Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation

Gregory I. Sacks; Vincent Destefano; Susan M. Fiore; Raphael P. Davis; Samuel Ahknoukh; Harry M. Mushlin

doi:10.14444/8650

Article Figures & Data

Tables

View popup

Table 1

Baseline characteristics of patients undergoing surgical management of lumbar disc herniation.

Characteristic	N (%)
Age, y, mean (SD)	47.0 (15.5)
Female sex	54 (43.9%)
BMI, mean (SD)	28.8 (5.3)
Race/ethnicity
Caucasian	104 (84.6%)
Hispanic	10 (8.1%)
Asian	2 (1.6%)
African American	2 (1.6%)
Native Hawaiian or other Pacific Islander	3 (2.4%)
Medical history
Diabetes mellitus	15 (12.2%)
Liver/kidney disease	6 (4.9%)
Alcohol use	75 (61.0%)
Current smoker	18 (14.6%)
Cannabis use	8 (6.5%)
Osteoporotic disease	4 (3.3%)
Rheumatoid arthritis	1 (0.8%)
Multiple sclerosis	1 (0.8%)
Surgical history
Prior spine surgery	17 (13.8%)
Prior decompression	6 (4.9%)
Prior fusion	9 (7.3%)
Prior “other spine surgery”	2 (1.6%)
Cervical	6 (4.9%)
Thoracic	1 (0.8%)
Lumbar	8 (6.5%)
Level of injury
L1–L2	1 (0.8%)
L2–L3	6 (4.9%)
L2–L4	1 (0.8%)
L3–L4	16 (13.0%)
L3–L5	1 (0.8%)
L4–L5	39 (31.7%)
L4–S1	6 (4.9%)
L5–S1	53 (43.1%)
Preoperative symptoms
Preoperative back pain	91 (74.0%)
Preoperative radicular pain	116 (94.3%)
Preoperative neurological symptoms	90 (73.2%)
Preoperative NRS, mean (SD)	7.0 (2.4)
Time from symptom onset to surgery (wk), mean (SD)	39.7 (56.8)
Prior management
Procedural intervention	89 (72.4%)
Physical therapy	47 (38.2%)
Acupuncture	9 (7.3%)
Chiropractic	19 (15.4%)
Surgical technique
Use of intraoperative microscope	22 (17.9%)
Open microdiscectomy	103 (83.7%)
Tubular (MIS) microdiscectomy	15 (12.2%)
Decompression w/out discectomy	3 (2.4%)
Fat graft	45 (36.6%)
Dural tear/CSF leak	3 (2.4%)
Operative time, min, mean (SD)	79.0 (38.1)

Abbreviations: BMI, body mass index; CSF, cerebrospinal fluid; MIS, minimally invasive surgery; NRS, Numerical Rating System.
Note: Data presented as n (%) unless otherwise noted.

View popup

Table 2

Bivariate analysis of outcomes after surgical treatment for lumbar disc herniation.

Variable	Outcome
	Absolute Change Threshold (3.5 points)			Resolution of Radicular Pain			Resolution of Neurological Symptoms
	Success	Failure	P	Success	Failure	P	Success	Failure	P
Total	42 (41.2%)	60 (58.8%)	-	43 (37.1%)	73 (62.9%)	-	31 (34.4%)	59 (65.6%)	-
Age, y	47 ± 15.1	48 ± 16.6	0.8776^{^b}	48 47 ± 15.7	47 ± 15.6	0.6518^{^b}	43 ± 17.9	49 ± 13.7	0.0611^{^b}
Female sex	18 (41.9%)	25 (58.1%)	>0.99^{^a}	20 (40.8%)	29 (59.2%)	0.560^{^a}	16 (39.0%)	25 (61.0%)	0.505^{^a}
BMI	28 ± 5.0	29 ± 5.3	0.4132^{^b}	29 ± 5.2	29 ± 5.5	0.7526^{^b}	28 ± 4.4	29 ± 5.7	0.3399^{^b}
Medical/surgical history
Diabetes mellitus	4 (28.6%)	10 (71.4%)	0.388^{^a}	6 (40.0%)	9 (60.0%)	0.783^{^a}	2 (22.2%)	7 (77.8%)	0.713^{^a}
Current smoker	5 (35.7%)	9 (64.3%)	0.774^{^a}	9 (56.3%)	7 (43.8%)	0.101^{^a}	3 (33.3%)	6 (66.7%)	>0.99
Osteoporotic disease	2 (50.0%)	2 (50.0%)	>0.99^{^a}	4 (100.0%)	0 (0.0%)	0.017^{^a}	3 (100.0%)	0 (0.0%)	0.038^{^a}
Prior spine surgery	1 (7.7%)	12 (92.3%)	0.013^{^a}	5 (29.4%)	12 (70.6%)	0.592^{^a}	5 (33.3%)	10 (66.7%)	>0.99^{^a}
Prior fusion surgery	0 (0.0%)	7 (100.0%)	0.039^{^a}	4 (44.4%)	5 (55.6%)	0.724^{^a}	4 (50.0%)	4 (50.0%)	0.439^{^a}
Level of injury
L2–L3	3 (60.0%)	2 (40.0%)	0.400^{^a}	3 (50.0%)	3 (50.0%)	0.669^{^a}	1 (50.0%)	1 (50.0%)	>0.99^{^a}
L3–L4	4 (26.7%)	11 (73.3%)	0.265^{^a}	8 (50.0%)	8 (50.0%)	0.274^{^a}	6 (50.0%)	6 (50.0%)	0.327^{^a}
L5–S1	21 (52.5%)	19 (47.5%)	0.068^{^a}	14 (28.0%)	36 (72.0%)	0.085^{^a}	15 (39.5%)	23 (60.5%)	0.501^{^a}
History of injury
Preoperative back pain	27 (37.5%)	45 (62.5%)	0.275^{^a}	36 (42.4%)	49 (57.6%)	0.055^{^a}	23 (35.4%)	42 (64.6%)	0.810^{^a}
Time from symptom onset to surgery, wk	28 ± 31.8	55 ± 72.3	0.0584^{^b}	38 ± 59.4	37 ± 49.6	0.5971^{^b}	33 ± 39.2	25 ± 26.0	0.5034^{^b}
Preoperative NRS	8 ± 1.7	6 ± 2.6	0.0002^{^b}	7 ± 2.6	7 ± 2.3	0.1886^{^b}	7 ± 2.4	7 ± 2.5	0.9548^{^b}
Preoperative physical therapy	11 (26.8%)	30 (73.2%)	0.032 ^{^a}	9 (20.9%)	34 (79.1%)	0.021 ^{^a}	5 (17.2%)	24 (82.8%)	0.026 ^{^a}
Operative time, min	72 ± 40.6	84 ± 38.6	0.016^{^b}	80 ± 37.8	79 ± 39.5	0.5932^{^b}	71 ± 24.3	81 ± 40.1	0.4085^{^b}
Surgical technique
Use of intraoperative microscope	7 (38.9%)	11 (61.1%)	>0.99^{^a}	9 (40.9%)	13 (59.1%)	0.809^{^a}	4 (23.5%)	13 (82.4%)	0.399^{^a}
Open microdiscectomy	38 (44.7%)	47 (55.3%)	0.176^{^a}	35 (36.5%)	61 (63.5%)	0.802^{^a}	27 (35.1%)	50 (64.9%)	>0.99^{^a}
Tubular (MIS) microdiscectomy	3 (23.1%)	10 (76.9%)	0.229^{^a}	5 (33.3%)	10 (66.7%)	>0.99^{^a}	3 (27.3%)	8 (72.7%)	0.742^{^a}
Decompression without discectomy	1 (33.3%)	2 (66.7%)	>0.99^{^a}	2 (66.7%)	1 (33.3%)	0.554^{^a}	0 (0.0%)	1 (100.0%)	>0.99^{^a}
Fat graft	16 (43.2%)	21 (56.8%)	0.835^{^a}	15 (36.6%)	26 (63.4%)	>0.99^{^a}	13 (38.2%)	21 (61.8%)	0.649^{^a}

Abbreviations: BMI, body mass index; MIS, minimally invasive surgery.
Note: Data presented as n (%) or mean ± SD. Boldface indicates statistically significant findings at P < 0.05.
↵a Fisher Exact.
↵b Mann-Whitney U Test.

View popup

Table 3

Multivariate analysis of outcomes after surgical treatment for lumbar disc herniation.

Variable	Outcome
	Absolute Change Threshold (3.5pt)		Resolution of Radicular Pain		Resolution of Neurological Symptoms
	OR (95% CI)	P	OR (95% CI)	P	OR (95% CI)	P
Age	1.003 (0.966–1.041)	0.866	0.995 (0.961–1.031)	0.793	0.952 (0.910–0.995)	0.030
Osteoporotic disease	-	-	-	-	-	-
Prior spine surgery	0.119 (0.011–1.231)	0.074	-	-	-	-
L5–S1	-	-	0.483 (0.153–1.529)	0.216	-	-
Preoperative back pain	0.559 (0.154–2.029)	0.377	-	-	-	-
Time from symptom onset to surgery	0.987 (0.971–1.004)	0.136	1.000 (0.988–1.012)	0.982	1.013 (0.992–1.035)	0.219
Preoperative NRS	1.554 (1.182–2.041)	0.002	1.214 (0.985–1.497)	0.069	1.126 (0.877–1.445)	0.352
Preoperative physical therapy	0.252 (0.073–0.873)	0.030	0.196 (0.062–0.621)	0.006	0.177 (0.037–0.842)	0.030
Operative time	0.991 (0.977–1.005)	0.211	0.994 (0.983–1.006)	0.350	0.989 (0.969–1.008)	0.256

Abbreviation: NRS, Numerical Rating System.
Note: Boldface indicates statistically significant findings at P < 0.05.