gms | German Medical Science

Objective: This study was held through based on prospective case observations. To aim of this study is to examine the patients with single level lumbar disc herniation according to Carragee disc classification including type 1, 2, 3 and 4 groups in the preoperative, intraoperative and postoperative period and compare the correlation of results with evaluation of modic changes, annular tear and Pfirrmann classification.

Method: We treated 193 patients with simple lumbar disc herniation by lumbar microdiscectomy. There are 90 male and 93 female patients and their average age is 45.2 (between the ages of 18-72). We have operated the cases most frequently in L4-L5 disc level and this level was followed by L5-S1 and L3-L4 disc levels respectively. The follow-up period was 15.2 (between 12-20) months in average. We followed-up with control contrast MR imaging and Visual Analogue Scale (VAS), Oswestry disability index (ODI) in 3^rd, 6^th and 12^th month and 18^th month in the postoperative period. The clinical results were evaluated with VAS and ODI.

Results: Disc recurrence rate was determined in 3 of 193 patients operated by reason of single level lumbar disc herniation. The average period of appearance for recurrence was 7.8 months. Perioperative dural defects occurred in 5 of 193 patients as a complication, they were primarily fixed during the operation and BOS fistula did not occur. Subcutaneous infection occurred in 1 patient and foot drop was observed in 1 patient during the postoperative period. A significant change in VAS and ODI scores was especially observed in Type 2 Carragee group patients in the first 3 months during the postoperative period. We observed that their complaints gradually decreased in the subsequent 6^th and 12^th months. A decline was determined in radicular pains in the patients with single level disc herniation included in Type 4 and Type 5 according to Pfirrman classification during the postoperative period, but localized low back pain continued. It was reported that 48.7% of the operated patients had Modic type 2 changes in the preoperative MR imaging and pain complaints continued in the postoperative period in 19.2% of these patients and 87.3% of the patients included in Modic type 2 group are composed of the patients included in Carragee Type 2 group.

Conclusions: According to our study Carragee Type 3 disc herniation was most frequently seen and the most frequent recurrence rate was seen in Carragee Type 2 group, which is also correlated with Modic type 2 changes.