A 10-year follow-up of the outcome of lumbar microdiscectomy.

STUDY DESIGN: A retrospective analysis of the outcome of lumbar microdiscectomy, with independent assessment of outcome. OBJECTIVES: To explore whether the initial positive outcome after microdiscectomy is maintained at long-term follow-up. SUMMARY OF BACKGROUND DATA: Previous reports on long-term outcome after lumbar disc surgery give conflicting messages about whether an initially positive surgical outcome is maintained throughout a 10-year period. This is partly due to differing methods and the failure to include initial outcome, thereby permitting assessment of possible deterioration in the quality of outcome. METHODS: This study presents the initial and long-term outcome after lumbar microdiscectomy, with an independent assessment of outcome. Eighty-eight consecutive patients undergoing lumbar microdiscectomy were identified. Assessment at 10 years after surgery was obtained in 79 (90%) of the cases. The initial outcome was assessed retrospectively by an independent observer at 6 months after surgery using the Macnab classification. The final outcome Macnab classification was completed by postal questionnaire by the patients themselves, who also completed a modified Roland-Morris disability questionnaire. RESULTS: A successful outcome at 6 months was achieved in 91% of the cases. At 10-year follow-up, this result declined slightly to an 83% success rate. However, there was no statistically significant difference between these outcome results. The long-term Macnab classification results correlated well with disability, as measured by the Roland-Morris score. Patient satisfaction with the results of microdiscectomy 10 years later was high. CONCLUSIONS: Lumbar microdiscectomy achieves a high level of initial success, and this positive outcome is maintained at a 10-year follow-up.

Recurrent self-inflicted craniocerebral injury: case report and review of the literature.

Self-inflicted craniocerebral injuries have been reported exclusively in mentally disturbed patients and criminals. We report a 28-year-old man with a severe mental disorder who initially hammered a nail into his brain and subsequently repeatedly inserted foreign objects into his brain. The literature is reviewed and the surgical and psychiatric management discussed.

Intracranial meningiomas following irradiation--a growing problem?

We present 10 cases of meningiomas occurring after high-dose irradiation for other brain tumours. These constitute 3.7% of 272 patients with meningiomas treated in our unit over 10 years. The clinical and pathological features of the 10 cases were added to those of 69 previous cases documented in the literature and compared with the features of our 262 spontaneous meningiomas. The literature on 119 cases of low-dose radiation-induced meningiomas was also reviewed. Malignant histological features and multiplicity were more common in the radiation-induced meningiomas (p < 0.01). Increasing long-term survival rates following radiotherapy for primary intracranial tumours, particularly in childhood, may lead to an increased incidence of postirradiation meningiomas.