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Adjacent Two-Level Lumbar Discectomy: Outcome and SF-36 Functional Assessment

Sun, Edward C. MD*; Wang, Jeffrey C. MD*; Endow, Kevin BS; Delamarter, Rick B. MD

doi: 10.1097/01.BRS.0000105986.16783.A9
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Study Design.  A retrospective outcomes study.

Objectives.  To examine the outcome following adjacent two-level lumbar discectomy using both surgeon-based evaluation criteria and validated patient-based quality of life instrument (SF-36).

Summary of Background Data.  Lumbar discectomies have documented success rates between 49% and 98% for single-level procedures. However, no prior study has specifically examined the outcome following adjacent two-level lumbar discectomy in a large series of patients.

Methods.  This study analyzed 55 patients with a minimum 2-year follow-up. All patients underwent adjacent two-level lumbar discectomy for radicular pain attributable to nerve root impingement at the corresponding levels. The patients were divided into two diagnostic groups based on their preoperative radiographic studies. Patients with two-level adjacent posterolateral lumbar disc herniations without concomitant osseous degenerative changes at the same levels constituted Group 1 (22 patients). Patients with associated osseous degenerative changes at the same levels made up Group 2 (33 patients). The patients’ clinical outcome was assessed using the MacNab classification and SF-36 questionnaire.

Results.  The average duration of follow-up was 41 months (range 24–96 months). The group consisted of 35 males and 20 females with average age of 49 years (range 19–82 years). Excellent results were observed in 49%, good in 20%, fair in 15%, and poor in 16%. However, patients in Group 1 have 86% excellent/good results, whereas patients in Group 2 have 57% excellent/good results. Overall, 15% of the patients required reoperation and subsequent spinal fusion. Analysis of the SF-36 scores revealed significant differences based on patient’s diagnostic grouping as well. Patients in Group 1 have physical and mental summary scores comparable with age- and sex-adjusted population norms and significantly higher than those in Group 2 (P < 0.01).

Conclusions.  Two-level discectomy is an effective treatment with clinical outcome comparable with single-level discectomy. Patients with posterolateral disc herniations and definitive radiculopathy without osseous degenerative changes at the same levels have better clinical outcome and quality of life scores compared with those patients having concomitant degenerative arthritis at the same levels. Patients having two-level discectomy may be at increased risk of requiring subsequent lumbar fusion compared with those with single-level discectomy.

Adjacent two-level lumbar discectomy has satisfactory results comparable with the single-level discectomy, as assessed by surgeon-based evaluation criteria and patient-based quality of life instrument (SF-36). Patients with isolated posterolateral disc herniations without corresponding osseous degenerative changes at the same levels and definitive radiculopathy have better clinical outcome compared with those with concomitant osseous arthritis. However, the rate of reoperation may be higher compared with those undergoing single-level discectomy.

From the *Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California;

and the †Spine Institute, St. John’s Health Center, Santa Monica, California.

Acknowledgment date: March 18, 2003.

First revision date: June 7, 2003.

Acceptance date: July 14, 2003.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence to Edward C. Sun, MD, Department of Orthopaedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; e-mail: Edward.sun@tch.harvard.edu.

© 2004 Lippincott Williams & Wilkins, Inc.