The long-term effects of wide laminectomy for lumbar disc excision. A review of 130 patients.

It is thirty-seven years since Mixter and Barr (1934) presented their classical paper on the surgical treatment of ruptured intervertebral discs. In 1941 they published the short-term results in ninety-four patients with lumbar lesions. They showed that fusion of the spine at the time of laminectomy lowered the incidence of subsequent back symptoms and concluded that laminectomy weakened the back. The first long-term results of lumbar disc operation did not appear until after the second world war. In 1949 Spurling and Grantham reported a questionnaire follow-up of327 patients after simple disc clearance through a unilateral interlaminar approach. In 1951 O’Connell published a series of 500 interlaminar operations followed up for two to ten years and in the same year Burns and Young published a review of 616 patients followed up for a similar period after wide laminectomy. The initial sciatica was relieved in much the same proportion in all three series. Post-operative back pain and recurrent sciatica were examined in detail both by Spurling and Grantham and by O’Connell. Burns and Young, though stating that the large proportion of cures in their series indicated that the spine was not weakened by the operation, did not investigate the incidence of back pain after laminectomy. No one has seriously challenged the assumption by Barr and Mixter (1941) that compared with the interlaminar approach the better exposure afforded by wide laminectomy is offset by greater post-operative disability. This “disability” has never been properly determined. The object ofthe present review was to investigate more fully the long-term effects of wide laminectomy and to compare the morbidity after this operation with that of the interlaminar approach.