Patient selection for lumbar discectomy with a revised objective rating system.
Inappropriate patient selection for the surgical treatment of lumbar disc herniation remains a major cause of failed laminectomy syndrome. Further experience with the use of a revised objective rating system for patient selection for lumbar laminectomy and discectomy for the treatment for disc herniation is presented. Based on the severity of findings within each of 4 categories (neurologic signs, root tension signs, imaging findings, and psychosocial environment), numeric scores are derived. A maximum of 25 points is available in each category, for a total of 100 points. Scores were determined prospectively in 275 patients who were treated by laminectomy for lumbar disc herniation. Followup averaged 4 years (range, 1 to 12.8 years). Overall, there were 226 (82%) good results, 26 (10%) fair results, and 23 (8%) poor results. Among the 89 patients with compensation/litigation issues, 52 (58%) had good outcomes; 16 (18%), fair outcomes; and 21 (24%), poor outcomes. Of the 186 patients without compensation or litigation issues, 174 (94%) had good results; 10 (5%), fair results; and 2 (1%), poor results. The objective rating score was highly predictive of patient outcome at followup.
Herron
L D
LD
Central Coast Spine Institute, San Luis Obispo, CA, USA.
Turner
J A
JA
Novell
L A
LA
Kreif
S L
SL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D016896:Treatment Outcome