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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2018

Open Access 01-12-2018 | Research article

Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis

Authors: Alison Rushton, Konstantinos Zoulas, Andrew Powell, JB Staal

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

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Abstract

Background

Success rates for lumbar discectomy are estimated as 78–95% patients at 1–2 years post-surgery, supporting its effectiveness. However, ongoing pain and disability is an issue for some patients, and recurrence contributing to reoperation is reported. It is important to identify prognostic factors predicting outcome to inform decision-making for surgery and rehabilitation following surgery. The objective was to determine whether pre-operative physical factors are associated with post-operative outcomes in adult patients [≥16 years old] undergoing lumbar discectomy or microdiscectomy.

Methods

A systematic review was conducted according to a registered protocol [PROSPERO CRD42015024168]. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. radicular pain] to 31/3/2017; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥1-year follow-up, evaluating candidate physical prognostic factors [e.g. leg pain intensity and straight leg raise test], in adult patients undergoing lumbar discectomy/microdiscectomy were included. Two reviewers independently searched information sources, evaluated studies for inclusion, extracted data, and assessed risk of bias [QUIPS]. GRADE determined the overall quality of evidence.

Results

1189 title and abstracts and 45 full texts were assessed, to include 6 studies; 1 low and 5 high risk of bias. Meta-analysis was not possible [risk of bias, clinical heterogeneity]. A narrative synthesis was performed. There is low level evidence that higher severity of pre-operative leg pain predicts better Core Outcome Measures Index at 12 months and better post-operative leg pain at 2 and 7 years. There is very low level evidence that a lower pre-operative EQ-5D predicts better EQ-5D at 2 years. Low level evidence supports duration of leg pain pre-operatively not being associated with outcome, and very low-quality evidence supports other factors [pre-operative ODI, duration back pain, severity back pain, ipsilateral SLR and forward bend] not being associated with outcome [range of outcome measures used].

Conclusion

An adequately powered low risk of bias prospective observational study is required to further investigate candidate physical prognostic factors owing to existing low/very-low level of evidence.
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Literature
1.
Buchbinder RBF, March LM, et al. Placing the global burden of low back pain in context. Best Pract Res Clin Rheumatol. 2013;27(5):575–89.CrossRefPubMed
2.
HCUPnet. Outcomes by 3 laminectomy, excision intervertebral disc. In: National statistics on all stays statistics on specific diagnoses or procedures; 2012.
3.
4.
Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American pain society clinical practice guideline. Spine (Phila Pa 1976). 2009;34(10):1094–109.CrossRef
5.
Gibson JNAWG. Surgical interventions for lumbar disc prolapse: updated Cochrane review. Spine. 2007;32(16):1735.CrossRefPubMed
6.
Oosterhuis TCL, Maher CG, et al. Rehabilitation after lumbar disc surgery. In: Cochrane Database Syst Rev vol. art. No: CD003007; 2014.
7.
Ostelo RWGM, de Vet HC, et al. Economic evaluation of a behavioral-graded activity program compared to physical therapy for patients following lumbar disc surgery. Spine. 2004;29:615–22.CrossRefPubMed
8.
Statistics HE. All procedures and interventions 2013/14. In: 3 character All procedures (V33) National Health Service Digital data; 2016.
9.
Lebow RL, Adogwa O, Parker SL, Sharma A, Cheng J, McGirt MJ. Asymptomatic same-site recurrent disc herniation after lumbar discectomy: results of a prospective longitudinal study with 2-year serial imaging. Spine. 2011;36(25):2147–51.CrossRefPubMed
10.
Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, McGirt MJ. Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res. 2015;473(6):1988–99.CrossRefPubMedPubMedCentral
11.
Steyerberg EW, Moons KG, van der Windt DA, Hayden JA, Perel P, Schroter S, Riley RD, Hemingway H, Altman DG, Group P. Prognosis research strategy (PROGRESS) 3: prognostic model research. PLoS Med. 2013;10(2):e1001381.CrossRefPubMedPubMedCentral
12.
Hemingway H, Croft P, Perel P, Hayden JA, Abrams K, Timmis A, Briggs A, Udumyan R, Moons KG, Steyerberg EW, et al. Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes. BMJ. 2013;346:e5595.CrossRefPubMedPubMedCentral
13.
den Boer JJ, Oostendorp RA, Beems T, Munneke M, Oerlemans M, Evers AW. A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery. Eur Spine J. 2006;15(5):527–36.CrossRefPubMed
14.
15.
Schoenfeld AJBM. Does surgical timing influence functional recovery after lumbar discectomy? A systematic review. Clin Orthop Relat Res. 2015;473:1963–70.CrossRefPubMed
16.
Ng LCL, Sell P. Predictive value of the duration of sciatica for lumbar discectomy: a PROSPECTIVE COHORT STUDY. J Bone Joint Surg Br. 2004;86-B(4):546–9.CrossRef
17.
Haugen AJ, Brox JI, Grovle L, Keller A, Natvig B, Soldal D, Grotle M. Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord. 2012;13:183.CrossRefPubMedPubMedCentral
18.
Lonne G, Solberg TK, Sjaavik K, Nygaard OP. Recovery of muscle strength after microdiscectomy for lumbar disc herniation: a prospective cohort study with 1-year follow-up. Eur Spine J. 2012;21(4):655–9.CrossRefPubMed
19.
Furlan A PV, Bombardier C, et al; from the editorial Board of the Cochrane Collaboration Back Review Group: Updated method guidelines for systematic reviews in the Cochrane collaboration back review group. Spine 2009, 34:1929–1941.CrossRefPubMed
20.
Higgins JP GS, Eds. : Cochrane handbook for systematic reviews of intervention in., vol. Version 5.1.0: the Cochrane collaboration 2011.
21.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, Group P-P. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647.CrossRefPubMed
22.
Moher DLA, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.CrossRefPubMed
23.
C B. Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine. 2000;25(24):3100–3.CrossRef
24.
Solberg T, Johnsen LG, Nygaard ØP, Grotle M. Can we define success criteria for lumbar disc surgery? Estimates for a substantial amount of improvement in core outcome measures. Acta Orthop. 2013;84(2):196–201.CrossRefPubMedPubMedCentral
25.
Chiarotto A, Deyo RA, Terwee CB, Boers M, Buchbinder R, Corbin TP, Costa LO, Foster NE, Grotle M, Koes BW, Kovacs FM. Core outcome domains for clinical trials in non-specific low back pain. Eur Spine J. 2015;24(6):1127–42.CrossRefPubMed
26.
Wilczynski NL, Haynes RB, Hedges T. Developing optimal search strategies for detecting clinically sound prognostic studies in MEDLINE: an analytic survey. BMC Med. 2004;2:23.CrossRefPubMedPubMedCentral
27.
Edwards P, Clarke M, DiGuiseppi C, Pratap S, Roberts I, Wentz R. Identification of randomized controlled trials in systematic reviews: accuracy and reliability of screening records. Stat Med. 2002;21(11):1635–40.CrossRefPubMed
28.
Hayden JA, Cote P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144(6):427–37.CrossRefPubMed
29.
Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158(4):280–6.CrossRefPubMed
30.
Bruls VEBC, de Bie RA. Prognostic factors of complaints of arm, neck and/or shoulder: a systematic review of prospective cohort studies. Pain. 2015;156(5):765–88.CrossRefPubMed
31.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
32.
Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the journal of clinical epidemiology. J Clin Epidemiol. 2011;64(4):380–2.CrossRefPubMed
33.
Huguet A, Hayden JA, Stinson J, McGrath PJ, Chambers CT, Tougas ME, Wozney L. Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework. Syst Rev. 2013;2:71.CrossRefPubMedPubMedCentral
34.
Lewis PJ, Weir BKA, Broad RW, Grace MG. Long-term prospective study of lumbosacral discectomy. J Neurosurg. 1987;67(1):49–53.CrossRefPubMed
35.
36.
Silverplats K, Lind B, Zoega B, Halldin K, Gellerstedt M, Brisby H, Rutberg L. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J. 2010;19(9):1459–67.CrossRefPubMedPubMedCentral
37.
Silverplats K, Lind B, Zoega B, Halldin K, Gellerstedt M, Rutberg L, Brisby H. Health-related quality of life in patients with surgically treated lumbar disc herniation: 2- and 7-year follow-up of 117 patients. Acta Orthop. 2011;82(2):198–203.CrossRefPubMedPubMedCentral
38.
Divecha MHFB, Verma R. Post-operative outcome following lumbar discectomy: The value of pre-operative radicular pain proportion. In: 8th British Spine Conference 2014. Warwick United Kingdom: European Spine Journal; 2014.
39.
Nygaard OPKR, Solberg T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow-up. J Neurosurg. 2000;92:131–4.PubMed
40.
Fisher CG, Noonan V, Bishop P, Boyd M, Fairholm D, Wing P, Dvorak M. Outcome evaluation of the operative management of lumbar disc herniation causing sciatica. J Neurosurg. 2004;100(4 SUPPL):317–24.PubMed
41.
Solberg TØPN, Sjaavik K, Hofoss D. The risk of “getting worse” after lumbar microdiscectomy. Eur Spine J. 2005;
42.
Moons KRP, Vergouwe Y, et al. Prognosis and prognostic research: what, why, and how? BMJ. 2009;338(7706):1317–20.
43.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.CrossRefPubMedPubMedCentral
Metadata
Title
Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis
Authors
Alison Rushton
Konstantinos Zoulas
Andrew Powell
JB Staal
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-018-2240-2

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