Clinical factors predicting outcome after surgery for herniated lumbar disc: an epidemiological multivariate analysis

A 5-year retrospective study of 150 patients operated on for lumbar disc herniation was conducted to evaluate the prognostic significance of several clinical variables in outcome. Patients with a clear lumbar herniated disc as diagnosed by computed tomography and/or myelography were operated on after a failed conservative treatment. Excellent outcome was defined as complete relief of complaints and neurological deficits. Mean follow-up period comprises 4 years; range, 2-6. At review, an excellent outcome was obtained in 73 patients (49%). Analyzing each variable separately, the application of autotraction during conservative treatment showed the major prognostic value, predicting excellent outcome. Other statistically significant parameters were a sedentary type of work and absence of motor or sensory deficits. The presence of intraoperative complications, namely dural tears, level errors, or root damage, indicated a poor prognosis. When the combined influence of all epidemiological variables was assessed by multiple regression analysis, a significant correlation could be found; the use of autotraction prior to surgery was the most important predicting factor. This study shows that there are some clinical factors that could fairly predict the surgical outcome of patients with lumbar disc herniation.