Prognostic criteria for work resumption after standard lumbar discectomy

Abstract

The purpose of this study was to determine prognostic criteria for return to work 9–12 years after standard nucleotomy for herniated nucleus pulposus confirmed by CT. From 1985 until 1988, 182 patients (102 male, 80 female, mean age 45 years) with a single-level herniated nucleus pulposus were operated on for the first time. In summer 1997, an average of 10.2 years after the operation, 101 of 182 patients (55.5%) returned a standardised questionnaire. Eighteen patients (9.8%) had died during the intervening years, while 63 patients (34.6%) were lost to follow-up because of moving to other cities. Two groups could then be distinguished: group I worked full time in their usual job; group II did not. The influence of the degree of the paresis, time elapsed since the occurrence, intraoperative findings, age, sex, weight, type of work and re-operations were analysed statistically. Group I consisted of 44 patients who still worked full time in their usual job. Group II contained 57 patients, of whom 18 worked only part of the time, 9 had changed to a lighter full-time job, 23 had taken early retirement, and 7 were receiving a pension. Patients in group I were significantly younger (38 vs 51 years), had a smaller proportion of patients with more than 20% overweight (27% vs 44%), had a smaller proportion of severe, grade 0 and 1, motor dysfunction (0% vs 16.3%), had been operated sooner (within 3 days: 52.3% vs 19.3%), had undergone fewer re-operations for recurrence of the herniation (4.5% vs 21.1%), and had worked less frequently in physically demanding jobs (6.7% vs 22.8%). We concluded that when there is a relative indication for herniated nucleus pulposus surgery, it should be limited to patients aged below 40 years, with slight motor dysfunction, who work in physically undemanding jobs, so as to make a satisfactory long-term result more likely.