title: Predictors of pain and disability outcomes in one thousand, one hundred and eight patients who underwent lumbar discectomy surgery.
abstract: BACKGROUND
  A key component toward improving surgical outcomes is proper patient selection. Improved selection can occur through exploration of prognostic studies that identify variables which are associated with good or poorer outcomes with a specific intervention, such as lumbar discectomy. To date there are no guidelines identifying key prognostic variables that assist surgeons in proper patient selection for lumbar discectomy. The purpose of this study was to identify baseline characteristics that were related to poor or favourable outcomes for patients who undergo lumbar discectomy. In particular, we were interested in prognostic factors that were unique to those commonly reported in the musculoskeletal literature, regardless of intervention type.
  
  
  METHODS
  This retrospective study analysed data from 1,108 patients who underwent lumbar discectomy and had one year outcomes for pain and disability. All patient data was part of a multicentre, multi-national spine repository. Ten relatively commonly captured data variables were used as predictors for the study: (1) age, (2) body mass index, (3) gender, (4) previous back surgery history, (5) baseline disability, unique baseline scores for pain for both (6) low back and (7) leg pain, (8) baseline SF-12 Physical Component Summary (PCS) scores, (9) baseline SF-12 Mental Component Summary (MCS) scores, and (10) leg pain greater than back pain. Univariate and multivariate logistic regression analyses were run against one year outcome variables of pain and disability.
  
  
  RESULTS
  For the multivariate analyses associated with the outcome of pain, older patients, those with higher baseline back pain, those with lesser reported disability and higher SF-12 MCS quality of life scores were associated with improved outcomes. For the multivariate analyses associated with the outcome of disability, presence of leg pain greater than back pain and no previous surgery suggested a better outcome.
  
  
  CONCLUSIONS
  For this study, several predictive variables were either unique or conflicted with those advocated in general prognostic literature, suggesting they may have value for clinical decision making for lumbar discectomy surgery. In particular, leg pain greater than back pain and older age may yield promising value. Other significant findings such as quality of life scores and prior surgery may yield less value since these findings are similar to those that are considered to be prognostic regardless of intervention type.
authors.affiliation: Department of Orthopaedics, Duke University, 2200 W. Main St., Ste. B230, Durham, NC, USA. chad.cook@duke.edu.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Cook
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Ms3021, Kansas City, KS, 66160, USA. PARNOLD@kumc.edu.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.affiliation: Department of Orthopaedic Surgery, NYU School of Medicine, 550 1st Avenue, New York, NY, 10016, USA. panagmd@gmail.com.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Neurosurgery, Division of Spinal Surgery, New York University - Langone Medical Center, 530 1st Avenue, Skirball Suite 8R, New York, NY, 10016, USA. Anthony.Frempong-Boadu@nyumc.org.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Frempong-Boadu
authors.affiliation: Department of Orthopaedic Surgery, Rothman Institute, 2500 English Creek Avenue, Egg Harbor, NJ, 08234, USA. radcliffk@gmail.com.
authors.forename: Kristen
authors.initials: K
authors.lastname: Radcliff
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, 200 Trent Drive #11, Durham, NC, 27710, USA. Robert.isaacs@duke.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Isaacs
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Discectomy; Low back pain; Prognosis; Surgery
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