Predictive outcome factors in the young patient treated with lumbar disc herniation surgery.
OBJECTIVE The aim of this study was to evaluate predictive factors for outcome after lumbar disc herniation surgery in young patients. METHODS In the national Swedish spine register, the authors identified 180 patients age 20 years or younger, in whom preoperative and 1-year postoperative data were available. The cohort was treated with primary open surgery due to lumbar disc herniation between 2000 and 2010. Before and 1 year after surgery, the patients graded their back and leg pain on a visual analog scale, quality of life by the 36-Item Short-Form Health Survey and EuroQol-5 Dimensions, and disability by the Oswestry Disability Index. Subjective satisfaction rate was registered on a Likert scale (satisfied, undecided, or dissatisfied). The authors evaluated if age, sex, preoperative level of leg and back pain, duration of leg pain, pain distribution, quality of life, mental status, and/or disability were associated with the outcome. The primary end point variable was the grade of patient satisfaction. RESULTS Lumbar disc herniation surgery in young patients normalizes quality of life according to the 36-Item Short-Form Health Survey, and only 4.5% of the patients were unsatisfied with the surgical outcome. Predictive factors for inferior postoperative patient-reported outcome measures (PROM) scores were severe preoperative leg or back pain, low preoperative mental health, and pronounced preoperative disability, but only low preoperative mental health was associated with inferiority in the subjective grade of satisfaction. No associations were found between preoperative duration of leg pain, distribution of pain, or health-related quality of life and the postoperative PROM scores or the subjective grade of satisfaction. CONCLUSIONS Lumbar disc herniation surgery in young patients generally yields a satisfactory outcome. Severe preoperative pain, low mental health, and severe disability increase the risk of reaching low postoperative PROM scores, but are only of relevance clinically (low subjective satisfaction) for patients with low preoperative mental health.
['Strömqvist|Fredrik|F|', 'Strömqvist|Björn|B|', 'Jönsson|Bo|B|', 'Gerdhem|Paul|P|', 'Karlsson|Magnus K|MK|']
D000293:Adolescent D001416:Back Pain D004185:Disability Evaluation D005260:Female D005500:Follow-Up Studies D006801:Humans D007405:Intervertebral Disc Displacement D008159:Lumbar Vertebrae D008297:Male D010147:Pain Measurement D017060:Patient Satisfaction D011788:Quality of Life D012042:Registries D013548:Sweden D016896:Treatment Outcome D055815:Young Adult
prediction outcome lumbar disc herniation surgery sex patient-reported outcome measures PROM EQ-5D = EuroQol–5 Dimensions LDH = lumbar disc herniation MCS = Mental Component Summary ODI = Oswestry Disability Index PROM = patient-reported outcome measures SF-36 = 36-Item Short-Form Health Survey VAS = visual analog scale