Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results.

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.

Forty-six consecutive patients with neck pain and arm radiculopathy were treated with anterior cervical discectomy and fusion. All patients had neurological symptoms corresponding to a herniated disc and/or spondylosis at one or two cervical levels, verified by magnetic resonance imaging. The patients were stabilized with an anterior graft and randomized to either fixation with a CSLP plate or no internal fixation. Preoperatively and 2 years postoperatively the patients filled in a questionnaire that included a modified Million Index, a modified Oswestry Index and the Zung Depression Scale. They were also asked to register their pain in the arm and in the neck on a vertical visual analogue scale (VAS). At the 2-year follow-up, an unbiased observer graded the patients' clinical outcome using Odom's criteria. A test-retest procedure was carried out to examine the questionnaire reproducibility. In the group that was operated at one level, there was no significant improvement in any of the scores. Nevertheless, 81% of the patients were satisfied with the outcome of the surgery. All scores improved in the group operated at two levels. The pain in the neck and arm, as measured on a VAS, decreased in both groups. The improvement in arm pain was significantly more pronounced in patients operated with a plate at two levels compared to those who were operated without a plate. At the 2-year follow-up, patients with an excellent or good result according to Odom's criteria had a lower Million Index (P < 0.0005), Oswestry Index (P < 0.0005), and Zung (P = 0.024) score, than the group classified as fair or poor. There was a significant correlation (P < 0.0001 for all scores) between the test and retest results. We conclude that the modified Million Index and Oswestry Index are clinically useful tools in the evaluation of outcome after degenerative cervical disc surgery. The clinical benefits of plate fixation were minimal. The outcome after surgery, measured with the Oswestry Index, Million Index and VAS for arm and neck pain, seems to correlate well with the classification of outcome by Odom.

A prospective randomised 2-year follow-up study on patients undergoing lumbar disc herniation surgery. The objective was to investigate the relationship between peridural scarring and clinical outcome, the scar development 6 and 24 months postoperatively by using MRI, and if ADCON-L (a bioresorbable carbohydrate polymer gel) has an effect on scar size and/or improve patients' outcome after lumbar disc herniation surgery. The association between peridural scarring and recurrent pain after lumbar disc herniation surgery is debated. Numerous materials have been used in attempts to prevent or reduce postoperative peridural scarring; however, there are conflicting data regarding the clinical effects. The study included 119 patients whose mean age was 39 years (18-66); 51 (47%) were women. Sixty patients (56%) were perioperatively randomised to receive ADCON-L, and 48 (44%) served as controls. All patients underwent MRI at 6 and 24 months postoperatively, and an independent radiologist graded the size, location and development of the scar, by using a previously described scoring system. Preand 2-year postoperatively patients graded their leg pain on a visual analogue scale (VAS). At the 2-year follow-up patients rated their satisfaction with treatment (subjective outcome) and were evaluated by an independent neurologist (objective outcome), using MacNab score. There was no relationship between size or localisation of the scar and any of the clinical outcomes (VAS, subjective and objective outcome). The scar size decreased between 6 and 24 months in 49%, was unchanged in 42% and increased in 9% of the patients. Patients treated with ADCON-L did not demonstrate any adverse effects, nor did they demonstrate less scarring or better clinical outcome than control patients. No significant association between the presence of extensive peridural scar or localisation of scar formation and clinical outcome could be detected in the present study. Further, no positive or negative effects of ADCON-L used in disc herniation surgery could be seen.