title: Predictive outcome factors in the young patient treated with lumbar disc herniation surgery.
abstract: OBJECTIVE The aim of this study was to evaluate predictive factors for outcome after lumbar disc herniation surgery in young patients. METHODS In the national Swedish spine register, the authors identified 180 patients age 20 years or younger, in whom preoperative and 1-year postoperative data were available. The cohort was treated with primary open surgery due to lumbar disc herniation between 2000 and 2010. Before and 1 year after surgery, the patients graded their back and leg pain on a visual analog scale, quality of life by the 36-Item Short-Form Health Survey and EuroQol-5 Dimensions, and disability by the Oswestry Disability Index. Subjective satisfaction rate was registered on a Likert scale (satisfied, undecided, or dissatisfied). The authors evaluated if age, sex, preoperative level of leg and back pain, duration of leg pain, pain distribution, quality of life, mental status, and/or disability were associated with the outcome. The primary end point variable was the grade of patient satisfaction. RESULTS Lumbar disc herniation surgery in young patients normalizes quality of life according to the 36-Item Short-Form Health Survey, and only 4.5% of the patients were unsatisfied with the surgical outcome. Predictive factors for inferior postoperative patient-reported outcome measures (PROM) scores were severe preoperative leg or back pain, low preoperative mental health, and pronounced preoperative disability, but only low preoperative mental health was associated with inferiority in the subjective grade of satisfaction. No associations were found between preoperative duration of leg pain, distribution of pain, or health-related quality of life and the postoperative PROM scores or the subjective grade of satisfaction. CONCLUSIONS Lumbar disc herniation surgery in young patients generally yields a satisfactory outcome. Severe preoperative pain, low mental health, and severe disability increase the risk of reaching low postoperative PROM scores, but are only of relevance clinically (low subjective satisfaction) for patients with low preoperative mental health.
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopaedics, Lund University, Skane University Hospital, Malmö; and.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Strömqvist
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopaedics, Lund University, Skane University Hospital, Malmö; and.
authors.forename: Björn
authors.initials: B
authors.lastname: Strömqvist
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopaedics, Lund University, Skane University Hospital, Malmö; and.
authors.forename: Bo
authors.initials: B
authors.lastname: Jönsson
authors.affiliation: Department of Orthopaedics, Karolinska University Hospital and Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Paul
authors.initials: P
authors.lastname: Gerdhem
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopaedics, Lund University, Skane University Hospital, Malmö; and.
authors.forename: Magnus K
authors.initials: MK
authors.lastname: Karlsson
mesh_terms: D000293:Adolescent; D001416:Back Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000601:surgery; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction; D011788:Quality of Life; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: EQ-5D = EuroQol–5 Dimensions; LDH = lumbar disc herniation; MCS = Mental Component Summary; ODI = Oswestry Disability Index; PROM; PROM = patient-reported outcome measures; SF-36 = 36-Item Short-Form Health Survey; VAS = visual analog scale; lumbar disc herniation; outcome; patient-reported outcome measures; prediction; sex; surgery