Patients With Persistent Low Back Pain and Nerve Root Involvement: To Operate, Or Not To Operate, That Is The Question

Tom Petersen, Carsten B Juhl, Gilles L Fournier

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

STUDY DESIGN: Prospective cohort study OBJECTIVE.: The aims of this study were to evaluate the outcome of surgical as well as non-surgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after two years and to identify predictors for non-success.

SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.

METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Non-success was defined as a Roland Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and MRI findings.

RESULTS: Rates of non-success at 2 years were about 30% in surgically treated patients with LHD, about 60% in patients with LSS for disability, and 30% and 40% respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, non-success after surgery was associated with male gender (OR 2.04, 95% CI: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01).

CONCLUSIONS: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male gender, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.

LEVEL OF EVIDENCE: 3.

OriginalsprogEngelsk
TidsskriftSpine
ISSN0362-2436
DOI
StatusE-pub ahead of print - 25. okt. 2019

Fingeraftryk

Low Back Pain
Intervertebral Disc Displacement
Logistic Models
Education
Leg
Cohort Studies
History
Regression Analysis
Prospective Studies

Citer dette

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title = "Patients With Persistent Low Back Pain and Nerve Root Involvement: To Operate, Or Not To Operate, That Is The Question",
abstract = "STUDY DESIGN: Prospective cohort study OBJECTIVE.: The aims of this study were to evaluate the outcome of surgical as well as non-surgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after two years and to identify predictors for non-success.SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Non-success was defined as a Roland Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and MRI findings.RESULTS: Rates of non-success at 2 years were about 30{\%} in surgically treated patients with LHD, about 60{\%} in patients with LSS for disability, and 30{\%} and 40{\%} respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, non-success after surgery was associated with male gender (OR 2.04, 95{\%} CI: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95{\%} CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95{\%} CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95{\%} CI: 1.36-9.46, P = 0.01).CONCLUSIONS: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male gender, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.LEVEL OF EVIDENCE: 3.",
author = "Tom Petersen and Juhl, {Carsten B} and Fournier, {Gilles L}",
year = "2019",
month = "10",
day = "25",
doi = "10.1097/BRS.0000000000003304",
language = "English",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams & Wilkins",

}

Patients With Persistent Low Back Pain and Nerve Root Involvement : To Operate, Or Not To Operate, That Is The Question. / Petersen, Tom; Juhl, Carsten B; Fournier, Gilles L.

I: Spine, 25.10.2019.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Patients With Persistent Low Back Pain and Nerve Root Involvement

T2 - To Operate, Or Not To Operate, That Is The Question

AU - Petersen, Tom

AU - Juhl, Carsten B

AU - Fournier, Gilles L

PY - 2019/10/25

Y1 - 2019/10/25

N2 - STUDY DESIGN: Prospective cohort study OBJECTIVE.: The aims of this study were to evaluate the outcome of surgical as well as non-surgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after two years and to identify predictors for non-success.SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Non-success was defined as a Roland Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and MRI findings.RESULTS: Rates of non-success at 2 years were about 30% in surgically treated patients with LHD, about 60% in patients with LSS for disability, and 30% and 40% respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, non-success after surgery was associated with male gender (OR 2.04, 95% CI: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01).CONCLUSIONS: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male gender, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.LEVEL OF EVIDENCE: 3.

AB - STUDY DESIGN: Prospective cohort study OBJECTIVE.: The aims of this study were to evaluate the outcome of surgical as well as non-surgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after two years and to identify predictors for non-success.SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Non-success was defined as a Roland Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and MRI findings.RESULTS: Rates of non-success at 2 years were about 30% in surgically treated patients with LHD, about 60% in patients with LSS for disability, and 30% and 40% respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, non-success after surgery was associated with male gender (OR 2.04, 95% CI: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01).CONCLUSIONS: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male gender, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.LEVEL OF EVIDENCE: 3.

U2 - 10.1097/BRS.0000000000003304

DO - 10.1097/BRS.0000000000003304

M3 - Journal article

C2 - 31658235

JO - Spine

JF - Spine

SN - 0362-2436

ER -