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Prognostic Factors and Models predicting Unfavorable Outcome After lumbar Discectomy: A Systematic Review
A G M Boeykens1, C Kik2, C Dirven2
1Erasmus Medical Center, Neurosurgery Department, Rotterdam, The Netherlands; Park Medical Center, Neurosurgery Departments, Rotterdam, The Netherlands.
World Neurosurgery
|March 27, 2026
Summary
Several preoperative factors like older age, female sex, smoking, high BMI, comorbidities, and psychological distress predict higher disability one year after lumbar discectomy. Most prognostic models lack validation, limiting their clinical use.
Area of Science:
- Neurosurgery
- Orthopedics
- Evidence-based medicine
Background:
- Lumbar discectomy is a common surgical procedure.
- Predicting postoperative outcomes is crucial for patient management.
- Existing prognostic tools for lumbar discectomy outcomes require evaluation.
Purpose of the Study:
- To identify preoperative prognostic factors for unfavorable outcomes one year post-lumbar discectomy.
- To assess prognostic models predicting one-year outcomes after lumbar discectomy.
Main Methods:
- Systematic review of prospective cohort studies.
- Searched multiple databases (Cochrane, Embase, Medline, CINAHL).
- Assessed risk of bias and certainty of evidence using QUIPS/PROBAST and GRADE.
Main Results:
- Fifteen studies (14,019 patients) were included.
- Identified nine prognostic factors and six prognostic models.
- Moderate evidence linked older age, female sex, smoking, high BMI, comorbidities, and psychological distress to increased postoperative disability.
Conclusions:
- Preoperative factors significantly influence disability after lumbar discectomy.
- Prognostic models show promise but often lack external validation and have a high risk of bias.
- Clinical applicability of current prognostic models is limited.