title: Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up.
abstract: OBJECTIVE
  A prospective study to evaluate whether certain baseline characteristics can predict outcome in patients treated with disc prosthesis or multidisciplinary rehabilitation.
  
  
  METHODS
  Secondary analysis of 154 patients with chronic low back pain (LBP) for at least 1 year and degenerative discs originally recruited for a randomized trial. Outcome measures were Oswestry Disability Index (ODI) dichotomized to < or ≥15 points improvement and whether subjects were working at 2-year follow-up. A multiple logistic regression analysis was used.
  
  
  RESULTS
  In patients treated with disc prosthesis, long duration of LBP and high Fear-Avoidance Beliefs for work (FABQ-W) predicted worse ODI outcome [odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.2-3.2 and OR = 1.7, CI 1.2-2.4 for every 5 years or 5 points]. Modic type I or II predicted better ODI outcome (OR = 5.3, CI 1.1-25.3). In patients treated with rehabilitation, a high ODI, low emotional distress (HSCL-25), and no daily narcotics predicted better outcome for ODI (OR = 2.5, CI 1.4-4.5 for every 5 ODI points, OR = 2.1, CI 1.1-5.1 for every 0.5 HSCL points and OR = 23.6, CI 2.1-266.8 for no daily narcotics). Low FABQ-W and working at baseline predicted working at 2-year follow-up after both treatments (OR = 1.3, CI 1.0-1.5 for every 5 points and OR = 4.1, CI 1.2-13.2, respectively).
  
  
  CONCLUSIONS
  Shorter duration of LBP, Modic type I or II changes and low FABQ-W were the best predictors of success after treatment with disc prosthesis, while high ODI, low distress and not using narcotics daily predicted better outcome of rehabilitation. Low FABQ-W and working predicted working at follow-up.
authors.affiliation: Department of Orthopaedics, Oslo University Hospital, University of Oslo, Kirkevn 166, 0407, Oslo, Norway. christian.hellum@medisin.uio.no
authors.forename: Christian
authors.initials: C
authors.lastname: Hellum
authors.forename: Lars Gunnar
authors.initials: LG
authors.lastname: Johnsen
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Gjertsen
authors.forename: Linda
authors.initials: L
authors.lastname: Berg
authors.forename: Gesche
authors.initials: G
authors.lastname: Neckelmann
authors.forename: Oliver
authors.initials: O
authors.lastname: Grundnes
authors.forename: Ivar
authors.initials: I
authors.lastname: Rossvoll
authors.forename: Jan Sture
authors.initials: JS
authors.lastname: Skouen
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Brox
authors.forename: Kjersti
authors.initials: K
authors.lastname: Storheim
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery*; D016015:Logistic Models; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000188:drug therapy / Q000534:rehabilitation* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D019736:Prostheses and Implants; D016896:Treatment Outcome
chemical_list: D009294:Narcotics