Prognosis of multifactorial outcome in lumbar discectomy: a prospective longitudinal study investigating patients with disc prolapse

OBJECTIVES: Although previous research has shown that certain medical data and psychosocial factors predict postoperative pain, it remains unclear whether they also contribute to a more distinct outcome measure that is based on classification of self-reported outcome criteria. To assess the prognostic power of somatic, psychologic, and social predictors when evident outcome criteria of surgical treatment are investigated, this study used a prospective longitudinal design examining preoperative factors associated with outcome six months after lumbar discectomy.

METHODS: Forty-eight out of 58 consecutive patients were included (60% male, 40% female, mean age 47 years). Preoperative data comprised of Lasegue sign (straight leg raising test), pain duration, paresis and radicular distribution, depression, pain disability, pain coping strategies, and qualitative descriptions of pain. Additionally, sociodemographic and occupational characteristics were observed. Six months' postoperative classification of outcome included pain intensity, pain locations, functional capacity, return to work, and health-related quality of life.

RESULTS: From a surgical point of view, lumbar discectomy was successfully carried out on all patients. But, when subjective criteria of outcome were investigated, 56% of patients benefited from lumbar discectomy, whereas 44% of patients had poor results. Lasegue sign, depression, and sensory pain descriptions proved to be significant predictors, whereas pain cognition and pain coping strategies had no significant influence on evident outcome classification.

DISCUSSION: Classification of patients regarding their individual outcome profiles showed that patients responded differently to lumbar disc-surgery. High risk factors for poor outcome of surgery are Laseque-sign and depression.