Outcome Analysis in 654 Surgically Treated Lumbar Disc Herniations

Abstract

This article reports the outcomes of 654 consecutive patients treated during a 4.5-year period. Patients had a microdiscectomy, a laminectomy plus microdiscectomy, or a decompressive laminectomy with a microdiscectomy. The causes of ruptured discs were lifting (31.4%), falls (10.2%), and sports (10.0%). Almost all patients had complained of leg pain (99%), and 79% had radicular pain in a dermatomal distribution. Thirty-three percent of the patients had been involved in industrial accidents, and 6% had legal claims pending during the surgical period. Almost 11% of the patients had complications, and there was one death caused by abdominal arterial bleeding. Patients were also rated according to the Prolo Functional-Economic Outcome Rating Scale to improve the ability to compare series in the future. Almost 80% of the patients had good outcomes as defined by scores on this scale of 8 (16.2%), 9 (33.2%), and 10 (26.9%). Several conclusions can be drawn from the results of this series: 1) most patients had good outcomes; 2) patients with nonindustrial injuries had better outcomes than did patients with industrial injuries; 3) professionals with legal concerns and laborers with industrial insurance had good outcomes; and 4) the Functional-Economic Outcome Rating Scale appears to be a useful tool for comparing different procedures more objectively and for comparing the outcomes across series.

The risk of ?getting worse? after lumbar microdiscectomy

“…The deterioration is significant, and it occurs within a larger cohort of patients with a favourable overall outcome, demonstrated by large effect sizes on all outcome measures. Similar results have been published elsewhere [2,9,17,21,25,26]. Patients who had been sicklisted for a longer period of time or had a better ODI score prior to operation were at a higher risk of "getting worse".…”

“…Several predictors of an unfavourable outcome have been identified [1,2,12,20,25,28,30,31,32] and socioeconomic and psychological factors seem to play a major role [7,9,15,21,24]. Risk factors for deterioration of functional status and HRQL after microdiscectomy have not been reported.…”

“…Some studies reported on increase in pain after microdiscectomy [17,26,29] and one study reported on decrease in health-related quality of life (HRQL) after such operations [30]. Prospective studies focusing on deterioration of functional status after microdiscectomy are lacking.Several predictors of an unfavourable outcome have been identified [1,2,12,20,25,28,30,31,32] and socioeconomic and psychological factors seem to play a major role [7,9,15,21,24]. Risk factors for deterioration of functional status and HRQL after microdiscectomy have not been reported.…”

Clinic-based training in comparison to home-based training after first-time lumbar disc surgery: a randomised controlled trial

“…Depending on patient selection and definitions, the success rate of surgery ranges from 60 to 90% [1,20,27,31,32,43]. In this study, both groups had a pronounced treatment effect 12 months after surgery, with a mean decrease of 24.6 (SD 20.5) in ODI scores for the whole sample: from a mean of 39.6 preoperatively to a mean of 15.1 at 12-month follow-up.…”

Excellent recovery of medical doctors after lumbar discectomy

“…The results of some earlier studies on patients operated on for lumbar disc herniation suggest that social and psychological factors may influence the postoperative outcome even more than do the operative findings or the preoperative clinical signs [2,4]. I have paid attention to the exceptionally good postoperative recovery of medical doctors who have undergone discectomy in our hospital.…”