Some patients have good outcome following lumbar spine surgery, while others do not. Patients likely to have a bad outcome from surgery should be offered the pain management approach rather than surgical intervention. An initial paper in 1995 listed parameters associated with outcome 12 months after surgery. This was followed in 1996 with a subset of parameters associated with outcome 2 years after surgery.
Patient groups:
(1) disc herniation only
(2) disc herniation and other relevant back diagnosis
(3) no disc herniation, but other relevant back diagnosis
Patient inclusion:
(1) age < 70 years
(2) native German (study performed in Germany; intent was to prevent misunderstandings due to language)
(3) has an indication for surgery on the lumbar spine
Criteria associated with bad outcome:
(1) severe low back pain (visual analogue scale >= 6)
(2) reduced working ability of more than half a year or no return to previous job
(3) frequent visits to treating physician, or hospital stay
|
Outcome |
Findings |
|---|---|
|
bad |
either (a) 2 criteria plus moderate to severe pain (visual analogue scale reading >= 4), or (b) all 3 criteria |
|
moderate |
either (a) 1 criteria, or (b) 2 criteria plus low pain (visual analogue scale reading of 0 to 3) |
|
good |
none of the criteria |
Parameters for 2 Year Assessment After Surgery (1996)
|
Parameter |
Finding |
Points |
|---|---|---|
|
duration of reduced work ability |
<= 2 weeks |
-3 |
|
|
> 2 weeks to 26 weeks |
0 |
|
|
> 26 weeks to 52 weeks |
1 |
|
|
> 52 weeks |
3 |
|
duration of acute back pain |
<= 2 weeks |
-2 |
|
|
> 2 weeks to 12 weeks |
0 |
|
|
> 12 weeks to 26 weeks |
1 |
|
|
> 26 weeks |
3 |
|
number of other pain locations |
0 |
-1 |
|
|
1 |
1 |
|
|
2 |
3 |
|
|
> 2 |
6 |
|
disability pensioned considered or applied |
no |
0 |
|
|
yes |
3 |
|
depression (BDI) |
<= 10 |
0 |
|
|
> 10 |
1 |
|
intensity of pain on VAD scale |
< 2 |
-4 |
|
|
>= 2 |
0 |
|
job level |
low |
1 |
|
|
middle |
0 |
|
|
high |
-2 |
|
deficiency of reflexes |
no |
1 |
|
|
yes |
0 |
|
additional diagnosis |
no |
0 |
|
|
yes |
1 |
where:
• BDI = Beck depression inventory
• VAD = visual analogue scale for pain, from 0 (none) to 10 (unbearable)
predictive score =
= SUM(points for parameters present)
Interpretation of 2 year assessment score after surgery (1996):
• minimum score: -12
• maximum score: 19
• for Group 1 and Group 2 patients, a score of <= 1 was associated with 27/30 good outcomes 2 years after surgery; a score > 1 was associated with 19/29 bad outcomes 2 years after surgery
• for Group 3 patients, the predictive score was not useful. It was found that patients with (a) previous back surgeries, (b) additional painful areas, (c) general pain avoidance behavior and (d) positive Lasegue sign (straight leg raising test) benefited less from spine surgery than patients without those characteristics
Parameters for Assessment 12 Months After Surgery (1995)
In addition to the parameters above used for the 2 year assessment, the following were included in the 12 month assessment (1995):
|
Parameter |
Finding |
Points |
|---|---|---|
|
physical mobility |
<= 25% |
-4 |
|
|
> 25% to 50% |
-1 |
|
|
> 50% to 75% |
1 |
|
|
> 75% |
2 |
|
diagnostic imaging of disc |
protrusion |
2 |
|
|
prolapse or sequester |
0 |
predictive score =
= SUM(points for parameters from 1996 and 1995 post-operative assessment)
Interpretation of 12 month post-operative assessment score (1995):
• minimum score: -16
• maximum score: 23
• scores <= 0: 129 out of 143 had good outcome
• scores > 0: 52 out of 92 had a bad outcome
Purpose: To predict the likely outcome to lumbar spine surgery for a patient with low back pain.
Specialty: Surgery, orthopedic
Objective: severity, prognosis, stage
ICD-10: M54.5,
