Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes.

STUDY
DESIGN: Patients were assessed by independent research teams in six different spine centers after indication for discectomy was established. Six- and twelve-month follow-ups were performed.
OBJECTIVES: Objectives of this study were to determine somatic subjective symptoms, objective signs, sociodemographic, and psychological factors that influence the outcome of lumbar disc surgery, as well as to develop a screening checklist and score of reliable predictors to distinguish bad and good responders of surgery.
METHODS: In addition to symptoms, signs, and neuroradiologic findings, sociodemographic data were obtained. A mobility questionnaire and Beck depression inventory were included in the structured interview.
RESULTS: In all, 381 patients were examined. At 6 months 89% and at 12 months, 86% of all operated patients were available for follow-up study. There was no significant difference in the outcome between the 6- and 12-month follow-ups. Of the patients, 51.5% had a good outcome, 28.4% moderate, and 20.1% bad at 12 months follow-up. The calculation of predictor score gave an overall appropriate prediction of 80%, for good outcome 76%, and for bad 79%.
CONCLUSION: In addition to clinical and radiologic examination, the Hannover Mobility Questionnaire, the Beck depression inventory, and structured interview should be included for preoperative assessment for disc surgery. If a bad outcome is predicted, it is probably more appropriate not to operate and await natural development of the disc disease or to apply conservative and psychological treatment.