Seven-year clinical follow-up after lumbar disc surgery: results and predictors of outcome

Abstract

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.

Risk factors for back pain-related loss of working time after surgery for lumbar disc herniation: a 5-year follow-up study

“…In the present study, 10% of the patients had a permanent work disability pension due to back after 5 years of surgery. Similar but also much differing rates of work disability have been reported earlier [15,22,34,40,49].…”

“…The 2 months sick leave which was routinely prescribed during this study may be inappropriately long in many cases. Longer sick leave has adverse psychosocial impact increasing the odds of permanent loss of employment [6,25] but the rate of work disability here was less than the reported in many studies [15,22,34,40,49]. A 2 months sick leave, however, may cause needless loss of work productivity.…”

“…With longer follow-up times (7-10 years) 77-93% of patients have regained employment [22,34]. However, shorter-term work disability, i.e., sick leave periods, may represent a substantial portion of the total impact of lumbar disc herniation on work performance.…”

Is preoperative occupation related to long-term pain in patients operated for lumbar disc herniation?

“…Graver et al 42 found that strenuous work activities were related to a lower frequency of return to work. In a subsequent paper, he found that physical fitness has no significant prognostic value 27 , reinforcing the concept that it is not the effort itself, but the patients' perception of it that may influence the outcome for return to work.…”

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

“…Additionally, a number of studies have suggested that litigation (Bernard, 1993;DeBerard, Masters, Colledge, Schleusener, & Schlegel, 2001;Epker & Block, 2001;Junge, Dvorak, & Ahrens, 1995;LaCaille et al, 2005;Taylor et al, 2000) and insurance compensation or worker's compensation (Bernard, 1993;Deyo, Mirza, Heagerty, Turner, & Martin, 2005;Epker & Block, 2001;Glassman et al, 1998;Greenough, Taylor, & Fraser, 1994;GrothMarnat & Fletcher, 2000;Klekamp, McCarty, & Spengler, 1998;Mannion & Elfering, 2006;Taylor et al, 2000) are also associated with poor surgical outcome. Other identified risk factors for poor surgical outcome include anger (Dvorak, Valach, Fuhrimann, & Heim, 1988;Herron, Turner, & Weiner, 1988), neuroticism , psychological distress (Andersen, Christensen, & Bunger, 2006;Derby et al, 2005;Deyo et al, 2005;Graver, Haaland, Magnaes, & Loeb, 1999; Van Susante, Van de Schaaf, & Pavlov, 1998), psychological trauma in childhood (Schofferman, Anderson, Hines, Smith, & Keane, 1993;Schofferman et al, 1992), chemical dependency (Spengler, Freeman, Westbrook, & Miller, 1980;Uomoto, Turner, & Herron, 1988), spousal reinforcement of pain behaviors , no support from spouse (Schade, Semmer, Main, Hora, & Boos, 1999), self-perception of pre-surgical good health (Katz et al, 1999), fear of movement or reinjury (den Boer, Oostendorp, Beems, Munneke, & Evers, 2006), negative outcome expectancy (den Boer, Oostendorp, Beems, Munneke, & Ev...…”