Factors Influencing the Outcome of Surgical Treatment of Lumbar Disc Herniation

Surgery for lumbar disc herniation is the most often-performed procedure for treatment of degenerative disease of the lumbar spine. Despite this, it remains unclear as to what factors definitely established before surgery influence the results of that treatment. One hundred and fifty-four patients were enrolled and followed for four years in this prospective study. The results of the treatment were monitored using standardized questionnaires: the Oswestry disability index (ODI), the Roland Morris score (RM) and a visual analogue score (VAS). The effects on the result of surgical treatment were evaluated in terms of symptom duration before surgery, immediate clinical situation before surgery, body mass index (BMI), smoking, occupation, presence of Modic changes (Modic I-II) on MRI, significant low back pain similar intensity compared to radicular pain and neurological deficit. The efficacy of surgical treatment of lumbar disc herniation was confirmed. A significant decrease of values in the questionnaires and significant improvement in patients clinical situations were recorded. These results tended towards slight deterioration as the four-year follow-up progressed; however, significant clinical improvement and decrease of scale values remained. The pre-operative presence of significant low back pain and duration of symptoms longer than one year had significantly negative effects on satisfactory clinical response to surgical treatment. Significant influence on outcome on the part of the immediate clinical situation before surgery, BMI, smoking, occupation, presence of the neurological deficit and Modic changes to clinical outcome was not demonstrated by this study.