The risk of ?getting worse? after lumbar microdiscectomy

Abstract

IntroductionLumbar microdiscectomy is the most frequently performed spinal operation. A frequent concern among the patients is the risk of "getting worse" after the operation. It is difficult to give an evidence-based estimate of the risk of deterioration, since previous studies have been more focused on unfavourable outcome in general, rather than on deterioration in particular. 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. Furthermore, patients with a favourable outcome score at follow-up may have deteriorated, but this only becomes evident when a change in score is considered. This implies that risk factors for deterioration and a "poor outcome" might be different.The aim of this prospective study was to evaluate the frequency and the predictors of "getting worse" in a cohort of 180 consecutive patients operated by microdiscectomy for lumbar disc herniation. Abstract A frequent concern among patients operated for lumbar disc herniation is the risk of "getting worse". To give an evidence-based estimate of the risk for worsening has been difficult, since previous studies have been more focused on unfavourable outcome in general, rather than on deterioration in particular. In this prospective study of 180 patients, we report the frequency of and the risk factors for getting worse after first time lumbar microdiscectomy. Follow-up time was 12 months. Primary outcome measure was the Oswestry disability index, assessing functional status and health-related quality of life. Of the patients 4% got worse. Independent risk factors of deterioration were a long duration of sick leave and a better functional status and quality of life prior to operation. We conclude that the risk of deterioration is small, but larger if the patient has been unable to work despite relatively small health problems. This study also demonstrates that changes in instrument scores should be reported, so that an accurate failure rate can be assessed.

Work-related outcome assessment instruments

“…Parallel with consistent findings of pain history as the most powerful predictor for future pain episodes [28], evidence suggests that prior inability to work despite relatively small health problems is a major risk factor for unfavourable work-related outcome after lumbar disk surgery. It follows from here that RTW after treatment for spinal disorder is no specific process and that work-related outcome should be adjusted against prior sick-leave history [97]. A second important consequence is that minor comorbidity factors in some patients might be responsible for delayed RTW that is attributed to recovery from spinal disorder.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…Indeed, prospective studies focusing on postoperative deterioration of functional status are lacking. This prompted Solberg et al [20] to study the risk of worsening after lumbar microdiscectomy. They prospectively studied 180 patients operated by microdiscectomy for lumbar disc herniation, with a follow-up time of 1 year.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal review

“…I enjoyed the two papers dealing with the outcome after operations by Kara et al [19] and Solberg et al [32].…”

“…The paper by Solberg et al [32] is also being discussed by Dr. Benoist, but one point I would make is that I was surprised that the authors did not mention the imaging studies. Patients who seem sufficiently disabled to justify surgical treatment, and yet have a small protrusion do less well, and I was surprised that they did not address this (Spengler et al [33]).…”