title: The risk of "getting worse" after lumbar microdiscectomy.
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.
authors.affiliation: Department of Neurosurgery, University Hospital of North Norway, 9038, Tromsø, Norway. tore.solberg@unn.no
authors.forename: Tore K
authors.initials: TK
authors.lastname: Solberg
authors.forename: Oystein P
authors.initials: OP
authors.lastname: Nygaard
authors.forename: Kristin
authors.initials: K
authors.lastname: Sjaavik
authors.forename: Dag
authors.initials: D
authors.lastname: Hofoss
authors.forename: Tor
authors.initials: T
authors.lastname: Ingebrigtsen
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000523:psychology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009664:Norway; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012008:Recurrence; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data; D018434:Sickness Impact Profile; D017211:Treatment Failure