Lumbar Disc Herniation in Heavy Manual Workers: Conventional Discectomy versus TLIF with Unilateral Fixation

Background: Conventional discectomy is a common surgical method for treating lumbar disc prolapse. The situation may differ in heavy manual workers who may have more pronounced degenerative spine disease, broad based disc herniations and are expected to be exposed postoperatively to the same preoperative manual stress. Objective: Our aim is to compare the clinical outcome in patients operated for conventional discetomy versus those operated for TLIF with unilateral spinal fixation. Patients and Methods: Sixty patients underwent surgeries for lumbar disc herniation. They were divided into two groups; the discectomy group and the fusion group. They were operated between 2008 and 2015. Participants were evaluated pre-operatively and post-operatively at 3, 6, 9, and 12 month intervals. Pain was scored by a VAS for both lower limbs and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale and a new outcome score. Results: The two groups of patients were fairly homogeneous and comparable. The work load exposure to repetitive vibration was the most risk for disc prolapse and surgery (28.3 %). Fusion group showed better clinical outcome parameters including better VAS for low back pain, better Prolo economic, functional rating scale and better new clinical outcome score. In comparison the discectomy group showed significantly higher recurrence rate and reoperation during the follow up period. Conclusion: Heavy manual workers treated with unilateral transforaminal interbody fusion reported less pain lower disability scores all over the follow up period. This technique is preferable to conventional discectomy because it decreases back leg pain while avoiding the possibility of recurrence by heavy duties and it maintains stability of the lumbar spine.