Document Type: RESEARCH PAPER
Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Background: Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH). The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L5-S1 LDH.
Methods: We retrospectively evaluated 181 patients (108 male and 73 female) who underwent simple discectomy in our orthopedic department from April 2009 to April 2013 and followed them up for more than one year. The mean age of the patients was 35.3±8.9 years old. Severity of reflex impairment was graded from 0 to 4+ and radicular pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables.
Results: Reflex impairment existed in 44.8% preoperatively that improved to 10% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (P=0.538 and P=0.709, respectively). There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (P=0.012 and P=0.002, respectively). Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (P
Conclusions: In the patients with L5-S1 LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction.
- 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. 2003; 85-A(1):102-8.
- Dewing CB, Provencher MT, Riffenburgh RH, Kerr S, Manos RE. The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine. 2008; 33(1):33-8.3.
- Miwa S, Yokogawa A, Kobayashi T, Nishimura T, Igarashi K, Inatani H, et al. Risk factors of recurrent lumbar disc herniation: a single center study and review of the literature. J Spinal Disord Tech. 2015; 28(5):E265-9.4.
- Sinigaglia R, Bundy A, Costantini S, Nena U, Finocchiaro F, Monterumici DA. Comparison of single-level L4-L5 versus L5-S1 lumbar disc replacement: results and prognostic factors. Eur Spine J. 2009; 18(Suppl 1):52-63.
- 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. 2006; 31(6):653-7.
- Faulhauer K, Manicke C. Fragment excision versus conventional disc removal in the microsurgical treatment of herniated lumbar disc. Acta Neurochir (Wien). 1995; 133(3-4):107-11.
- Moller AM, Pedersen T, Villebro N, Munksgaard A. Effect of smoking on early complications after elective orthopaedic surgery. J Bone Joint Surg Br. 2003; 85(2):178-81.
- Lee JC, Kim MS, Shin BJ. An analysis of the prognostic factors affecting the clinical outcomes of conventional lumbar open discectomy: clinical and radiological prognostic factors. Asian Spine J. 2010; 4(1):23-31.
- Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013; 95(1):1-8.
- Iglesias-Casarrubios P, Alday-Anzola R, Ruíz-López P, Gómez-López P, Cruz-Bértolo J, Lobato RD. Lasegue’s test as prognostic factor for patients undergoing lumbar disc surgery. Neurocirugia (Astur). 2004; 15(2):138-43.
- Rihn JA, Hilibrand AS, Radcliff K, Kurd M, Lurie J, Blood E, et al. Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2011; 93(20):1906-14.
- D’Angelo C, Mirijello A, Ferrulli A, Leggio L, Berardi A, Icolaro N, et al. Role of trait anxiety in persistent radicular pain after surgery for lumbar disc herniation: a 1-year longitudinal study. Neurosurgery. 2010; 67(2):265-71.
- Karabekir HS, Emel E, Atar EK, Yildizhan A. Is age a prognostic factor of postoperative outcome of lumbar disc herniation operations? Neurosciences (Riyadh). 2007; 12(4):282-4.
- Girardi FP, Cammisa FP Jr, Huang RC, Parvataneni HK, Tsairis P. Improvement of preoperative foot drop after lumbar surgery. J Spinal Disord Tech. 2002; 15(6):490-4.
- Postacchini F, Giannicola G, Cinotti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. J Bone Joint Surg Br. 2002; 84(7):1040-5.
- Carragee EJ, Han MY, Yang B, Kim DH, Kraemer H, Billys J. Activity restrictions after posterior lumbar discectomy. A prospective study of outcomes in 152 cases with no postoperative restrictions. Spine. 1999; 24(22):2346-51.
- Boes CJ. The history of examination of reflexes. J Neurol. 2014; 261(12):2264-74.
- Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990; 13(4):227-36.
- Fairbank JC, Pynsent PB. The oswestry disability index. Spine. 2000, 25(22):2940-52.
- Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The oswestry disability index, the roland-morris disability questionnaire, and the quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine. 2006, 31(14):E454-9.
- Wood EG, Hanley EN. Lumbar disc herniation and open limited discectomy: indications, techniques, and results. Oper Tech Orthop. 1991; 1(1):23-8.
- Blaauw G, Braakman R, Gelpke GJ, Singh R. Changes in radicular function following low-back surgery. J Neurosurg. 1988; 69(5):649-52.
- Mariconda M, Galasso O, Secondulfo V, Cozzolino A, Milano C. The functional relevance of neurological recovery after lumbar discectomy: a follow-up of more than 20 years. J Bone Joint Surg Br. 2008; 90(5):622-8.