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Background. The results of treatment in patients with transpedicular instrumented or interbody cage fusion for lumbar disc extrusions at L4-L5 level were retrospectively analyzed. The goal was to determine whether comparable clinical outcome can be achieved in cases with and without previous surgery.Methods. Ten patients who had first symptomatic acute massive disc herniation underwent herniotomy, posterior decompression as necessary, and fusion (Group A). Nine patients with recurrent disc herniation treated 6 years (mean, range 4 months to 14 years) earlier for the same disease were reoperated and fused because of worsening of the symptoms (Group B). At final follow-up of at least 2 years the patients were asked to estimate their low back and leg pain as well as their activity level on a visual scale, and to fill-in the Oswestry questionnaire. Clinical and radiological evaluation was performed using modified scoring system of the Japanese Orthopaedic Association (JOA) and score after Tria. Overall clinical results were assessed using the modified Stauffer-Coventry’s evaluating criteria.Results. Patients in Group A were doing better than those in Group B according to low back pain (p < 0.01), leg pain (p = 0.01), and Oswestry questionnaire (p < 0.05). However, the results were not significantly different if measured by the score of Tria, JOA and activity level (p > 0.05; two-group t-test). 8 patients of Group A and 3 patients in Group B achieved an overall satisfactory result.Conclusions. Despite the groups were small for statistical analysis, the results of the study suggest that patients undergoing fusion for massive disc herniation at L4-L5 level may do better if being fused at the time of primary procedure.

Background. Degenerative lumbar spinal stenosis (DLSS) is a common cause of low back and leg pain in the elderly. Conservative treatment seldom results in sustained improvement.Methods. Fifty-six patients (33 women, 23 men) older than 50 years (mean 67 years, range 51 to 82 years) and with no prior low back surgery were treated from 1993 to 1999 for clinical and radiologic evidence of DLSS. The goal of this study was to describe the results of decompressive laminectomy with or without fusion in terms of reoperation, severity of back pain, leg pain and patient satisfaction. Answers to Swiss spinal stenosis questionnaires completed before surgery and one to five years afterwards were evaluated. Seven patients (12.5%) with degenerative spondylolisthesis, scoliosis and/or more radical facetectomies received fusion.Results. Of the 56 patients in the original cohort, two were deceased and two had undergone reoperation by follow-up. Forty-eight patients answered questionnaires. Average duration of follow-up was 2.5 years. More than 70 percent of the respondents had no or only mild back or buttock pain at follow-up and more than 60 percent were able to walk more than 500 m. Added fusion reduced the incidence of low back pain and pain frequency, and increased walking distance (ANOVA).Conclusions. Eighty-one percent of patients were satisfied with the results of surgery and 87.5% would choose to have the operation again if they had the choice. Decompressive laminectomy for DLSS yields best results if instrumented fusion is included in the procedure.