This study evaluates the 7-year outcome of lumbar disc surgery and the predictive value of pre- and perioperative risk factors. The 7-year follow-up rate of a sample of 122 patients was 93% (n = 114). Six per cent of the patients had undergone repeat surgery. Approximately 90% reported that they were satisfied with having undergone surgery. The clinical outcome was evaluated in 96 patients (54 men and 42 women) by means of patient-scores (VAS) of low back and leg pain, and a Clinical Overall Score (COS). In multivariate regression analyses, women were shown to have poorer outcome than men. Preoperative psychological distress and impaired fibrinolytic activity were predictors of poor 7-year outcome. Age, weight, smoking habits and physical fitness had no statistically significant prognostic value. Whether the patients were operated for one or two herniated discs, or whether surgery involved a full or partial laminectomy, did not influence the outcome significantly.

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Summary The pathophysiology of Raynaud's phenomenon after Cisplatin-Bleomycin-Vinblastine combination chemotherapy, its relationship to polyneuropathy, and response to transcutaneous nerve stimulation (TNS), was studied in eight patients previously treated for testicular cancer. Peripheral circulation in the index finger was measured by laser Doppler flowmetry before and after cold provocation. In all patients there was an exaggerated and prolonged vasoconstrictor response to cold, with a mean flux reduction of 61%, and a mean restitution time of >7 min, characteristic of Raynaud's phenomenon of the vasospastic type. The normal controls had a mean flux reduction of 24% and a restitution time of 1.5 min. Clinical examination and nerve conduction measurements revealed a mild polyneuropathy in five of the eight patients, but an etiological relationship with Raynaud's phenomenon could not be ascertained. There was no measurable effect of TNS.

The amount of scar formation after lumbar discectomy seems to be related to the clinical outcome, the size of the surgical exposure, and some fibrinolytic factors.