Study Design A retrospective cohort study. Objectives To determine the outcome and any differences in the clinical results of three different surgical methods for lumbar
disk herniation and to assess the effect of factors that could predict the outcome of surgery. 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. Data were analyzed with SPSS version 16.0 (SPSS, Inc., Chicago, Illinois, United States). Statistical significance was set at 0.05. For statistical analysis, chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and repeated measure analysis were performed. For determining the confounding factors, univariate analysis by chi-square test was used and followed by logistic regression analysis. 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. Predictive factors for ineffective surgical treatment for lumbar
disk herniation were female sex and negative preoperative straight leg raising. Age, level of education, and preoperative VAS for
low back pain were other factors that showed prediction power.