Lumbar disc herniation surgery

Abstract: Lumbar disc herniation (LDH) most commonly affects individuals in their early forties but can occur at any age. In most instances,the initial treatment is non-surgical and a clear majority of the patients recover with this management. Surgical treatment isgenerally an option first after 6-8 weeks of non-surgical management with unsuccessful outcome in terms of pain, disability andquality of life. The long-term outcome is not different when surgical- and non-surgical treatment are compared. Surgical treatmentgenerally yields a satisfying outcome and shortens the period with severe morbidity. There are however many factors that influencethe surgical outcome and by identifying these, it is possible to make a better patient selection for surgery. Further, the informationgiven to patients when scheduled for surgery is of significant importance for the patients expectations as well as the surgicaloutcome.In papers I, II and III we analyzed data from surgically treated LDH patients included in the national Swedish Spine Register, withspecial interest in the effect of age and gender. In paper IV we analyzed changes in clinical status in patients operated due to LDH,from before surgery to postoperatively and during the first two postoperative weeks. Preoperative SweSpine data was obtained asbaseline comparison and all patients were interviewed postoperatively at day 1, 7 and 14 following surgery (pain, consumption ofanalgesics and quality of life).In paper I we found that there was significant preoperative impairment in children and adolescents who were surgically treated dueto LDH, with girls reporting a more severe clinical impairment. Improvement by surgery was no different in boys and girls andsurgery was associated with a low complication rate. Pain, quality of life and disability was virtually normalized one year after theoperation.In paper II, we found that patients were with higher ages referred to surgery with a more severe preoperative clinical impairment,that the improvement after surgery was inferior in patients with higher age and that the one year outcome following this was inferiorwith increasing age of the patient. There was also a higher frequency of complications with increasing age.In paper III, we found that females surgically treated due to LDH report inferior preoperative clinical status, that both gendersimprove to a similar extent after surgery and that the one year outcome following this was inferior in females.In paper IV, we found that leg pain improved directly by surgery, that back pain improved gradually during the first twopostoperative weeks and that quality of life improved directly after surgery but also continued to improve during the following twoweeks. The patients had already at two weeks after the operation reached the in the literature defined criteria for “successfuloutcome” of LDH surgery.In conclusion, the outcome of LDH surgery is encouraging in children and adolescents. There is age- and gender related outcomedifferences, but these differences are of minor clinical relevance since both elderly and females in general reach the improvementthat in the literature is defined as a “clinical successful outcome” and this already within two weeks after the operation. We are ofthe opinion that age and gender should, if anything, only to minor extent influence the decision making regarding if LDH surgeryshould be performed or not.