| objective Lumbar disc herniation is a common diease of orthopedics. A nucleotomy following Love's method has been the standard treatment for the care of lumbar disc herniation. Since the late 1970s, some minial invasive techniques (chemonucleolysis, percutaneous nucleotomy) have been proposed and have become more popular in some area. Recent evidence has suggested that complications form the use of these techniques may worsen the neurological status, because of wrong indications and inexperience. So we believe that a reevaluation of the simple and conventional standard discectomy is needed. The aim of the present study was to evaluate the outcome of standard surgery for disc herniation and to study the factors that influence the outcome by means of a retrospective analysis of results in a group of treated patients.Method A total of 63 consecutive patients who underwent a standard lumbar discectomy were analysised retrospective. At the preoperative examination all patients suffered persistent sciatica and clearly presented a radiological picture of lumbar disc herniation using CT or MRI. Patients routinely underwent standard discectomy consisting of interlaminal fenestration followed by herniotomy. We evaluated the clinical results according to comparing the difference between post treatment score and pretreatment score of the Japanese Orthopedic Association(JOA) score, calculating the improvement in JOA score and the MacNab classification. Correlations between improvement of JOA scores and preoperative JOA scores, duration of preoperative sciatica, age at the operation, sex, body-mass index, smoking, educational level, number of fenestrations were investigated by multiple regression analysis.According to the MacNab classification, patients were divided into two groups (success and failure). The difference of the clinical characteristics between two groups were compared.We also evaluated the outcomes of different follow-up period and different number of operation levels.More frequently low back pain was found in 12.7% of the patients. There was no significant difference in age, body-mass index, amount of disc removed and number of fenestrations between patients with severe low back pain and others. Results The mean follow-up period for the 63 patients was 3.9 years, rang 2 to 7 years. After the operation, their JOA scores significantly increased from 11.8±4.2 to 23.7±3.6 (P<0.01). Overall improvement of JOA scores was 68.7%. Statistically significant predictor for improvement of JOA scores was duration of preoperative sciatica (P<0.01 r=-0.572). The longer duration of preoperative sciatica, the worse outcome. Patients suffering for more than 60 days from sciatica were found to have statistically worse outcome than patients suffering for less than 60 days (P<0.01).There was significant difference in the duration of preoperative sciatica between success group and failure group according to the MacNab classification (P<0.01).There was no significant difference in the outcome between single-level operation and two-level operation. There was no significant difference in the improvement in JOA score between the 2 to 4 years and more than 4 years follow-up. The outcome of standard discectomy remains unchanged in 2 years after operation. Conclusion 1,Being"golden standard"of operative treatment for lumbar disc herniation, the outcome of the standard discectomy are satisfying. There doesn't appear to be a significant deterioration with time after surgery. 2,Being the classic symptom of lumbar disc herniation, sciatica is not only one of the indications of operation but also a instructor of the opportunity of operation. We recommend conservative treatment up to 2 months and, if conservative management does not succeed, consideration of surgery.3,The most important factor for a good outcome in lumbar disc herniation is indication for surgery. It is important to assess patient from clinic and radiology. A prerequisite is radiologic identification of compressive pathology that is concordant with the patient's signs and symptoms. Orthopedic surgeon should also assess patient from psychosocial and biologic factors.
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