Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis

Abstract

BackgroundSuccess rates for lumbar discectomy are estimated as 78–95% patients at 1–2 years post-surgery, supporting its effectiveness. However, ongoing pain and disability is an issue for some patients, and recurrence contributing to reoperation is reported. It is important to identify prognostic factors predicting outcome to inform decision-making for surgery and rehabilitation following surgery. The objective was to determine whether pre-operative physical factors are associated with post-operative outcomes in adult patients [≥16 years old] undergoing lumbar discectomy or microdiscectomy.MethodsA systematic review was conducted according to a registered protocol [PROSPERO CRD42015024168]. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. radicular pain] to 31/3/2017; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥1-year follow-up, evaluating candidate physical prognostic factors [e.g. leg pain intensity and straight leg raise test], in adult patients undergoing lumbar discectomy/microdiscectomy were included. Two reviewers independently searched information sources, evaluated studies for inclusion, extracted data, and assessed risk of bias [QUIPS]. GRADE determined the overall quality of evidence.Results1189 title and abstracts and 45 full texts were assessed, to include 6 studies; 1 low and 5 high risk of bias. Meta-analysis was not possible [risk of bias, clinical heterogeneity]. A narrative synthesis was performed. There is low level evidence that higher severity of pre-operative leg pain predicts better Core Outcome Measures Index at 12 months and better post-operative leg pain at 2 and 7 years. There is very low level evidence that a lower pre-operative EQ-5D predicts better EQ-5D at 2 years. Low level evidence supports duration of leg pain pre-operatively not being associated with outcome, and very low-quality evidence supports other factors [pre-operative ODI, duration back pain, severity back pain, ipsilateral SLR and forward bend] not being associated with outcome [range of outcome measures used].ConclusionAn adequately powered low risk of bias prospective observational study is required to further investigate candidate physical prognostic factors owing to existing low/very-low level of evidence.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2240-2) contains supplementary material, which is available to authorized users.

Predictors of improvement following early exercises rehabilitation program for patients undergoing open lumbar discectomy

“…It is important to recognize prognostic factors predicting patients' outcomes to inform decision-making for rehabilitation following lumbar discectomy. [24] Our study was inconsistent with the study of Soriano et al…”

“…[22] Similarly, Soriano et al (2010), also found that age and sex had no predictive value in all outcome measure. [23] A study by Rushton et al (2018), identified that there was a very low-quality evidence that pre-operative ODI predict better ODI at twelve months. Lumbar discectomy success rates have been reported as high as 78%-95% at one to two years post-surgery.…”

Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis

“…It was not possible to investigate the influence of age at time of surgery, level of education, work satisfaction, coexistence of psychological complaints, evidence of passive avoidance coping function, and duration of sick leave, as data were insufficient. Selection of variables was informed by a recent review of prognostic factors [32].…”

Timing of Surgery in Tubular Microdiscectomy for Lumbar Disc Herniation and Its Effect on Functional Impairment Outcomes

“…Variables for adjustment, such as age, sex, BMI, and baseline PROM values, were additionally selected based on previously published data, and represent potential confounders. [25][26][27][28] Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) in reaching MCID were assessed for different cutoffs set at every 2 weeks, from week 2 to 52. The optimal TTS cutoff was established with the use of quantitative as well as qualitative analyses.…”