Lumbar laminectomy for herniated disc: a prospective controlled comparison with internal fixation fusion

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spine Surgery

Background:

• Herniated lumbar discs are a common cause of low back pain.
• Surgical intervention, including laminectomy and fusion, is a treatment option.
• The necessity and efficacy of fusion in conjunction with laminectomy for herniated discs remain debated.

Purpose of the Study:

• To compare the outcomes of bilateral lumbar laminectomy with and without intertransverse fusion and internal fixation for herniated lumbar discs.
• To evaluate the long-term success rates based on functional and subjective criteria.

Main Methods:

• A controlled prospective study of matched patients with herniated lumbar discs.
• Two groups: one with laminectomy and disc excision only, the other with added intertransverse fusion and internal fixation.
• Outcomes assessed by an independent examiner at an average of 3 years postoperatively, including activity level, medication use, and subjective/objective evaluations.

Main Results:

• Both groups had an overall success rate of 87%.
• Patients undergoing fusion had a significantly longer mean time to return to work.
• Excellent results were achieved by 29% of the nonfusion group versus 11% of the fusion group.

Conclusions:

• Intertransverse fusion with internal fixation is not necessary for simple herniated lumbar disc cases treated with laminectomy.
• Fusion may lead to less favorable excellent outcomes and delayed return to work compared to nonfusion.
• Conservative care for at least 3 months is a prerequisite for surgical consideration.