Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathy.
METHODS
Prospective cohort study.


OBJECTIVE
To assess health-related quality of life (HRQOL) following either lumbar discectomy or nonoperative care for lumbar disc protrusion causing radiculopathy (LDPR).


BACKGROUND
Although LDPR is a prevalent disorder, little progress has been made in defining the optimal treatment strategy.


METHODS
A total of 497 patients (333 in the lumbar discectomy group and 164 in the nonoperative group) were analyzed. Patients completed baseline as well as 6- and 12-month generic (SF-36) and disease-specific (NASS Lumbar Spine Instrument) HRQOL measures. Demographic comparisons between groups, using standard descriptive statistics, were made. Multivariate analysis was used to obtain a regression coefficient for the primary outcome: the neurogenic symptoms score (NSS) from the NASS instrument. Outcome measures were compared between groups and to published normative data.


RESULTS
The mean baseline score was lower in the surgical group (30.9 nonoperative, 25.3 surgical), indicative of greater baseline disability. The scores at follow-up were approximately equivalent (44.6 nonoperative, 43.8 surgical). However, neither group returned to an age-matched normative NSS (51.6) within the timeframe of the study. Using regression analysis, the outcome "change in NSS" was not associated with variable "treatment group."


CONCLUSIONS
HRQOL after LDPR, as measured in this study by NASS NSS, demonstrated similar improvement in both groups and was not meaningfully associated with the treatment received, within the timeframe of this study. At follow-up, all outcome measures remained lower than population normative scores, suggesting that, irrespective of treatment, an element of disability remained.
Thomas
Kenneth C
KC
Department of Surgery (Orthopedics) and Neurosciences, University of Calgary, Calgary, AB, Canada.
Fisher
Charles G
CG
Boyd
Michael
M
Bishop
Paul
P
Wing
Peter
P
Dvorak
Marcel F
MF
D000328:Adult; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery* / Q000628:therapy*; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D011446:Prospective Studies; D011788:Quality of Life; D011843:Radiculopathy / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D016896:Treatment Outcome