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Degeneration and Instability and the Relation to Patients’ Function Late After Lumbar Disc Surgery

Data from a 12-Year Follow-Up

Ebenbichler, Gerold R. MD; Leitgeb, Jürgen MD; Amtmann, Gabriele MD; König, Franz PhD; Schernthaner, Melanie MD; Resch, Karl-Ludwig MD, PhD; Kainberger, Franz MD

American Journal of Physical Medicine & Rehabilitation: December 2016 - Volume 95 - Issue 12 - p 871–879
doi: 10.1097/PHM.0000000000000522
Original Research Articles CME Article . 2016 Series . Number 12
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Objective To investigate the excess risk of degeneration and segmental instability in operated segments late after lumbar disc surgery in patients with presurgically stable segments, and whether local pathological findings relate to patients’ back health.

Design This retrospective analysis reports on 69 patients 12 years after first-time, uncomplicated lumbar disc surgery. Two independent radiologists evaluated the patients’ lumbar functional x-rays; the Back Pain Rating Score (LBP-RS) assessed back-specific function.

Results At 12 years after lumbar disc surgery, degenerative changes as well as segmental instability occurred significantly more frequently in the operated than nonoperated lumbar segments, but there was no association between increased degeneration and segmental instability rates. The risk for acquiring segmental instability was significantly associated with surgery (odds ratio, 6.5; 95% confidence interval, 1.5–28.8). Prevalence of segmental instabilities was associated with better LBP-RS scores. Analyses of LBP-RS subscores revealed a clear association of segmental instability with physical function, but not with pain or activities of daily living.

Conclusions Lumbar disc surgery seems to be associated with an increased risk of degeneration and segmental instability in the long term. This structural impairment, however, seems functionally well compensated and does not seem to be a relevant causal factor for a chronic back pain syndrome.

To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives: Upon completion of this article, the reader should be able to: (1) Describe the impact of lumbar disc surgery on segmental instability and degenerative changes; (2) Recognize the lack of association between degenerative changes and segmental instability after lumbar disc surgery; and (3) State the value of lumbar spinal functional tests in the evaluation of patients after lumbar disc surgery.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria (GRE); Vienna Medical University, Vienna, Austria (JL, GA); Section for Medical Statistics, Institute for Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria (F König); Department of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria (MS, F Kainberger); and German Institute of Health Research, Bad Elster and Dresden, Germany (KLR).

All correspondence and requests for reprints should be addressed to: Gerold R. Ebenbichler, MD, Department of Physical Medicine and Rehabilitation, Vienna Medical University, Währinger Gürtel 18-20, 1090 Vienna, Austria.

This study did not receive funding, grants or equipment provided for the project from any source. Authors did not receive any financial benefit. This work was a master’s thesis by Gabriele Amtmann, MD, and by Jürgen Leitgeb, MD. JL and GA published most of the results of this research in their master theses, Vienna Medical University in 2014 and 2015. The long-term follow-up examination was approved by Vienna University’s Ethics committee (Project No. 301/2009). Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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