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Predictors of clinical outcome following lumbar disc surgery: the value of historical, physical examination, and muscle function variables

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Abstract

Purpose

Explore the relationships between preoperative findings and clinical outcome following lumbar disc surgery, and investigate the prognostic value of physical examination findings after accounting for information acquired from the clinical history.

Methods

We recruited 55 adult patients scheduled for first time, single-level lumbar discectomy. Participants underwent a standardized preoperative evaluation including real-time ultrasound imaging assessment of lumbar multifidus function, and an 8-week postoperative rehabilitation programme. Clinical outcome was defined by change in disability, and leg and low back pain (LBP) intensity at 10 weeks. Linear regression models were used to identify univariate and multivariate predictors of outcome.

Results

Univariate predictors of better outcome varied depending on the outcome measure. Clinical history predictors included a greater proportion of leg pain to LBP, pain medication use, greater time to surgery, and no history of previous physical or injection therapy. Physical examination predictors were a positive straight or cross straight leg raise test, diminished lower extremity strength, sensation or reflexes, and the presence of postural abnormality or pain peripheralization. Preoperative pain peripheralization remained a significant predictor of improved disability (p = 0.04) and LBP (p = 0.02) after accounting for information from the clinical history. Preoperative lumbar multifidus function was not associated with clinical outcome.

Conclusions

Information gleaned from the clinical history and physical examination helps to identify patients more likely to succeed with lumbar disc surgery. While this study helps to inform clinical practice, additional research confirming these results is required prior to confident clinical implementation.

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References

  1. Gibson JN, Waddell G (2007) Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine 32:1735–1747. doi:10.1097/BRS.0b013e3180bc2431

    Article  PubMed  Google Scholar 

  2. Deyo RA, Mirza SK (2006) Trends and variations in the use of spine surgery. Clin Orthop Relat Res 443:139–146. doi:10.1097/01.blo.0000198726.62514.75

    Article  PubMed  Google Scholar 

  3. Carragee EJ, Kim DH (1997) A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology. Spine 22:1650–1660

    Article  PubMed  CAS  Google Scholar 

  4. Hakkinen A, Kautiainen H, Sintonen H, Ylinen J (2005) Health related quality of life after lumbar disc surgery: a prospective study of 145 patients. Disabil Rehabil 27:94–100. doi:10.1080/09638280400007430

    Article  PubMed  Google Scholar 

  5. Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85-A:102–108

    PubMed  Google Scholar 

  6. Mannion AF, Elfering A (2006) Predictors of surgical outcome and their assessment. Eur Spine J 15(Suppl 1):S93–S108. doi:10.1007/s00586-005-1045-9

    Article  PubMed  PubMed Central  Google Scholar 

  7. Silverplats K, Lind B, Zoega B, Halldin K, Rutberg L, Gellerstedt M, Brisby H (2010) Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J 19:1459–1467. doi:10.1007/s00586-010-1433-7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peul WC, Brand R, Thomeer RT, Koes BW (2008) Influence of gender and other prognostic factors on outcome of sciatica. Pain 138:180–191. doi:10.1016/j.pain.2007.12.014

    Article  PubMed  Google Scholar 

  9. Rothoerl RD, Woertgen C, Brawanski A (2002) When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25:162–165

    Article  PubMed  Google Scholar 

  10. Junge A, Dvorak J, Ahrens S (1995) Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes. Spine 20:460–468

    Article  PubMed  CAS  Google Scholar 

  11. Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, Weinstein J (2013) The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am 95:1–8. doi:10.2106/JBJS.K.01558

    Article  PubMed  PubMed Central  Google Scholar 

  12. Birkmeyer NJ, Weinstein JN, Tosteson AN, Tosteson TD, Skinner JS, Lurie JD, Deyo R, Wennberg JE (2002) Design of the Spine Patient outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 27:1361–1372

    Article  Google Scholar 

  13. Yoshihara K, Nakayama Y, Fujii N, Aoki T, Ito H (2003) Atrophy of the multifidus muscle in patients with lumbar disk herniation: histochemical and electromyographic study. Orthopedics 26:493–495

    PubMed  Google Scholar 

  14. Yoshihara K, Shirai Y, Nakayama Y, Uesaka S (2001) Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine 26:622–626

    Article  PubMed  CAS  Google Scholar 

  15. Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A (1993) Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine 18:575–581

    Article  PubMed  CAS  Google Scholar 

  16. Hebert JJ, Fritz JM, Thackeray A, Koppenhaver SL, Teyhen D (2015) Early multimodal rehabilitation following lumbar disc surgery: a randomised clinical trial comparing the effects of two exercise programmes on clinical outcome and lumbar multifidus muscle function. Br J Sports Med 49:100–106. doi:10.1136/bjsports-2013-092402

    Article  PubMed  Google Scholar 

  17. Majlesi J, Togay H, Unalan H, Toprak S (2008) The sensitivity and specificity of the Slump and the straight leg raising tests in patients with lumbar disc herniation. J Clin Rheumatol 14:87–91. doi:10.1097/RHU.0b013e31816b2f99

    Article  PubMed  Google Scholar 

  18. Kosteljanetz M, Bang F, Schmidt-Olsen S (1988) The clinical significance of straight-leg raising (Lasegue’s sign) in the diagnosis of prolapsed lumbar disc. Interobserver variation and correlation with surgical finding. Spine (Phila Pa 1976) 13:393–395

    Article  CAS  Google Scholar 

  19. Kilpikoski S, Airaksinen O, Kankaanpaa M, Leminen P, Videman T, Alen M (2002) Interexaminer reliability of low back pain assessment using the McKenzie method. Spine (Phila Pa 1976) 27:E207–E214

    Article  Google Scholar 

  20. Fritz JM, Delitto A, Vignovic M, Busse RG (2000) Interrater reliability of judgments of the centralization phenomenon and status change during movement testing in patients with low back pain. Arch Phys Med Rehabil 81:57–61

    Article  PubMed  CAS  Google Scholar 

  21. Hebert JJ, Koppenhaver SL, Magel JS, Fritz JM (2010) The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study. Arch Phys Med Rehabil 91:78–85. doi:10.1016/j.apmr.2009.08.146

    Article  PubMed  Google Scholar 

  22. Hicks GE, Fritz JM, Delitto A, Mishock J (2003) Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil 84:1858–1864

    Article  PubMed  Google Scholar 

  23. Kiesel KB, Uhl TL, Underwood FB, Rodd DW, Nitz AJ (2007) Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging. Man Ther 12:161–166. doi:10.1016/j.math.2006.06.011

    Article  PubMed  Google Scholar 

  24. Koppenhaver SL, Parent EC, Teyhen DS, Hebert JJ, Fritz JM (2009) The effect of averaging multiple trials on measurement error during ultrasound imaging of transversus abdominis and lumbar multifidus muscles in individuals with low back pain. J Orthop Sports Phys Ther 39:604–611. doi:10.2519/jospt.2009.3088

    Article  PubMed  Google Scholar 

  25. Koppenhaver SL, Hebert JJ, Fritz JM, Parent EC, Teyhen DS, Magel JS (2009) Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles. Arch Phys Med Rehabil 90:87–94. doi:10.1016/j.apmr.2008.06.022

    Article  PubMed  Google Scholar 

  26. Hebert JJ, Koppenhaver SL, Parent EC, Fritz JM (2009) A Systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine 34:E848–E856

    Article  PubMed  Google Scholar 

  27. Koppenhaver SL, Hebert JJ, Parent EC, Fritz JM (2009) Rehabilitative ultrasound imaging is a valid measure of trunk muscle size and activation during most isometric sub-maximal contractions: a systematic review. Aust J Physiother 55:153–169

    Article  PubMed  Google Scholar 

  28. Ostelo RWJG, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, De Vet HCW (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90–94

    Article  PubMed  Google Scholar 

  29. Fritz JM, Irrgang JJ (2001) A comparison of a modified Oswestry Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 81:776–788

    PubMed  CAS  Google Scholar 

  30. Jensen MP, Turner JA, Romano JM, Fisher LD (1999) Comparative reliability and validity of chronic pain intensity measures. Pain 83:157–162

    Article  PubMed  CAS  Google Scholar 

  31. Fritz JM, Lindsay W, Matheson JW, Brennan GP, Hunter SJ, Moffit SD, Swalberg A, Rodriquez B (2007) Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine 32:E793–E800. doi:10.1097/BRS.0b013e31815d001a

    Article  PubMed  Google Scholar 

  32. Werneke M, Hart DL (2001) Centralization phenomenon as a prognostic factor for chronic low back pain and disability. Spine 26:758–765

    Article  PubMed  CAS  Google Scholar 

  33. Werneke MW, Deutscher D, Hart DL, Stratford P, Ladin J, Weinberg J, Herbowy S, Resnik L (2014) McKenzie lumbar classification: inter-rater agreement by physical therapists with different levels of formal McKenzie postgraduate training. Spine (Phila Pa 1976) 39:E182–E190. doi:10.1097/BRS.0000000000000117

    Article  Google Scholar 

  34. Junge A, Frohlich M, Ahrens S, Hasenbring M, Sandler A, Grob D, Dvorak J (1996) Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years’ follow up. Spine (Phila Pa 1976) 21:1056–1064 (discussion 1064–1055)

    Article  CAS  Google Scholar 

  35. Kohlboeck G, Greimel KV, Piotrowski WP, Leibetseder M, Krombholz-Reindl M, Neuhofer R, Schmid A, Klinger R (2004) Prognosis of multifactorial outcome in lumbar discectomy: a prospective longitudinal study investigating patients with disc prolapse. Clin J Pain 20:455–461

    Article  PubMed  Google Scholar 

  36. Abramovitz JN, Neff SR (1991) Lumbar disc surgery: results of the Prospective Lumbar Discectomy Study of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Neurosurgery 29:301–307 (discussion 307–308)

    Article  PubMed  CAS  Google Scholar 

  37. Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Mirza S, Weinstein J (2012) Who should have surgery for an intervertebral disc herniation? Comparative effectiveness evidence from the spine patient outcomes research trial. Spine (Phila Pa 1976) 37:140–149. doi:10.1097/BRS.0b013e3182276b2b

    Article  Google Scholar 

  38. Woertgen C, Rothoerl RD, Breme K, Altmeppen J, Holzschuh M, Brawanski A (1999) Variability of outcome after lumbar disc surgery. Spine (Phila Pa 1976) 24:807–811

    Article  CAS  Google Scholar 

  39. Hakkinen A, Ylinen J, Kautiainen H, Airaksinen O, Herno A, Kiviranta I (2003) Does the outcome 2 months after lumbar disc surgery predict the outcome 12 months later? Disabil Rehabil 25:968–972. doi:10.1080/0963828031000122258

    Article  PubMed  Google Scholar 

  40. Copay AG, Martin MM, Subach BR, Carreon LY, Glassman SD, Schuler TC, Berven S (2010) Assessment of spine surgery outcomes: inconsistency of change amongst outcome measurements. Spine J. doi:10.1016/j.spinee.2009.12.027

    Google Scholar 

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Acknowledgments

We wish to thank Dr. Faris Al-Odaibi and Dr. Nathan Savage for their valuable assistance with data collection. This study received funding from the Orthopaedic Section of the American Physical Therapy Association. The funding source had no role in the planning, conduct, or reporting of this study.

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. School of Psychology and Exercise Science, Murdoch University, 90 South Street, SS 2.015, Murdoch, WA, 6150, Australia

    Jeffrey J. Hebert, Shane L. Koppenhaver & Per Kjaer

  2. Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA

    Julie M. Fritz & Anne Thackeray

  3. Intermountain Healthcare, Salt Lake City, UT, USA

    Julie M. Fritz

  4. US Army-Baylor University Doctoral Programme in Physical Therapy, San Antonio, TX, USA

    Shane L. Koppenhaver

  5. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

    Per Kjaer

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  1. Jeffrey J. Hebert
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Correspondence to Jeffrey J. Hebert.

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Hebert, J.J., Fritz, J.M., Koppenhaver, S.L. et al. Predictors of clinical outcome following lumbar disc surgery: the value of historical, physical examination, and muscle function variables. Eur Spine J 25, 310–317 (2016). https://doi.org/10.1007/s00586-015-3916-z

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  • DOI: https://doi.org/10.1007/s00586-015-3916-z

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