Lumbar Disc Herniation Surgery - Novel Approaches, Timing and Outcomes

Abstract: BACKGROUND Full Endoscopic Lumbar Discectomy (FELD) is a minimal invasive procedure to treat lumbar disc herniation. A description of the clinical introduction in Sweden and a comparison to other surgical methods is a prerequisite before a widespread national introduction. Mental health status and proper surgical timing have been hypothesized to influence the outcomes after lumbar disc herniation surgery and was investigated in a large national cohort. AIM The purpose of the thesis was to introduce FELD to a larger audience, and to gain further knowledge about important predictors for an unsuccessful result after lumbar disc herniation surgery. STUDY POPULATION The study population contain the first 92 patients having a FELD procedure at the Sahlgrenska University Hospital, Gothenburg, Sweden. They were recruited and compared to controls from the Swedish national spine register – Swespine. Preoperative sciatic pain duration and mental health measured by the EQ-5D were examined for 6216 patient having lumbar disc herniation surgery 2013-2017 and patient reported outcomes were analysed. METHODS The introduction of the FELD procedure was described using a cohort of patients from the Sahlgrenska University Hospital. Postoperative patient reported outcomes measures were compared to matched controls. Preoperative duration of sciatica, anxiety and depression as predictive factors of postoperative residual leg pain and disability was studied in lumbar disc herniation patients. RESULTS The Swedish introduction of FELD was described and the postoperative results were compared to patients having standard surgery for lumbar disc herniation. FELD was able to achieve comparable in post-operative leg pain, satisfaction and disability. An extended duration of sciatica was associated with patients reporting inferior outcomes. A significant proportion of patients that state extreme anxiety and depression preoperatively, fail to improve after lumbar disc herniation surgery. CONCLUSION: The FELD procedure can be introduced with similar results to standard surgery for LDH. A prolonged duration of preoperative sciatica leads to a greater risk of achieving dissatisfied patients with a higher level of residual leg pain. Patients that suffer from anxiety and depression are able to reach the same level of quality of life as other lumbar disc herniation patients, but at a higher risk of not improving and expressing disability or residual leg pain.