Morphological changes after open lumbar microdiscectomy at 2-year follow-up

Article type: Research Article

Authors: Şimşek, Abdullah Talha^a | Baysal, Begümhan^b | Adam, Baha Eldin^a | Çalış, Fatih^a | Topçam, Arda^a | Demirkol, Mahmut^a | Doğan, Mahmut Bilal^b | Binguler, Ayse Hande Erol^c | Karaarslan, Numan^d | Balak, Naci^{a; *}

Affiliations: [a] Department of Neurosurgery, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey | [b] Department of Radiology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey | [c] Department of Industrial Engineering, Faculty of Engineering, Marmara University, Istanbul, Turkey | [d] Department of Neurosurgery, Istanbul Haliç University, Istanbul, Turkey

Correspondence: [*] Corresponding author: Naci Balak, Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey. Tel.: +90 216 6065200 Ext. 450202; Fax: +90 216 6065200; E-mails: semih.balak@medeniyet.edu.tr, naci.balak@gmail.com. ORCID: https://orcid.org/0000-0002-2395-0004.

Abstract: BACKGROUND: It is known that a possible decrease in disc height (DH) and foraminal size after open lumbar microdiscectomy (OLM) may cause pain in the long term. However, there is still insufficient information about the short- or long-term pathoanatomical and morphological effects of microdiscectomy. For example, the exact temporal course of the change in DH is not well known. OBJECTIVE: The purpose of this study was to examine morphological changes in DH and foramen dimensions after OLM. METHODS: In patients who underwent OLM for single-level lumbar disc herniation, MRI scans were obtained before surgery, and at an average of two years after surgery. In addition to DH measurements, foraminal area (FA), foraminal height (FH), superior foraminal width (SFW), and inferior foraminal width (IFW), were measured bilaterally. RESULTS: A postoperative increase in DH was observed at all vertebral levels, with an average of 5.5%. The mean right FHs were 15.3 mm and 15.7 mm before and after surgery, respectively (p= 0.062), while the left FHs were 14.8 mm and 15.8 mm before and after surgery (p= 0.271). The mean right SFW was 5.4 mm before surgery and 5.7 mm after surgery, while the mean right IFW ranged from 3.6 mm to 3.9 mm. The mean left SFW was 4.8 mm before surgery and 5.2 mm after surgery, while the mean left IFW ranged from 3.5 mm to 3.9 mm. Before surgery, the FAs were, on average, 77.1 mm2 and 75.6 mm2 on the right and left sides, respectively. At the 2-year follow-up, the mean FAs were 84.0 mm2 and 80.2 mm2 on the right and left sides, respectively. CONCLUSIONS: Contrary to prevalent belief, in patients who underwent single-level unilateral OLM, we observed that there may be an increase rather than a decrease in DH or foramen size at the 2-year follow-up. Our findings need to be confirmed by studies with larger sample sizes and longer follow-ups.

Keywords: Disc height, foraminal area, foraminal height, lumbar disc herniation, magnetic resonance imaging, open lumbar microdiscectomy

DOI: 10.3233/BMR-220371

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 1, pp. 75-87, 2024