Abstract
The purpose of the study was to compare segmental motion in the early postoperative phase after lumbar discectomy to the outcome 5 years postoperatively. The study population had radiologically verified symptomatic L4–L5 or L5–S1 lumbar disc herniation and was referred with an indication for lumbar discectomy. Radiostereometry was performed in the supine and standing positions. The L4–L5 and L5–S1 segments were analysed separately. L4–L5 segments adjacent to the operated L5–S1 segment constituted a reference segment for the operated L4–L5 and vice versa. Twenty-one patients were available for the follow-up at 5 years. Outcome was classified as functionally good or poor. Repeated or planned repeat surgery at the same level during follow-up was considered as poor outcome. The L4–L5 segments in the poor group showed different direction of sagittal rotation (anterior versus posterior) of L4 on L5 compared with the good group (p<0.01). On the L5–S1 segment, patients with poor outcome displayed an increased anterior translation of about 1 mm (p<0.01) compared with the reference segments. Our study suggests that increased inducible vertebral displacement in the early postoperative phase after discectomy is associated with a poor clinical outcome.
Résumé
Le but de l’étude était de comparer la mobilité segmentaire dans la phase postopératoire précoce après discectomie lombaire avec le résultat cinq années après l’intervention. La population de l’étude avait une hernie discale symptomatique radiologiquement vérifié L4–L5 ou L5–S1 avec une indication pour discectomie lombaire. L’analyse radiostéréométrique a été exécuté en position debout et en décubitus dorsal. Les segments L4–L5 et L5–S1 ont été analysés séparément. Le segment L4–L5 adjacent au segment L5–S1 opéré a constitué le segment de référence pour le L4–L5 opéré et vice versa. Vingt et un malades étaient disponibles pour le suivi à 5 ans. Le résultat a été classé comme bon ou mauvais fonctionnellement. La chirurgie répétée au même niveau pendant le suivi a été considéré comme un mauvais résultat. Les segments L4–L5 dans le groupe “mauvais” ont montré une direction différente de rotation (antérieur contre postérieur) de L4 sur L5 comparés au groupe “bon” (p<0.01). Sur le segment L5–S1, les malades avec un résultat mauvais ont montré une translation antérieure augmentée d’approximativement 1 mm (p<0.01) comparée aux segments de référence. Notre étude suggère que l’augmentation du déplacement vertébral dans la phase postopératoire précoce après la discectomie est associé avec un mauvais résultat clinique.
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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. The study was approved by the Regional Ethical Review Board,Göteborg University, Sweden.
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