Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes.

摘要

STUDY DESIGN. Patients were assessed by independent research teams in six different spine centers after indication for discectomy was established. Six- and twelve-month follow-ups were performed. OBJECTIVES. Objectives of this study were to determine somatic subjective symptoms, objective signs, sociodemographic, and psychological factors that influence the outcome of lumbar disc surgery, as well as to develop a screening checklist and score of reliable predictors to distinguish bad and good responders of surgery. METHODS. In addition to symptoms, signs, and neuroradiologic findings, sociodemographic data were obtained. A mobility questionnaire and Beck depression inventory were included in the structured interview. RESULTS. In all, 381 patients were examined. At 6 months 89% and at 12 months, 86% of all operated patients were available for follow-up study. There was no significant difference in the outcome between the 6- and 12-month follow-ups. Of the patients, 51.5% had a good outcome, 28.4% moderate, and 20.1% bad at 12 months follow-up. The calculation of predictor score gave an overall appropriate prediction of 80%, for good outcome 76%, and for bad 79%. CONCLUSION. In addition to clinical and radiologic examination, the Hannover Mobility Questionnaire, the Beck depression inventory, and structured interview should be included for preoperative assessment for disc surgery. If a bad outcome is predicted, it is probably more appropriate not to operate and await natural development of the disc disease or to apply conservative and psychological treatment.