The Journal of Bone and Joint Surgery, Vol 71, Issue 5 719-721, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
The development of low-back pain after excision of a lumbar disc
EN Hanley and DE Shapiro
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania.
One hundred and twenty consecutive patients who had primary excision of a
lumbar disc at a single level for predominantly radicular symptoms were
studied. Of these patients, eighty-seven (72 per cent) were available for
comprehensive review. The duration of follow-up ranged from twenty-four to
eighty-seven months (average, thirty-eight months). Radiculopathy was
initially relieved in eighty-six (99 per cent) of the patients, although
six patients (7 per cent) had recurrent herniation, which was successfully
treated by reoperation. In an additional twelve patients (14 per cent), the
operation was deemed a failure due to subsequent disabling low-back pain.
Narrowing of the disc space was present radiographically in 98 per cent of
the patients, but the amount of narrowing did not correlate with the degree
of low-back pain, the age of the patient, or the length of time after
operation. Factors predisposing to failure of the operation due to
disabling low-back pain included coverage under Workmen's Compensation (p
less than 0.00001), a history of more than fifteen pack-years of
cigarette-smoking (average, one pack a day for fifteen years) (p less than
0.01), and an age of more than forty years (p less than 0.05).
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