Skip to main content
SpringerLink
Log in

The risk of “getting worse” after lumbar microdiscectomy

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

A frequent concern among patients operated for lumbar disc herniation is the risk of “getting worse”. To give an evidence-based estimate of the risk for worsening has been difficult, since previous studies have been more focused on unfavourable outcome in general, rather than on deterioration in particular. In this prospective study of 180 patients, we report the frequency of and the risk factors for getting worse after first time lumbar microdiscectomy. Follow-up time was 12 months. Primary outcome measure was the Oswestry disability index, assessing functional status and health-related quality of life. Of the patients 4% got worse. Independent risk factors of deterioration were a long duration of sick leave and a better functional status and quality of life prior to operation. We conclude that the risk of deterioration is small, but larger if the patient has been unable to work despite relatively small health problems. This study also demonstrates that changes in instrument scores should be reported, so that an accurate failure rate can be assessed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Abramovitz JN, Neff SR (1991) Lumbar disc surgery: results of the Prospective Lumbar Discectomy Study of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgery 29:301–307

    CAS  PubMed  Google Scholar 

  2. Asch HL, Lewis PJ, Moreland DB, Egnatchik JG, Yu YJ, Clabeaux DE, Hyland AH (2002) Prospective multiple outcomes study of outpatient lumbar microdiscectomy: should 75 to 80% success rates be the norm? J Neurosurg 96:34–44

    PubMed  Google Scholar 

  3. Baker DJP, Pynsent PB, Fairbank CT (1990) The Oswestry disability index revisited: its reliability, repeatability and validity, and a comparison with the St Thomas’s disability index. In: Roland M, Jenner JR (eds) Back pain. New approaches to rehabilitation and education. Manchester University Press, Manchester, pp 174–186

  4. Brazier J, Deverill M, Green C, Harper R, Booth A (1999) A review of the use of health status measures in economic evaluation. Health Technol Assess 3:1-164

    CAS  Google Scholar 

  5. Carmines EG, Zeller RA (1979) Reliability and validity assessment. Quantitiative applications in the social sciences #17. Sage Publications, Newbury Park, CA

  6. Dauch WA, Fasse A, Brucher K, Bauer BL (1994) Predictors of treatment success after microsurgical operation of lumbar intervertebral disk displacement. Zentralbl Neurochir 55:144–155

    CAS  PubMed  Google Scholar 

  7. Deyo RA (1988) Measuring the functional status of patients with low back pain. Arch Phys Med Rehabil 69:1044–1053

    CAS  PubMed  Google Scholar 

  8. Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H (1999) A comparison of pain, functional limitations, and work status indices as outcome measures in back pain research. Spine 24:2339–2345

    Article  CAS  PubMed  Google Scholar 

  9. Dvorak J, Gauchat MH, Valach L (1988) The outcome of surgery for lumbar disc herniation. I. A 4–17 years follow-up with emphasis on somatic aspects. Spine 13:1418–1422

    CAS  PubMed  Google Scholar 

  10. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    CAS  PubMed  Google Scholar 

  11. Findlay GF, Hall BI, Musa BS, Oliveira MD, Fear SC (1998) A 10-year follow-up of the outcome of lumbar microdiscectomy. Spine 23:1168–1171

    Article  CAS  PubMed  Google Scholar 

  12. Greenough CG (1993) Results of treatment of lumbar spine disorders. Effects of assessment techniques and confounding factors. Acta Orthop Scand Suppl 251:126–129

    CAS  PubMed  Google Scholar 

  13. Hagg O, Fritzell P, Nordwall A (2003) The clinical importance of changes in outcome scores after treatment for chronic low back pain. Eur Spine J 12:12–20

    PubMed  Google Scholar 

  14. Howe J, Frymoyer JW (1985) The effects of questionnaire design on the determination of end results in lumbar spinal surgery. Spine 10:804–805

    CAS  PubMed  Google Scholar 

  15. Hurme M, Alaranta H (1987) Factors predicting the result of surgery for lumbar intervertebral disc herniation. Spine 12:933–938

    CAS  PubMed  Google Scholar 

  16. Kazis LE, Anderson JJ, Meenan RF (1989) Effect sizes for interpreting changes in health status. Med Care 27:S178–S189

    CAS  PubMed  Google Scholar 

  17. Lewis PJ, Weir BK, Broad RW, Grace MG (1987) Long-term prospective study of lumbosacral discectomy. J Neurosurg 67:49–53

    CAS  PubMed  Google Scholar 

  18. McGregor AH, Hughes SP (2002) The evaluation of the surgical management of nerve root compression in patients with low back pain: part 1: the assessment of outcome. Spine 27:1465–1470

    Article  PubMed  Google Scholar 

  19. McGregor AH, Hughes SP (2002) The evaluation of the surgical management of nerve root compression in patients with low back pain: part 2: patient expectations and satisfaction. Spine 27:1471–1476

    Article  PubMed  Google Scholar 

  20. Nygaard OP, Kloster R, Solberg T (2000) Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg 92:131–134

    CAS  PubMed  Google Scholar 

  21. Pappas CT, Harrington T, Sonntag VK (1992) Outcome analysis in 654 surgically treated lumbar disc herniations. Neurosurgery 30:862–866

    CAS  PubMed  Google Scholar 

  22. Patrick DL, Deyo RA (1989) Generic and disease-specific measures in assessing health status and quality of life. Med Care 27:S217–S232

    CAS  PubMed  Google Scholar 

  23. Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB (1995) Assessing health-related quality of life in patients with sciatica. Spine 20:1899–1908

    CAS  PubMed  Google Scholar 

  24. Pearce JM (2000) Aspects of the failed back syndrome: role of litigation. Spinal Cord 38:63–70

    Article  CAS  PubMed  Google Scholar 

  25. Sorensen LV, Mors O (1989) A two-year prospective follow-up study of the outcome after surgery in patients with slipped lumbar disk operated upon for the first time. Acta Neurochir (Wien) 96:94–99

    Google Scholar 

  26. Stromqvist B, Jonsson B, Fritzell P, Hagg O, Larsson BE, Lind B (2001) The Swedish National Register for lumbar spine surgery: Swedish Society for Spinal Surgery. Acta Orthop Scand 72:99–106

    CAS  PubMed  Google Scholar 

  27. Tandon V, Campbell F, Ross ER (1999) Posterior lumbar interbody fusion. Association between disability and psychological disturbance in noncompensation patients. Spine 24:1833–1838

    CAS  PubMed  Google Scholar 

  28. Weber H (1983) Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine 8:131–140

    CAS  PubMed  Google Scholar 

  29. Weir BK (1979) Prospective study of 100 lumbosacral discectomies. J Neurosurg 50:283–289

    CAS  PubMed  Google Scholar 

  30. Woertgen C, Holzschuh M, Rothoerl RD, Brawanski A (1997) Does the choice of outcome scale influence prognostic factors for lumbar disc surgery? A prospective, consecutive study of 121 patients. Eur Spine J 6:173–180

    CAS  PubMed  Google Scholar 

  31. Woertgen C, Rothoerl RD, Holzschuh M, Breme K, Brawanski A (1998) Are prognostic factors still what they are expected to be after long-term follow-up? J Spinal Disord 11:395–399

    CAS  PubMed  Google Scholar 

  32. Woertgen C, Rothoerl RD, Breme K, Altmeppen J, Holzschuh M, Brawanski A (1999) Variability of outcome after lumbar disc surgery. Spine 24:807–811

    Article  CAS  PubMed  Google Scholar 

  33. Wood-Dauphinee SL (2001) Assessment of back-related quality of life: the continuing challenge. Spine 26:857–861

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital of North Norway, 9038, Tromsø, Norway

    Tore K. Solberg & Tor Ingebrigtsen

  2. Department of Neurosurgery, University Hospital of St. Olav, Trondheim, Norway

    Øystein P. Nygaard

  3. Faculty of Medicine, University of Tromsø, Norway

    Kristin Sjaavik

  4. Foundation for Health Services Research, Oslo, Norway

    Dag Hofoss

Authors
  1. Tore K. Solberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Øystein P. Nygaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kristin Sjaavik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dag Hofoss
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tor Ingebrigtsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tore K. Solberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Solberg, T.K., Nygaard, Ø.P., Sjaavik, K. et al. The risk of “getting worse” after lumbar microdiscectomy. Eur Spine J 14, 49–54 (2005). https://doi.org/10.1007/s00586-004-0721-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-004-0721-5

Keywords

Search

Navigation