Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up

Abstract

Factors as age, sex, smoking, duration of leg pain, working status, type/level of disc herniation and psychosocial factors have been demonstrated to be of importance for short-term results after lumbar discectomy. There are few studies with long-term follow-up. In this prospective study of lumbar disc herniation patients undergoing surgery, the result was evaluated at 2 and 5-10 (mean 7.3) years after surgery. Predictive factors for satisfaction with treatment and objective outcome were investigated. Out of the included 171 patients undergoing lumbar discectomy, 154 (90%) patients completed the 2-year follow-up and 140 (81%) completed the long-term follow-up. Baseline data and questionnaires about leg- and back pain intensity (VAS), duration of leg pain, disability (Oswestry Disability Index), depression (Zung Depression Scale), sick leave and employment status were obtained preoperatively, at 2-year- and long-term follow-up. Primary outcome included patient satisfaction with treatment (at both time points) and assessment of an independent observer at the 2-year follow-up. Secondary outcomes at 2-year follow-up were improvement of leg and back pain, working capacity and the need for analgesics or sleeping pills. In about 70% of the patients excellent or good overall result was reported at both follow-ups, with subjective outcome measurements. The objective evaluation after 2 years was in agreement with this result. Time on sick leave was found to be a clinically important predictor of the primary outcomes, with a potential of changing the probability of a satisfactory outcome (both objective and subjective) from around 50% (sick leave >3 months) to 80% (sick leave <2 months). Time on sick leave was also an important predictor for several of the secondary outcomes; e.g. working capacity and the need for analgesics.

Recovery of muscle strength after microdiscectomy for lumbar disc herniation: a prospective cohort study with 1-year follow-up

“…The surgical method used in this study, microdiscectomy, seems to be the preferred method in many publications [13][14][15][16][17], and has fewer complications than other methods [18]. This study shows that 75% of the patients with limb paresis due to herniated lumbar disc had full recovery 12 months after micro discectomy.…”

How to predict return to work after lumbar discectomy: answers from the NeuroPoint-SD registry

“…Similarly, a prospective Swedish study found that 89% of patients who underwent lumbar discectomy were working in some capacity 2 years after surgery. 13 The factors predictive of return to work at 2 years included a shorter duration of leg pain (less than 6 months) and less time spent on sick leave preoperatively (less than 2 months).…”

Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation

“…7,8 Recurrence was defined as appearance of symptoms of LDH, confirmed by MRI at the same site and level or another level and re-operation was defined for re-surgery for recurrence or any other complication related with index surgery.…”

“…[4][5][6] All of these studies, based upon western population, have found three important variables; medical insurances, worker's compensation and sick leave as important predictors of outcome after LDH surgery. 7,8 But these predictors are not present among Nepalese population because of different social, economic and cultural factors. Hence, it can be assumed that predictors for outcome after LDH surgery will be different in Nepalese population.…”