1 – Results
Between February 1993 and July 2009 Dr. J. Destandau used Endospine to operate on 7,025 patients with lumbar disc herniations.
This is a report of the data concerning these patients and especially the complications encountered. Since April 1999 a satisfaction questionnaire is given to each person operated on; it gives information on the time frame in which activities are resumed and determines the Prolo score which evaluates the functional and socio-economic results.
71.5% of the patients operated on between April 1999 and July 2009 returned their questionnaires (3,558 out of 4,978).
The results were excellent in 92% of the cases (3,274 cases), good in 0.7% of the cases (25 cases) and poor in 7.3% of the cases (259 cases).
Of the 2,670 patients who were working before the operation and who answered the questionnaire, 2,442 (68.6%) returned to work within an average period of 4 weeks and 13 others returned to work part-time.
95% (3,380 patients) stated that they were satisfied with the intervention and the supervision and 93.2% (3,316 patients) that they had received accurate information.
2 – Sample
The average age of this series of 7,025 patients was 45 years with extremes from 14 years to 89 years. 61% were men (4,291) and 39% women (2,734).
Radiculalgia (pain in the inferior limb) was on the left side in 53.2% of the patients (3,737), on the right side in 45.3% (3,185) and bilateral in 1.5% of the cases (103).
The herniation was located at the L1-L2 level in 9 cases (0.1%), L2-L3 level in 94 cases (1.3%), L3-L4 level in 359 cases (5.1%), L4-L5 level in 3,220 cases (45.8%) and L5-S1 level in 3,343 cases (47.6%).
In 2,013 cases (28.6%) a simple herniectomy was done without additional discectomy. 1,514 patients had motor disorders (21.5%), 2,443 sensory disorders (34.8%), and 3,185 reflex disorders (45.3%).
The herniation was subligamentary in 4,523 cases (64.4%), ruptured or protruding in 1,330 cases (18.9%) and foraminal in 646 cases (9.2%).
3 – Methodology
Since April 1999 each patient receives a questionnaire to be completed and returned at the end of his/her convalescence. This form gives information on the length of time it takes before leisure activities, work and daily activities are resumed.
After 3 months, if the patient has not resumed his regular activities, the results are considered to be poor even if this occured later.
The results are evaluated using the Prolo criteria, which evaluate the patient’s return to economic and social activities (from 1 to 5) and functional (from 1 to 5) status. The two numbers are added and the result gives the Prolo score. The result is judged as excellent when the score is 9 or 10, good for 7 or 8, fair for 5 or 6 and poor for less than 5.
4 – Complications
The complications that were encountered were:
- complications of deep infections: 13 (0.2%)
- complications of superficial infections: 8 (0.1%)
- access to two levels following poor detection in 77 cases (1.1%)
- an error in the level in 5 cases (0.1%)
- a dural tear in 129 cases (1.8%)
- a partial nerve lesion in 12 cases (0.2%)
Of the 7,025 patients operated on, 449 (6.4%) had a second surgery. 362 (5,2%) underwent a second operation at the same level, among who 316 at the same level and on the same side.
5 – Post-operative follow-up
The patient stands for the first time as soon as he got back to his/her room.
Rehabilitation starts immediately and the objective is to mobilise the lumbar spine and loosen up the paravertebral musculature.
The waterproof dressing allows a normal life, showers and baths in particular.
The return home takes place 24 hours after the operation. No specialised transport is necessary.
Return to former activities including sports is encouraged as soon as possible. No restrictive instructions are given to the patient.