A Prospective Study on the Role of Neurophysiological Studies in Predicting Functional Outcome After Lumbar Discectomy

Background and Aim: Lumbar intervertebral discs are complex anatomical structures essential for the mobility of intervertebral joints. There is general consensus for some indications for surgery, including acute or progressive neurological deficit(s), cauda equine syndrome, or refractory pain unresponsive to conservative treatments. However, controversy exists regarding the optimal management of cases with the disparity between radiological and clinical findings, which includes a great proportion of patients. This study examines whether neurophysiological studies can be used to identify subgroups with improved post-operative outcomes. Methods and Materials/Patients: This prospective cohort study was conducted on 60 patients with clinical and imaging evidence in favor of Lumbar Disc Herniation (LDH). The pre-operative radiological assessment was the lateral X-rays in flexion and extension positions, and lumbar spine Magnetic Resonance Imaging (MRI). Pre-operative clinical assessment was done by the Oswestry Low Back Pain Disability Questionnaire and Visual Analog Scale (VAS). Neurophysiological studies were done at least one month after the onset of radiculopathy. Surgery was performed at the level suggested by neuroimaging. In all patients, we found an abnormal disc, which was removed along with any loose disc material. The patients were followed up for 1 year with intervals of 3  months for post-operative assessments. Results: In the two study arms with abnormal or normal pre-operative electrodiagnostic studies, a significant decrease was observed in the percentages of visual analog scale reduction (73.69% and 95.59%, respectively) and Oswestry disability score (65.3% and 76.2%, respectively) at the month 12 post-operative (P=0.993 to 0.002 and P=0.200 to 0.037, respectively). Conclusion: Neurophysiological studies could be regarded as helpful adjuncts to distinguish a subgroup of patients with LDH, who may experience a favorable outcome after surgical intervention.  

کلیدواژه ها:

Low back pain ، Visual analog scale ، Intervertebral disc ، Magnetic Resonance Imaging (MRI) ، Lumbar Vertebrae ، Neuroimagingroimaging