Does the neurological recovery parallel the patient self-reported outcome a minimum of 20 years after lumbar discectomy?

The objective of this study was to evaluate if the neurologic recovery is correlated with the patient-oriented outcome a minimum of 20 years after surgery for lumbar disc herniation. Ninety patients were examined an average of 25.4 years after lumbar discectomy (range: 20-32 years). All patients underwent physical and neurological evaluation as well as a patient-oriented assessment including: an SF-36 questionnaire, Oswestry Disability Index, Cumulative Illness Rating Scale, and a study-specific questionnaire dealing with daily life activities and satisfaction with the surgery. Relationships between changes in clinical and neurological signs and quality of life, disability, or satisfaction with the surgery were checked by linear and logistic regression analysis. Disappearance of preoperative Lasegue and Wassermann signs on follow-up was noted in 64 of 80 (80%) and 19 of 31 (61.3%) patients, respectively, whereas preoperative areflexia and motor disturbances were persistently improved in 16 of 31 (52%) and 33 of 44 (75%) subjects, respectively. The SF-36 indexes and Oswestry scores in our patients were similar to normative data and/or postoperative results reported in other studies with much earlier follow-up dates. Both satisfaction with surgery and willingness to undergo the same procedure again were expressed by 81 of 90 patients (90 %). When possible differences in the selfreported outcome were analysed in the study group, no sign of neurological recovery independently predicted the subjective result in the patients. In conclusion, patients who had undergone lumbar discectomy a minimum of 20 years earlier have satisfactory self-reported outcomes and sustained improvement of the neurological function. The long-term subjective outcome is independent of the neurological recovery.