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European Spine Journal

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01-01-2016 | Original Article

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

Authors: Jeffrey J. Hebert, Julie M. Fritz, Shane L. Koppenhaver, Anne Thackeray, Per Kjaer

Published in: European Spine Journal | Issue 1/2016

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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Title: Predictors of clinical outcome following lumbar disc surgery: the value of historical, physical examination, and muscle function variables
Authors: Jeffrey J. Hebert
Julie M. Fritz
Shane L. Koppenhaver
Anne Thackeray
Per Kjaer
Publication date: 01-01-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 1/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-3916-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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