title: Predictors of clinical outcome following lumbar disc surgery: the value of historical, physical examination, and muscle function variables.
abstract: OBJECTIVE
  Explore the relationships between preoperative findings and clinical outcome following lumbar disc surgery, and investigate the prognostic value of physical examination findings after accounting for information acquired from the clinical history.
  
  
  METHODS
  We recruited 55 adult patients scheduled for first time, single-level lumbar discectomy. Participants underwent a standardized preoperative evaluation including real-time ultrasound imaging assessment of lumbar multifidus function, and an 8-week postoperative rehabilitation programme. Clinical outcome was defined by change in disability, and leg and low back pain (LBP) intensity at 10 weeks. Linear regression models were used to identify univariate and multivariate predictors of outcome.
  
  
  RESULTS
  Univariate predictors of better outcome varied depending on the outcome measure. Clinical history predictors included a greater proportion of leg pain to LBP, pain medication use, greater time to surgery, and no history of previous physical or injection therapy. Physical examination predictors were a positive straight or cross straight leg raise test, diminished lower extremity strength, sensation or reflexes, and the presence of postural abnormality or pain peripheralization. Preoperative pain peripheralization remained a significant predictor of improved disability (p = 0.04) and LBP (p = 0.02) after accounting for information from the clinical history. Preoperative lumbar multifidus function was not associated with clinical outcome.
  
  
  CONCLUSIONS
  Information gleaned from the clinical history and physical examination helps to identify patients more likely to succeed with lumbar disc surgery. While this study helps to inform clinical practice, additional research confirming these results is required prior to confident clinical implementation.
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, 90 South Street, SS 2.015, Murdoch, WA, 6150, Australia. j.hebert@murdoch.edu.au.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Hebert
authors.affiliation: Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.|Intermountain Healthcare, Salt Lake City, UT, USA.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, 90 South Street, SS 2.015, Murdoch, WA, 6150, Australia.|US Army-Baylor University Doctoral Programme in Physical Therapy, San Antonio, TX, USA.
authors.forename: Shane L
authors.initials: SL
authors.lastname: Koppenhaver
authors.affiliation: Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Thackeray
authors.affiliation: School of Psychology and Exercise Science, Murdoch University, 90 South Street, SS 2.015, Murdoch, WA, 6150, Australia.|Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Kjaer
mesh_terms: D000293:Adolescent; D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D017586:Diskectomy; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D010808:Physical Examination; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Diskectomy; Lumbosacral region; Paraspinal muscles; Physical examination; Prognosis
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