An objective rating scale can be used to evaluate patients being considered for lumbar laminectomy and discectomy to treat disc herniation. The rating score is predictive of the surgical result and can aid in appropriate patient selection
Categories:
(1) neurologic signs
(2) root tension signs
(3) myelogram or CT scan findings
(4) psychosocial environment)
|
Parameter |
Finding |
Points |
|---|---|---|
|
neurologic signs |
normal |
0 |
|
|
reflex asymmetry, age > 50 or previous surgery |
0 |
|
|
reflex asymmetry, age <= 50 years of age |
5 |
|
|
motor weakness |
10 |
|
|
sensory deficit |
10 |
|
|
motor and sensory deficits |
25 |
|
root tension signs |
list-flexed knee stance |
10 |
|
|
femoral nerve stretch positive |
10 |
|
|
unilateral straight leg raising > 75° |
0 |
|
|
unilateral straight leg raising 60-75° |
10 |
|
|
unilateral straight leg raising < 60° |
20 |
|
|
crossed straight-leg response |
20 |
|
myelogram, CT scan |
positive; does not correlate with clinical findings |
0 |
|
|
minimal ventral defect |
0 |
|
|
moderate ventral defect |
5 |
|
|
minimal lateral defect |
5 |
|
|
moderate lateral defect |
15 |
|
|
severe ventral and lateral defect |
25 |
|
psychosocial environment |
compensation litigation issues |
0 |
|
|
unemployed >= 6 months |
0 |
|
|
MMPI hypochondriasis and hysteria scale score > 75; pain drawing >= 3 |
0 |
|
|
MMPI hypochondriasis and hysteria scale score <= 75; pain drawing = 1 or 2; no compensation litigation; unemployed < 6 months |
10 |
|
|
MMPI hypochondriasis and hysteria scale score <= 75; pain drawing = 1 or 2; no compensation litigation; employed |
15 |
|
|
MMPI hypochondriasis and hysteria scale score < 70; pain drawing = 0; no compensation litigation; employed |
25 |
where:
• Straight leg raising should be restricted by leg pain, not back pain, in order to be considered positive.
• A patient with bilateral straight leg raising restriction is possibly a pain magnifier
• A maximum of 25 points can be assigned in each of the 4 categories.
• MMPI = Minnesota Multiphasic Personality Inventory; the hypochondriasis (Hs) and hysteria (Hy) are 2 of the scales measured
• Pain drawing score is performed as described by Ransford et al.
• Scoring of imaging studies is unclear for scoring of lateral and ventral defects when one or the other but not both are severe. I have implemented points for a severe ventral defect as 10 points and a severe lateral defect as 20 points; these are 5 points above the moderate defect value (which are 5 points above the minimal defect value).
• Scoring the psychological environment was the most difficult to implement.
rating scale score =
= (points for neurologic signs) + (points for root tension signs) + (points for myelogram or CT scan) + (points for psychosocial environment)
Interpretation
• minimum score 0
• maximum score 100
In 106 patients, the following correlation of the objective rating scale with outcome was found:
|
|
Objective Rating Scale |
|||||
|---|---|---|---|---|---|---|
|
outcome |
< 30 |
30-39 |
40-49 |
50-59 |
60-69 |
>=70 |
|
good |
6% |
13% |
69% |
94% |
100% |
100% |
|
fair |
38% |
50% |
20% |
6% |
0% |
0% |
|
poor |
56% |
37% |
11% |
0% |
0% |
0% |
Specialty: Surgery, orthopedic
