Prognostic Value of Impaired Preoperative Ankle Reflex in Surgical Outcome of Lumbar Disc Herniation

  Background: Several prognostic factors exist influencing the outcome of surgical discectomy in the patients with lumbar disc herniation (LDH). The aim of this study is to evaluate the relationship between severity of preoperative impaired ankle reflex and outcomes of lumbar discectomy in the patients with L۵-S۱ LDH. Methods: We retrospectively evaluated ۱۸۱ patients (۱۰۸ male and ۷۳ female) who underwent simple discectomy in our orthopedic department from April ۲۰۰۹ to April ۲۰۱۳ and followed them up for more than one year. The mean age of the patients was ۳۵.۳±۸.۹ years old. Severity of reflex impairment was graded from ۰ to ۴+ and radicular pain and disability were assessed by visual analogue scale (VAS) and Oswestry disability index (ODI) questionnaires, respectively. Subjective satisfaction was also evaluated at the last follow-up visit. Chi-square and Kruskal-Wallis tests were used to compare qualitative variables. Results: Reflex impairment existed in ۴۴.۸% preoperatively that improved to ۱۰% at the last follow-up visit. Statistical analyses could not find a significant relationship between the severity of impaired ankle reflex and sex or age (P=۰.۵۳۸ and P=۰.۷۰۹, respectively). There was a remarkable relationship between severity of reflex impairment and preoperative radicular pain or disability (P=۰.۰۱۲ and P=۰.۰۰۲, respectively). Kruskal-Wallis test showed that a more severity in ankle reflex impairment was associated with not only less improvement in postoperative pain and disability but also less satisfaction rate (P Conclusions: In the patients with L۵-S۱ LDH, more severe ankle reflex impairment is associated with less improvement in postoperative pain, disability, and subjective satisfaction.

Keywords:

Ankle Reflex , Discectomy , Outcome , Prognosis