Keywords : Outcome

Preoperative Predictors of Outcome Post Lumbar Discectomy

Iraqi Postgraduate Medical Journal, 2019, Volume 18, Issue 2, Pages 96-106

Deciding the prognostic factors that influence the surgical result would be useful for judgment planning. Other than that, recognizing the prognostic factors that foresee the clinical course of remaining dissensions may be essential for assist advancement of viable strategies for treatment, particularly when these prognostic components can be changed.
The aim of the study was to determine the positive, negative and unrelated predictors of surgical outcome for patients undergo lumbar discectomy.
A prospective cohort study including consecutive series of 102 patients, who had undergone surgical management for herniated lumbar discs at the private nursing home hospital in Baghdad, Iraq, between March 2017 and March 2018, were included in this study. The patient population consisted of 45 females and 57 males, ranging in age from 22 years to 65 years at the time of initial diagnosis with a mean age of 44.7 ± 7.9 years. A full available investigation had done including X-rays and M.R.I.
Male: female ratio equals 1.3:1, 69.6% are employed, 58% with no or basic educational level and 70% of patients were smokers. Average duration of low back pain and radicular pain were 8 and 4 months respectively. In 89% there was disc space height loss, the level lumbar disc herniation was at L4-L5 in 45% while at L5-S1 in 41%. Mean Oswestry disability index (ODI) was 63 and 27.7 respectively both pre and postoperatively. Mean Visual Analogue Score (VAS) for low back pain for pre (4.8) and postoperative period (1.8) while mean VAS for radicular pain preoperatively was 4.3 and postoperatively 1.4. The mean MCID – TUG test was 4.3 seconds.
Comparisons have been made with other studies regarding preoperative predictor factors and the lumbar discectomy surgical outcome.
- The good surgical outcome can be predicted with MCID ~ TUG test ≥ 3.4 seconds, TUG < 14 seconds, L5 - S1 disc level, annular defects, employed status, higher education, preserve disc height, BMI < 25, short duration of < 3 months of preoperative radicular pain. Lower VAS low back pain preoperatively of < 4 will have better postoperative results regarding back pain.
- Worse outcome predictors include male gender, tall patients >180 cm, low level of education, unemployment, higher preoperative ODI ≥ 40%, positive tension root signs, > 50 % disc height loss, preoperative motor deficits, prolonged duration of preoperative low back pain (> 3 months) and higher preoperative VAS score radicular pain (≥ 4). Also to mention that higher preoperative VAS low back pain (≥ 4) will be translated to more postoperative radicular pain.
- Factors that have no effect on outcome include age and smoking.
KEYWORDS: Outcome, predictor factors, lumbar discectomy.