Abstract
Introduction
The knowledge of prognostic factors related to good and poor surgical outcome is crucial to perform a proper patient selection and achieve a good surgical outcome. The patient satisfaction and quality of life has been considered one of the most important outcomes in spinal surgery. The objective is to report the prognosis factors related to satisfaction after an open discectomy procedure in LDH through a prospective study design.
Materials and Methods
Prospective cohort of adults with LDH associated with neurological impairment and sciatica who underwent open discectomy. The inclusion criteria was the presence of L4–L5 or L5–S1 LDH on magnetic resonance image, with clinical correlation. The patients were submitted to surgical procedure if persisted with sciatica after clinical treatment of 4 to 8 weeks or if presented progressive motor impairment despite conservative treatment. All patients were evaluated preoperatively and 1, 6, and 12 months postoperatively using a validated instruments were used to evaluate pain, disability, quality of life, anxiety, and depression and fear and beliefs related to work and physical activity. In the last evaluation, the patients answered the following question to determinate their satisfaction with the procedure: Would you have the same treatment to achieve the same result again? The patients who answered “definitively Yes” or “probably Yes” were considered satisfied with the procedure. The patients were considered dissatisfied when they answered, “do not know,” “probably would not,” or “definitively would not.”
Results
A total of 125 patients with one level discectomy in L4–L5 or L5–S1 were included in this study. Paired analyses demonstrated that open discectomy improved pain, function, quality of life, depression, and anxiety scores, and reduced fear-avoidance beliefs of patients with lumbar disc herniation. The satisfaction rate with treatment was 84.8 and 86.4% at 30 days and 1-year postoperative, respectively. Patients considered satisfied with treatment presented higher improvement in ODI (mean difference: −19.24, CI 95%: −9.00to −29.48; p = 0.001), PC–SF-36 (mean difference: 12.71; CI 95%: 6.68–18.74; p < 0.0001), and BDI (mean difference: −3.57, CI 95%: −0.22 to −6.92; p = 0.039). Regarding fear-avoidance beliefs, the satisfied group presented lower levels of FAB–PA (p = 0.051) at final follow-up. No difference was observed in the FAB-W during the periods of evaluation. The instruments related to depression and anxiety demonstrated that the levels of anxiety and depression in 1-year postoperative were higher in patients dissatisfied (BDI: p = 0.005, HADS: p = 0.038).
Conclusion
The cutoff value to distinguish between satisfaction and dissatisfaction after open discectomy to patients with LDH was a change score of 21 (sensitivity: 0.88, specificity: 0.60, LR + : 2.20, and LR − : 0.23) for the ODI, 8 (sensitivity: 0.85, specificity: 0.69, LR + : 2.74, and LR − : 0.21) for PC–SF-36, and 3.5 (sensitivity: 0.76, specificity: 0.52, LR + : 1.58, and LR − : 0.46) for BDI.