Outcome evaluation of the operative management of lumbar disc herniation causing sciatica

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors conducted a study to assess health-related quality of life (HRQOL) and the appropriateness of surgery in patients who have undergone elective lumbar discectomy.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The study involved a prospective cohort of 82 surgically treated patients with lumbar disc herniation causing lower-extremity radiculopathy. An independent study coordinator recorded demographic data and administered the North American Spine Society (NASS) lumbar spine instrument and the Short Form—36 (SF-36) before treatment, and at 6 months and 1 year after surgery. The HRQOL results were also compared with normative data for the NASS and SF-36. The influence of baseline variables on HRQOL was determined using regression modeling. The InterQual Indicators for Surgery and Procedures (ISP) were used to compare surgeon practice patterns with standardized indications for surgery.</jats:p> <jats:p content-type="fine-print">The NASS neurogenic symptom (NSS) and pain/disability scores (PDSs) showed very significant improvement at 6 months and little change between 6 months and 1 year. The SF-36 physical function and bodily pain scale scores were associated with the greatest improvement. Interestingly, the 1-year NASS (NSS and PDS) and SF-36 (only PCS) scores remained lower than those of age-matched normative data. Other than preoperative HRQOL scores, the only other variable that inversely influenced HRQOL was the duration of time between symptom onset and surgery. Ninety-five percent of ISP forms were completed, and 97% of the indications recorded by the surgeon matched the criteria.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The reporting of standardized outcomes in association with indications for surgery is feasible and may help elucidate the ideal rate for discectomy.</jats:p>

Optimal Duration of Conservative Management Prior to Surgery for Cervical and Lumbar Radiculopathy: A Literature Review

“…In the 43 patients who underwent surgery within 60 days following the onset of their symptoms, HRQOL scores were greater (0.08 compared with 0.05), QALYs were greater (2.50 compared with 1.64), and cost per QALY was less (€1351 compared with €2182) compared with the 58 patients who waited longer than 60 days for surgery 5. Fisher et al prospectively studied 82 patients with lumbar disk herniation with radiculopathy and found that patients who had surgery within 3 months of symptom onset had better HRQOL scores (based on the North American Spine Society instruments Neurogenic Symptoms Score and Pain/Disability Score and Short Form-36) compared with patients who were operated on later after symptom onset (following 3.1 to 6 months, 6.1 to 9 months, or 9.1 to 12 months) 13. However, Akagi and colleagues retrospectively studied 46 patients who had surgery for lumbar disk herniation before or after 3 months of symptom duration and found that there were no differences in pain or functional status based on the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire 14.…”

Patientsʼ Satisfaction With Provided Care/Information and Expectations on Clinical Outcome After Lumbar Disc Herniation Surgery

“…The patients remained at the hospital for 5 days. 2,3,8,9,[11][12][13][14][15][16] The study population had a mean age of 40 years (range 18 -66), and 68 (46%) of the patients were women. Sixty-six (45%) patients underwent surgery at the L4 -L5 level and 82 (55%) at the L5-S1 level.…”

How Does Surgery Affect Sexual Desire and Activities in Patients With Lumbar Disc Herniation?

“…In general, preoperative disability and surgical outcomes have been assessed by severity of pain, general health status, and return to work. [1][2][3] There is a paucity of information regarding quality of sexual activities before and after surgical treatment of lumbar disc herniation. Patients and health care professionals often hesitate to talk about the effects of disease, illness, or surgery on sexuality, but it is imperative that sexuality issues be addressed.…”