A two-year prospective follow-up study of the outcome after surgery in patients with slipped lumbar disk operated upon for the first time

Abstract

57 patients who were operated upon for the first time for slipped lumbar disk have been investigated in a prospective blind follow-up design. In both the preoperative and postoperative evaluation objective as well as subjective conditions have been considered, and the surgeons have not re-examined the patients. There is a 100% follow-up of the patients. We found that the following preoperative conditions are associated with surgical outcome, 6 and 24 months postoperatively: Medical parameters like statement of pain and surgical findings; social parameters such as being employed, duration of education, and whether you get sufficient social support from family and friends; duration of sick-leave, actions for damages, and number of life events. Psychological parameters such as pain drawing and the MMPI-scales: F, K, Hs, D, Hy, Pa, Pt, Sc, Ma, and Ad. In the statistical analysis multiple linear regression analysis is used, which allows evaluation of the different parameters compared with each other. It is found that conditions such as being employed, increase of the MMPI-scale Ad, alone could explain the 42% difference in surgical outcome. Good outcome is correctly predicted in 88% of the cases with observed good outcome. Poor outcome is correctly predicted in 54% of the cases with observed poor outcome.

The relations between social support, life stress, and quality of Life following spinal decompression surgery

“…For example, among patients who have undergone lumbar disc surgery, those with postoperative medical complaints reported lower satisfaction in family and social support than those patients with no postoperative medical complaints. 8,14 More generally, social support has been negatively associated with morbidity among patients with musculoskeletal disorders. 7 On a more positive note, social support from a spouse has been positively associated with pain relief up to 2 years after spinal decompression surgery.…”

“…13 Furthermore, those patients who are unemployed at the time of surgery tend to have poorer postoperative outcomes. 14,15 There may also be social incentives that negatively impact patients' recovery. Researchers have found increases in reported pain, disability, and psychological distress among those with chronic low back pain who are also receiving workers' compensation benefits compared to those not receiving benefits.…”

“…For example, life stress and social support have been identified as important variables influencing medical outcome in people with degenerative spine disease. 7,8,14,[19][20][21] In fact, some studies have shown that life stress and social support predict objective postoperative outcome better than clinical findings or radiologically identified morphological changes in the spine. 21,22 Despite these intriguing findings, the relations between life stress, social support, and subjective quality of life among degenerative spine disease patients have not yet been directly studied.…”

The risk of ?getting worse? after lumbar microdiscectomy

“…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.…”