We estimated the long term results of the different methods in chirurgical treatment of lumbar disk herniation in consideration with the presence or absence of degenerative changes and the grade in witch these factors influence the result of this kind of treatment. Seventy eight patents with lumbar disk herniation have been submitted in partial discectomy. The men were 42 and 36 women. The patients were separated in tow groups. In the first group [48 patients, 31 of them (A1) without degenerative changes, while the 17 (A2) with degenerative changes], was applied macrodiscectomi. In the second group [30 patients, 18 of them (B1) without degenerative changes and the 12 (B2) with changes], was applied microdiscectomi with use of magnifying lenses. The mean age during operation was 44 years (18–67) and 38 years (24–62) respectively for the tow groups, and the mean time of follow-up was 7 years and 8 months (18 months-13 years). For all patients, the operation was executed from the same surgeon. The elements that were evaluated were the Visual analog scale (VAS, O-10), the Oswestry Disability Index (ODI), as well as the complications during and after the operation and the cases that required a reoperation. In the first group VAS score was improved from 9.1 to 3.1 and the ODI score was improved from 86% to 24.2%. In the second group VAS score was improved from 9 to 2.6 and the ODI score was improved from 84.2% to 19.2%. From all patients, subgroup B1 without degenerative changes, which was submitted in microdiscectomy presented the biggest improvement. We have had to reoperate 6 patients (7.8%). In cases of lumbar disk hernia both methods are appropriate and lead to a considerable improvement of the symptoms. Degenerative changes of the lumbar spine is a factor that leads in less satisfactory results

Aim: Evaluate the preoperative prognostic factors of a poor result in conventional surgery of lumbar disc herniation. Methods: From November 1995 to November 2001, we performed 113 standard discectomies (63 males/50 females) with a mean-age of 42 years (21–75). All patients had been evaluated preoperatively with X-ray and C.T. scan. Fifty-nine patients (52%) had a preoperative M.R.I., and an evaluation was made of disk degeneration degree, multilevel degeneration and bone changes in vertebral end-plates (according Modic classiþcation). The postoperative mean follow-up was 46,2 months. The outcomes were evaluated considering the reoperation rate, the intensity of pain in the Visual Analogue Score, and þnal function with the Oswestry Disability Index. The results were compared using ANOVA. Results: We have found a statistical correlation between a poor result and older age (p=0.006), diabetes (p=0.005), psychological factors (p=0.006) and preoperative X-ray changes, such as disk height loss greater than a third (p< 0.001), subcondral sclerosis (p< 0.001), segmental instability (p=0.019) and ostheo-arthritis (p< 0.001). Regarding M.R.I., the multilevel degeneration and the Modic changes (type I, II or III) have been correlated in this study with poor functional result (p=0.004 and p< 0.001 respectively). Conclusions: Our results support the concept that in patients with lumbar disk herniation and with described X-ray or M.R.I. changes, especially changes in vertebral end-plate, we should strongly consider treatment for disk degeneration and not limit the intervention to the excision of disk extrusion