J Korean Neurosurg Soc.  2024 Mar;67(2):209-216. 10.3340/jkns.2023.0110.

Changes in Disc Height as a Prognostic Factor in Patients Undergoing Microscopic Discectomy

• Kweon M
• Bak KH
• Yi HJ
• Choi KS
• Han MH
• Na MK
• Chun HJ

• KMID: 2553127
• DOI: http://doi.org/10.3340/jkns.2023.0110

Abstract

Objective
: Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc.
Methods
: This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery.
Results
: A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months.
Conclusion
: In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.

Keyword

Intervertebral disc displacement; Diskectomy; Back pain; Prognosis

Figure

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  Fig. 1. Measurement of disc height (DH) and disc height index (DHI). DH was measured as (a + b + c) / 3, DHI is defined as [(a + b + c) /3] / d. a : anterior DH, b : middle DH, c : posterior DH, d : overlying vertebral body width.

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  Fig. 2. Simple linear regression analysis of the data in Table 1 demonstrates the effects of ratio of disc height (DH) at each time point on pain scores at 12 months after surgery. A : DH ratio immediately after surgery has no significant effect on pain scores at the 12-month follow-up. DH ratios at (B) 1 month, (C) 6 months, and (D) 12 months after surgery showed a positive correlation with pain scores at 12 months after surgery.

Reference

References

1. Azarhomayoun A, Chou R, Shirdel S, Lakeh MM, Vaccaro AR, RahimiMovaghar V. Sequestrectomy versus conventional microdiscectomy for the treatment of a lumbar disc herniation: a systematic review. Spine (Phila Pa 1976). 40:E1330–E1339. 2015.

2. Belykh E, Krutko AV, Baykov ES, Giers MB, Preul MC, Byvaltsev VA. Preoperative estimation of disc herniation recurrence after microdiscectomy: predictive value of a multivariate model based on radiographic parameters. Spine J. 17:390–400. 2017.

3. Brinckmann P, Grootenboer H. Change of disc height, radial disc bulge, and intradiscal pressure from discectomy. An in vitro investigation on human lumbar discs. Spine (Phila Pa 1976). 16:641–646. 1991.

4. Camino Willhuber G, Kido G, Mereles M, Bassani J, Petracchi M, Elizondo C, et al. Factors associated with lumbar disc hernia recurrence after microdiscectomy. Rev Esp Cir Ortop Traumatol. 61:397–403. 2017.

5. Carragee EJ, Han MY, Suen PW, Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am. 85:102–108. 2003.

6. Carragee EJ, Spinnickie AO, Alamin TF, Paragioudakis S. A prospective controlled study of limited versus subtotal posterior discectomy: short-term outcomes in patients with herniated lumbar intervertebral discs and large posterior anular defect. Spine (Phila Pa 1976). 31:653–657. 2006.

7. Chen X, Sandhu HS, Vargas Castillo J, Diwan AD. The association between pain scores and disc height change following discectomy surgery in lumbar disc herniation patients: a systematic review and meta-analysis. Eur Spine J. 30:3265–3277. 2021.

8. Fakouri B, Patel V, Bayley E, Srinivas S. Lumbar microdiscectomy versus sequesterectomy/free fragmentectomy: a long-term (>2 y) retrospective study of the clinical outcome. J Spinal Disord Tech. 24:6–10. 2011.

9. Fakouri B, Shetty NR, White TC. Is sequestrectomy a viable alternative to microdiscectomy? A systematic review of the literature. Clin Orthop Relat Res. 473:1957–1962. 2015.

10. Haden N, Latimer M, Seeley HM, Laing RJ. Loss of inter-vertebral disc height after anterior cervical discectomy. Br J Neurosurg. 19:469–474. 2005.

11. Ilyas H, Savage J. Lumbar disk herniation and SPORT: a review of the literature. Clin Spine Surg. 31:366–372. 2018.

12. Iorio-Morin C, Fisher CG, Abraham E, Nataraj A, Attabib N, Paquet J, et al. Low-back pain after lumbar discectomy for disc herniation: what can you tell your patient? J Neurosurg Spine. 35:715–721. 2021.

13. Kim KT, Lee DH, Cho DC, Sung JK, Kim YB. Preoperative risk factors for recurrent lumbar disk herniation in L5-S1. J Spinal Disord Tech. 28:E571–E577. 2015.

14. Kim KT, Park SW, Kim YB. Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976). 34:2674–2678. 2009.

15. McGirt MJ, Ambrossi GL, Datoo G, Sciubba DM, Witham TF, Wolinsky JP, et al. Recurrent disc herniation and long-term back pain after primary lumbar discectomy: review of outcomes reported for limited versus aggressive disc removal. Neurosurgery. 64:338–344. discussion 344-345. 2009.

16. McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, et al. A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976). 34:2044–2051. 2009.

17. Meredith DS, Huang RC, Nguyen J, Lyman S. Obesity increases the risk of recurrent herniated nucleus pulposus after lumbar microdiscectomy. Spine J. 10:575–580. 2010.

18. Miwa S, Yokogawa A, Kobayashi T, Nishimura T, Igarashi K, Inatani H, et al. Risk factors of recurrent lumbar disk herniation: a single center study and review of the literature. J Spinal Disord Tech. 28:E265–E269. 2015.

19. Mohd Isa IL, Teoh SL, Mohd Nor NH, Mokhtar SA. Discogenic low back pain: anatomy, pathophysiology and treatments of intervertebral disc degeneration. Int J Mol Sci. 24:208. 2022.

20. Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, et al. Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res. 473:1988–1999. 2015.

21. Shin EH, Cho KJ, Kim YT, Park MH. Risk factors for recurrent lumbar disc herniation after discectomy. Int Orthop. 43:963–967. 2019.

22. Silverplats K, Lind B, Zoëga B, Halldin K, Rutberg L, Gellerstedt M, et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J. 19:1459–1467. 2010.

23. Smith EJ, Inkrott BP, Kim CY, Du JY, Ahn UM, Ahn NU. The effect of obesity on revision discectomy after singlelevel lumbar discectomy. J Surg Orthop Adv. 29:10–12. 2020.

24. Spengler DM. Lumbar discectomy. Results with limited disc excision and selective foraminotomy. Spine (Phila Pa 1976). 7:604–607. 1982.

25. Sulaiman A, Mahfoud M, Abdalrahman M. Comparison of sequestrectomy with or without nucleotomy in patients with sequestered fragment and small perforations within the fibrous ring: 2 years’ experience. Interdiscip Neurosurg. 24:101098. 2021.

26. Tabibkhooei A, Ziaei SE, Azar M, Abolmaali M. Evaluating predictive value of preoperative clinical and imaging findings on the short-term outcome of surgery in patients undergoing lower lumbar discectomy. Cureus. 13:e20772. 2021.

27. Thomé C, Barth M, Scharf J, Schmiedek P. Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine. 2:271–278. 2005.

28. Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine (Phila Pa 1976). 3:175–182. 1978.

29. Wenger M, Mariani L, Kalbarczyk A, Gröger U. Long-term outcome of 104 patients after lumbar sequestrectomy according to Williams. Neurosurgery. 49:329–334. discussion 334-335. 2001.

30. Xu X, Li X, Wu W. Association between overweight or obesity and lumbar disk diseases: a meta-analysis. J Spinal Disord Tech. 28:370–376. 2015.