Predictors of pain and disability outcomes in one thousand, one hundred and eight patients who underwent lumbar discectomy surgery

Background A key component toward improving surgical outcomes is proper patient selection. Improved selection can occur through exploration of prognostic studies that identify variables which are associated with good or poorer outcomes with a specific intervention, such as lumbar discectomy. To date...

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Bibliographic Details
Published in:International orthopaedics 2015-11, Vol.39 (11), p.2143-2151
Main Authors: Cook, Chad E., Arnold, Paul M., Passias, Peter G., Frempong-Boadu, Anthony K., Radcliff, Kristen, Isaacs, Robert
Format: Article
Language:English
Subjects:
Adult
Aged
Disability Evaluation
Diskectomy - adverse effects
Female
Humans
Low Back Pain - diagnosis
Low Back Pain - etiology
Low Back Pain - surgery
Lumbar Vertebrae - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Original Paper
Orthopedics
Pain Measurement
Prognosis
Prospective Studies
Quality of Life
Retrospective Studies
Treatment Outcome
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Summary:Background A key component toward improving surgical outcomes is proper patient selection. Improved selection can occur through exploration of prognostic studies that identify variables which are associated with good or poorer outcomes with a specific intervention, such as lumbar discectomy. To date there are no guidelines identifying key prognostic variables that assist surgeons in proper patient selection for lumbar discectomy. The purpose of this study was to identify baseline characteristics that were related to poor or favourable outcomes for patients who undergo lumbar discectomy. In particular, we were interested in prognostic factors that were unique to those commonly reported in the musculoskeletal literature, regardless of intervention type. Methods This retrospective study analysed data from 1,108 patients who underwent lumbar discectomy and had one year outcomes for pain and disability. All patient data was part of a multicentre, multi-national spine repository. Ten relatively commonly captured data variables were used as predictors for the study: (1) age, (2) body mass index, (3) gender, (4) previous back surgery history, (5) baseline disability, unique baseline scores for pain for both (6) low back and (7) leg pain, (8) baseline SF-12 Physical Component Summary (PCS) scores, (9) baseline SF-12 Mental Component Summary (MCS) scores, and (10) leg pain greater than back pain. Univariate and multivariate logistic regression analyses were run against one year outcome variables of pain and disability. Results For the multivariate analyses associated with the outcome of pain, older patients, those with higher baseline back pain, those with lesser reported disability and higher SF-12 MCS quality of life scores were associated with improved outcomes. For the multivariate analyses associated with the outcome of disability, presence of leg pain greater than back pain and no previous surgery suggested a better outcome. Conclusions For this study, several predictive variables were either unique or conflicted with those advocated in general prognostic literature, suggesting they may have value for clinical decision making for lumbar discectomy surgery. In particular, leg pain greater than back pain and older age may yield promising value. Other significant findings such as quality of life scores and prior surgery may yield less value since these findings are similar to those that are considered to be prognostic regardless of intervention type.
ISSN:0341-2695
1432-5195
DOI:10.1007/s00264-015-2748-0