The outcome for a patient following surgery to excise a herniated lumbar disc can be predicted based on a preoperative questionnaire. The questionnaire is of predictive value if the patient has not previously undergone lumbar spine surgery. The questionnaire is not designed to encompass candidates for other types of lumbar spine surgery such as decompression laminectomy or fusion. This was developed at the Low Back Pain Clinic at the Crozer-Chester Medical Center in Pennsylvania.
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Positive Factors
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Points
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low back and sciatic pain severe enough to be incapacitating
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5
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sciatica is more severe than back pain
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15
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weight bearing (sitting or standing) aggravates pain; bed rest (in some positions) eases the pain
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5
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neurological examination demonstrates a single root syndrome indicating a specific interspace
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25
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myelographic defect corroborating the neurologic examination
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25
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straight leg raising test
• positive
• crossed
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10
20
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patient has a realistic self-appraisal of future life-style
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10
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where:
• grading the straight leg raising test is a little unclear; I have opted to only use one of the 2 values
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Negative Factors
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Points
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back pain primarily
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15
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gross obesity
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10
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nonorganic signs and symptoms
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10
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poor psychological background
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15
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secondary gain
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20
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history of previous law suit for medico-legal problems
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10
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Nonorganic signs and symptoms include:
(1) entire leg numb;
(2) simultaneous weakness of flexion and extension of toes;
(3) extension of pain into areas not explainable by an organic lesion
Poor psychological background includes:
(1) attempted suicide;
(2) unrealistically high expectations from surgery;
(3) previous admissions for nonorganic symptoms such as hyperventilation, unexplainable chest pains, and/or abdominal pains;
(4) alcoholic;
(5) not happy with job;
(6) physical demands of present occupation excessive;
(7) hostility to environment, employer or spouse;
(8) much time off from work for medical reasons (man out of work >= 6 months, woman out of work >= 16 months)
Secondary gain is suggested by:
(1) work connected accident;
(2) vehicular accident;
(3) medico-legal adversary situation;
(4) near retirement age and eligible for disability pension if symptoms persist
score for positive factors =
= SUM(factors present)
score for negative factors =
= SUM(factors present)
predictive score =
= (score for positive factors) - (score for negative factors)
Interpretation
• maximum score for positive factors: 105
• maximum score for negative factors: 80
• maximum predictive score: 105
• minimum predictive score: - 80
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Predictive Score
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Outcome
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> 75
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good
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65 - 75
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fair
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55 - 65
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marginal
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< 55
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poor
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