Comparing Patient-Reported Outcomes of Lateral to Paramedian Lumbar Disc Herniation: A Propensity-Score Matched Observational Study

Gustav Østerheden Andersen; Stefan Milosevic; Mads Moss Jensen; Leah Carreon; Casper Friis Pedersen; Mikkel Østerheden Andersen; Peter Helmig

doi:10.1016/j.wneu.2024.123641

Comparing Patient-Reported Outcomes of Lateral to Paramedian Lumbar Disc Herniation: A Propensity-Score Matched Observational Study

World Neurosurg. 2025 Jan 9:123641. doi: 10.1016/j.wneu.2024.123641. Online ahead of print.

Authors

Gustav Østerheden Andersen¹, Stefan Milosevic², Mads Moss Jensen², Leah Carreon³, Casper Friis Pedersen³, Mikkel Østerheden Andersen³, Peter Helmig²

Affiliations

¹ Department of Clinical Medicine - Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK-8200, Aarhus N. Electronic address: gustavoesterheden@gmail.com.
² Department of Clinical Medicine - Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, DK-8200, Aarhus N.
³ Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej 55, DK-5500, Middelfart.

PMID: 39798789
DOI: 10.1016/j.wneu.2024.123641

Abstract

Aim: The aim of this study was to investigate patient-reported outcomes (PROs) following lumbar discectomy on patients with lateral lumbar disc herniation (LDH) compared to patients with paramedian LDH.

Background: Surgery for disc herniation is one of the most common procedures of the lumbar spine. LDHs can be divided into median, paramedian, foraminal and extraforaminal types based on the anatomical site of the lesion. Lateral (foraminal and extraforaminal) LDH surgery is considered challenging compared to paramedian LDH surgery.

Methods: Data on patients with lateral and paramedian LDH, operated between 2017 and 2020 at a single public spine unit, was extracted from the National Danish Spine Registry, DaneSpine. A propensity score-matched, case-control analysis was conducted to compare the two groups. Subgroup analysis was made by further dividing the lateral LDHs into a foraminal and extraforaminal group. Patient demographics, Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) of leg and back pain (0-100), EuroQol-5D questionnaire (EQ-5D), measures of patient improvement and satisfaction were collected at baseline and 1-year postoperatively.

Results: Of 887 eligible patients, baseline and 1-year follow-up data was available on 525 paramedian and 68 lateral LDH patients. Following propensity-score matching the two groups were similar in terms of all baseline characteristics (P>0.05). There was no significant difference between the paramedian and lateral LDH group in ODI, VAS leg pain, VAS back pain and EQ-5D 1-year postoperatively. Both groups improved in all outcomes from inclusion to follow-up (P<0.001). Subgroup analysis showed that patients with foraminal LDH, compared to extraforaminal LDH, had a significantly greater improvement in VAS leg pain (x vs x, P = 0.016) with a larger number of patients with clinically significant leg pain improvement (x vs x, P = 0.03).

Conclusion: Lateral and paramedian LDH patients reported similar postsurgical outcomes. Spine surgeons should be less hesitant to operate patients with lateral LDH. Extraforaminal LDH patients experienced the least relief of leg pain.

Keywords: extraforaminal; lateral; lumbar disc herniation; patient-reported outcomes; surgery.