plane over time for discectomy patients. The reason for decreasing mobility over time after discectomy at the L5–S1 but not at the L4–L5 level is unknown. Mechanical factors caused by the more vertical orientation of the L5–S1 disc in combination with degenerative changes could be one explanation.
Résumé
Nous avons mesuré les effets de la discectomie lombaire sur la mobilité segmentaire sur une période de 5 années. Vingt-quatre malades avec une hernie discale lombaire ont été opérés par discectomie standard au niveau L4–L5 ou L5–S1. Des marqueurs en tantale ont été insérés en peropératoire dans L4, L5 et le sacrum. L’analyse radiostéréométrique a été exécutée à la sortie de l’hopital et 5 ans après l’intervention. Le niveau opéré a été comparé avec le niveau non-opéré correspondant. Donc, les malades opérés sur L4–L5 ont servi comme contrôles pour malades opérés sur L5–S1 et vice versa. La rotation et la translation relatives selon les trois axes cardinaux ont été calculées. Les déplacements induits sur les deux disques ont été calculés entre les positions debout et couché sur le dos. Sur L4/L5 il n’y avait pas de différences dans les déplacements induits entre les opérés et le contrôle initial ou 5 ans aprés. Sur L5/S1 nous avons trouvé avec le temps des mouvements induits décroissants dans le plan sagittal pour les malades opérés. La raison de la mobilité décroissante avec le temps après discectomie L5–S1 mais pas au niveau L4–L5 est inconnue. Les facteurs mécaniques en relation avec l’orientation plus verticale du disque L5–S1, en association avec l’évolution dégénérative pourraient être une explication.
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Acknowledgements
The authors acknowledge technical support by Ulla Grangård and Birgitta Runze, RSA lab. This work was supported by grants from the Göteborg Medical Society, the Greta and Einar Askers Foundation, and the Doktor Félix Neubergh and Arne och Ingabritt Lundberg Foundation.
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