| lumbar disc herniation (LDH) , which is demonstrated in 25% of back and leg pain patients, is one of the most common diseases with back and leg pain. Most patients with LDH are 20 to 50 years old. Al-though the majority of patients with LDH respond to conservative, nonoperative treatment, 10 ?20% of patients require surgical inter-vention. However, the poor outcomes or the failure rate of the opera-tions is still high, with a failed back surgery syndrome varied from 5% to 33%. Inappropriate patient selection appears to the most common cause of failure after lumbar surgery. Most authors recommend the point of view that the success rate of operations depends on operative techniques in 10% and on appropriate patient selection in 90%. The intent of the current study is to define the predictors of surgical out-comes by analyzing the preoperative data of symptoms and functions, and to provide evidence for appropriate patient selection of lumbar disc surgery and the increase of the surgical success rate.Materials and methods167 patients with lumbar disc herniation who underwent the surgi-cal procedures in the 2nd hospital of china medical university over a 43- month period between May of 1997 and December of 2000 were in-cluded in this study, all patients underwent follow - up studies for more than 21 months. 128 patients were followed up successfully. They consisted of 75 men and 53 women, having a mean age of 42.18 ?.20 years (range, 20 to 70 years). The average follow - up peri-od was 33. 8 ?10.7 months (range, 21 to 62 months). Preoperative and postoperative scoring of symptoms and function were performed by a questionnaire, which has been applied for five years in our hospital. The current study focused on symptoms and functions with a total score of 50, excluding the scoring of signs and imaging examination, in which the score of symptoms and function is 12 and 38, respectively. In the postoperative questionnaire, we supplemented five contents in-cluding postoperative intake of analgesics, life ability, return to work, symptoms relief, and satisfaction to the operation. The surgery out-comes were evaluated according to Spengler and Helrron criteria. Sta-tistical analysis of outcomes was managed by SPSSIO. 0 software and Pearson correlation and regression were performed.ResultsThe surgical outcome is classified to three groups including good, moderate and bad group. Among 128 patients, 50 patients (39.1% ) were in the good outcome group as defined in our study, while 60 pa-tients (46. 9%) were in the moderate group and 18 patients (14. 1% ) belonged to the bad outcome group.The preoperative scoring is 36.12 ?.63, 32.58 ?.04, 25.50.21 in the good, moderate and bad group, respectively. There wasa significant statistical difference in the preoperative score betweengood and bad group ( p = 0. 000 ) , moderate and bad group ( p = 0. 000) , good and moderate group ( p =0.030).Among the eleven scored indices, eight have predictive signifi-cance for surgical outcomes. The preoperative scoring in the severity of back or buttocks pain, the severity of the leg pain or numbness, walking, standing, sitting, lifting, and sleeping is higher in good and moderate group than that of the bad group and t test shows the signifi-cant difference between the two groups. The significant difference is observed in the preoperative scoring of the frequency of back and leg pain between the good and bad group ( p =0.024). There is no differ-ence in the preoperative scoring of the active movement, sexuality, uresis between the good and bad group.Pearson correlation and regression showed that the preoperative total score was correlated to the surgical outcome positively. There was a significant positive correlation between outcomes and the frequency of back and leg pain, the severity of back or buttocks pain, the severi-ty of leg pain or numbness, walking, standing, sitting, lifting, sleep-ing. The active movement, sexuality, and uresiS were not correlated to outcomes significantly.DiscussionsAp... |
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