Comparison of Outcome Using Three Methods of Treatment for Intervertebral Lumbar Disc Disease

Background and Purpose: There are controversies with treatment for intervertebral disc disease of the lumbar spine. Methods: We performed 3 surgical methods for intervertebral lumbar spine disc disease during the period 1994 to 1999. Clinical and radiological follow-up data were obtained to compare the results and sequential complications. The methods were a traditional discectomy (38 patients), posterolateral fusion (PLF; 6 patients), and posteriorlumbar interbody fusion (PLIF; 11 patients). Fifty-five patients who underwent surgery and for whom postoperative lumbar spinal X-ray films were obtained completed questionnaires regarding pain relief, recovery to work ability, recurrent symptoms, and the need for a reoperation. Disc height change, segmental instability, and spondylolisthesis were determined by comparing the pre- and postoperative X-ray films. Results: Clinical and radiological outcomes were compared between groups undergoing the 3 operative methods. In the discectomy group, 18% required a reoperation, due in all cases to recurrence of disc herniation. The worst postoperative symptoms and greatest disc height loss were also noted in this group. PLF group patients had fewer postoperative symptoms, yet more junction problems were noted radiologically. Conclusion: PLIF group patients had the best stability but only fair improvement in postoperative symptoms. None of the 3 methods was superior to the other methods in terms of surgical outcomes.