Lumbar sacralization and L4-L5 microdiscectomy, a prospective cohort study on radiologic and clinical outcomes

Pouya Omidi; Saeid Abrishamkar; Mehdi Mahmoodkhani; Arman Sourani; Amin Dehghan; Mina Foroughi; Sadegh Baradaran Mahdavi; Donya Sheibani Tehrani; Roham Nik Khah; Shaahin Veisi

doi:10.1016/j.wnsx.2024.100333

Lumbar sacralization and L₄-L₅ microdiscectomy, a prospective cohort study on radiologic and clinical outcomes

World Neurosurg X. 2024 Mar 7:23:100333. doi: 10.1016/j.wnsx.2024.100333. eCollection 2024 Jul.

Authors

Affiliations

¹ Neurosurgeon, Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
² Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
³ Isfahan Medical Students' Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Aim: To evaluate the role of lumbar sacralization (LS) on the surgical outcomes of L4-L5 microdiscectomy.

Methods: This prospective cohort study was conducted in a university referral hospital. The patients with L4-L5 disc herniation and eligible for microdiscectomy were enrolled and allocated in G1 (with LS) and G2 (no LS). After the L4-L5 microdiscectomy patients were followed, clinical and radiological parameters were collected to investigate the influence on the outcomes. Recurrence, low back outcome score (LBOS), and the Oswestry disability index (ODI) were defined as main outcomes.

Results: Two hundred and forty patients (n = 120, each), were reviewed in the final analysis. There was no difference between groups regarding baseline characteristics. Postoperative radicular and back pain was more severe in LS(P < 0.05). Univariate analysis showed recurrence was significantly higher in LS with a direct correlation with postoperative back pain persistence and low LBOS (p = 0.001). Age had a negative impact on G2 recurrence(p = 0.008). LS had a negative impact on LBOS and ODI scores. Postoperative radicular pain and higher lumbar lordosis were associated with a higher disability (ODI) index.

Conclusion: L4-L5 microdiscectomy in patients with lumbar sacralization was associated with higher recurrence rates, worse ODI and LBOS scores, persistent postoperative axial back pain, and radicular pain. Postoperative axial back pain and poor LBOS results could effectively predict a higher recurrence rate following L4-L5 microdiscectomy in lumbar sacralization.

Keywords: Disc herniation; L4-L5 discectomy; Low back outcome score; Low back pain; Lumbar sacralization; Lumbosacral transitional vertebra; Oswestry disability index; Recurrence.