Perioperative complication rate of lumbar disc microsurgery depending on the surgeon's level of training

Lumbar disc surgery is one of the procedures performed early in neurosurgical training. Agreement exists concerning the use of microsurgical techniques. With increasing surgical experience the clinical outcome should improve, partly because of a reduction in the complication rate. The aim of this study was to evaluate the correlation between patients' immediate clinical outcome, the perioperative complication rate and the surgeons' level of experience.

Patients undergoing surgery for lumbar disc herniation between January 1998 and December 2000 were investigated. Exclusion criteria were recurrent disc herniations and spinal stenosis. The surgeons were divided into four groups depending on their neurosurgical experience (group A: < or =2 years, group B >2 to < or =6 years, group C: >6 to < or =10 years, group D: >10 years). Anthropometric data, duration of surgery, early and late surgery-related complications and outcome at discharge were analysed.

A total of 1 205 patients (556 females, 649 males) were entered in the study. Six hundred and six of the 1 205 patients were treated by surgeons with < or =6 years of training. Seventy-five patients (6.2%) required re-operation. The re-operation rate was lowest (2.91%) in group A and higher (5.25-9.5%) in the other groups. The intraoperative complication rate was highest (4.75%) in group B and significantly lower (1.1-2.5%) in the other groups. On the other hand, fewer patients in group B had persistent postoperative radicular pain.

The clinical outcome after surgery for lumbar disc herniation does not improve linearly with the surgeon's experience. The intraoperative complication rate is highest between the 3rd and the 6th year of training.