Elective discectomy for herniation of a lumbar disc. Additional experience with an objective method.

An objective evaluation for the assessment of patients who have persistent low-back pain and sciatica was tested in eighty-four patients who were operated on by one of us (D.M.S.). In this scoring system, there are four major categories for preoperative assessment: neurological signs, sciatic-tension signs, psychological factors, and imaging studies. When the preoperative scores of the eighty-four patients were correlated with the findings at operation, the three patients who had the lowest scores were the only ones in whom the operative findings were negative. As shown by statistical analysis, the score for imaging studies correlated best with the operative findings. In contrast, in the sixty-one patients who were followed sufficiently to determine the clinical outcome, the psychological score was the best predictor of the outcome of treatment. On the basis of these studies, we concluded that the use of this objective scoring system reduced the incidence of negative findings at exploration of the disc and improved the clinical result after elective discectomy. The higher the score was preoperatively, the more likely the patient was to have a good result after discectomy.