Materiały źródłowe

• #1 Predictors of bad and good outcome of lumbar spine surgery. A prospective clinical study with 2 years’ follow up – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8724090/

  Study design: Based on prospective assessment, patients with lumbar disc surgery were examined to determine reliable predictors for clinical outcome. […] The prognostic value of a screening checklist developed in a previous study was evaluated in a 2-year follow-up. […] Outcome studies of lumbar disc surgery document a success rate between 49-90%. It has been shown that a number of medical history data and sociodemographic and psychodiagnostic findings are of prognostic value for the outcome of lumbar spine surgery. […] In patients with disc herniation only, good results were observed in 53%, moderate in 19%, and bad in 28%. The accuracy of prediction of the postoperative result was 75% for the patients with good outcome and 86% for those with bad outcome. […] Patients with a high risk of a bad operation outcome after lumbar discectomy could be identified preoperatively. It is suggested that those patients take part in a pain management approach instead of or in addition to surgical intervention.

• #1 Herniated Disk (Bulging Disk): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/12768-herniated-disk

  Herniated disks usually heal on their own within four to six weeks. […] If you’ve had symptoms for more than a few weeks, reach out to a healthcare provider. They can explain your treatment options and get you back to enjoying the activities that you love. […] Herniated disks get better on their own or with nonsurgical treatment for 9 out of 10 people. […] If other treatments don’t relieve your symptoms, your healthcare provider may recommend surgery. […] For the majority of people, herniated disk pain gets better on its own or with simple medical care. You’ll probably feel better within a month. […] An untreated herniated disk can get worse. […] See a healthcare provider if you still have symptoms after four to six weeks of conservative care.

• #1 Systematic review and meta-analysis of predictive factors for spontaneous regression in lumbar disc herniation in: Journal of Neurosurgery: Spine Volume 39 Issue 4 (2023) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/39/4/article-p471.xml

  Relatively little evidence exists on predictive factors for the spontaneous regression of lumbar disc herniation (LDH), although it is a well-documented phenomenon. […] The probabilities of spontaneous regression with bulging, protruded, extruded, and sequestered discs were 13.3%, 52.5%, 70.4%, and 93.0%, respectively (2 = 126.01, p 0.001). […] Extruded and sequestered discs were also significantly more likely to completely regress than smaller morphologies. […] This study shows further evidence of the influence of disc morphology on predicting LDH regression as well as provides the first meta-analysis of data indicating additional predictive factors. […] Further investigation of predictive factors for early ( 6 months) LDH regression is suggested to optimize clinical use. […] Larger baseline herniation volume (1260.16 vs 1006.71 mm3, p 0.002), transligamentous herniation (2 = 13.321, p 0.001), and higher Komori types (2 = 14.5132, p 0.001) were also identified as predictors of regression.

• #1 The outcome predicted value of enhanced MRI for prolapsed or sequestrated lumbar disc herniation | Chinese Journal of Orthopaedics;(12): 1350-1360, 2021. | WPRIM

  https://pesquisa.bvsalud.org/portal/resource/pt/wpr-910722

  The outcome predicted value of enhanced MRI for prolapsed or sequestrated lumbar disc herniation […] Objective:To analyze the predictive value of enhanced MRI in the outcome of prolapsed and sequestrated lumbar disc herniation through a retrospective analysis. […] Conclusion:Under close clinical observation, parts of the prolapsed or sequestrated lumbar disc herniations can be conservatively treated, and the herniated disc can be resorption in many people and the clinical symptoms were alleviated. Rim-enhancement signal differentiation by enhanced MR has a better predictive value for the outcome of the herniation, type I is more prone to resorption, preferred conservative treatment, type II is not easy to resorption, preferred surgery treatment, and the higher thickness of rim enhancement, the greater extend the rim-enhancement, the more prone to resorption phenomenon.

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921966/

  Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients; there was little to no degradation of outcomes in either group (operative and non-operative) from 4 to 8 years. […] In patients with a herniated disc confirmed by imaging and leg symptoms persisting for at least 6 weeks, surgery was superior to non-operative treatment in relieving symptoms and improving function. […] In the longitudinal intention-to-treat analysis, all the outcomes showed small advantages for surgery, but only the secondary outcomes of sciatica bothersomeness, satisfaction with symptoms, and self-rated improvement were statistically significant. […] The persistent small benefit in the surgery group over time has made the overall intention-to-treat comparison more statistically significant over time despite high levels of cross-over.

• #1 Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0474-9

  Lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. […] Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. […] Identification of prognostic factors predicting persistent pain and disability is important for better understanding of the clinical course information that can be provided to patients and physicians and decision-making in treatment and guidance of patients with radiculopathy. […] We identified higher age and reflex impairment as prognostic factors for non-success, and higher education, working full-time and low fear avoidance as prognostic factors for a successful outcome.

• #1 Recurrent herniated disc > Symptoms, therapy, surgery

  https://avicenna-klinik.com/en/spine-symptoms-disorders/recurrent-renewed-herniated-disc/

  Approximately 480,000 lumbar spine surgeries are performed annually in the U.S., mostly to treat herniated discs. […] However, in 10 to 15 percent of those successfully operated on, a new herniated disc occurs at the same site, a so-called recurrence. […] In this case, affected persons feel pain again despite previous surgery and suffer a relapse. […] Recurrences usually occur months or years after the first operation – very rarely earlier. […] The causes of a herniated disc recurrence lie here: In the progression of the wear process of the disc. […] If you have been „successfully” operated on a herniated disc, but your discomfort and back pain have recurred, then you should see your doctor. […] The MRI then shows whether a new prolapse is present and allows conclusions to be drawn about the exact size and location of the recurrence.

• #1 Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089200

  The vast majority of patients undergoing surgery for a herniated disc attended a post-hospital rehabilitation treatment program (93%). […] More than half of the outpatient rehabilitees (56%) compared to only one third of the inpatient rehabilitees (33%) returned to work three months after disc surgery (p.001). […] The results suggest a pre-selection of patients with better health status in outpatient rehabilitation. […] The presented findings outline that there is almost no difference between the setting-specific rehabilitation preferences during acute hospital stay and the actual rehabilitation participation afterwards. […] OPR patients return to the work place significantly more often than IPR patients. […] These findings should not be interpreted as quality differences between IPR and OPR treatments.

• #1 Outcome prediction following lumbar disc surgery: a longitudinal study of outcome trajectories, prognostic factors, and risk models in: Journal of Neurosurgery: Spine Volume 42 Issue 1 (2024) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/42/1/article-p33.xml

  This study aimed to 1) describe the 2-year postoperative trajectories of leg pain and overall clinical outcome after surgery for radiculopathy, 2) identify the preoperative prognostic factors that predict trajectories representing poor clinical outcomes, and 3) develop and internally validate multivariable prognostic models to assist with clinical decision-making. […] The trajectory models identified 3 subgroups based on the patients postoperative courses of pain or disability: 88.6% of patients in the leg pain model and 71.9% in the overall outcome model experienced a good-to-excellent outcome. The models classified 11.4% (leg pain outcome) and 28.2% (overall outcome) of patients as experiencing a poor clinical outcome, which was defined as minimal improvement in pain or disability after surgery.

• #1

  https://link.springer.com/article/10.1007/s00586-023-07528-4

  There is little, and low quality, evidence to guide practice in terms of factors that predict outcomes in patients following ESI for disc-related sciatica. […] No prognostic factor was found to be consistently associated with outcomes following ESI. […] Most studies found no association or results that conflicted with other studies. […] The review found 15 eligible studies, which explored 42 potential prognostic factors assessed before the ESI. […] Our review showed that no prognostic factor is consistently associated with patient outcomes, most studies found no association or conflicting results. […] This systematic review highlights the continued uncertainty about prognostic factors in patients having ESI for sciatica.

• #2 Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0474-9

  Lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. […] Specifically, lower age and low fear avoidance predict a better functional outcome and less back pain, while higher education and working full-time predict less leg pain. […] Identification of prognostic factors predicting persistent pain and disability is important for better understanding of the clinical course information that can be provided to patients and physicians and decision-making in treatment and guidance of patients with radiculopathy. […] We identified higher age and reflex impairment as prognostic factors for non-success, and higher education, working full-time and low fear avoidance as prognostic factors for a successful outcome.

• #2 Systematic review and meta-analysis of predictive factors for spontaneous regression in lumbar disc herniation in: Journal of Neurosurgery: Spine Volume 39 Issue 4 (2023) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/39/4/article-p471.xml

  The presence of Modic changes on MRI, noted in 1%30% of LDH cases, has also been associated with regression. […] In our study, we demonstrate a trend of LDH regression in those without Modic changes on MRI. […] This relationship between morphology and regression seen in both our quantitative and qualitative analyses is in keeping with previous reviews, as is the timeline for complete regression in our study of 10 months.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921966/

  The as-treated analysis combining the randomized and observational cohorts, which carefully controlled for potentially confounding baseline factors, showed significantly greater improvement in pain, function, satisfaction, and self-rated progress over 8 years compared to patients treated non-operatively. […] The non-operative group, however, also showed substantial improvements over time, with 54% reporting being satisfied with their symptoms and 73% satisfied with their care after 8 years.

• #2 Outcome prediction in chronic unilateral lumbar radiculopathy: prospective cohort study | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0474-9

  These prognostic factors may be used by clinicians to inform patients about the one-year prognosis of chronic unilateral lumbar radiculopathy. […] The main finding of this study is that lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. […] This study also shows that the prognosis for patients referred to multidisciplinary back clinics for chronic unilateral lumbar radiculopathy is good. […] A total of 75 (64.7%) patients at follow-up had an ODI score below 20, 54 (46.6%) had a VAS leg pain score below 17.5 and 47 (40.5%) had a VAS leg pain score below 22.5. […] We found that lower age, higher education, working full-time and low fear avoidance beliefs each predict a better outcome of chronic unilateral lumbar radiculopathy. […] These results should be validated in further studies before being used to inform patients.

• #2 Recurrent herniated disc > Symptoms, therapy, surgery

  https://avicenna-klinik.com/en/spine-symptoms-disorders/recurrent-renewed-herniated-disc/

  A second herniated disc has actually occurred in the same location. […] The decision for a new disc surgery (microsurgery) to remove the „new” herniated disc is made if the above therapies have not helped or if they can not be applied. […] However, we assume that timely and correct mobilization after the first operation and correct postoperative follow-up are the best therapies to prevent recurrence. […] The answer lies in the experience of the second recurrence. […] These mostly younger disc recurrence patients have mostly well-preserved discs, and they are willing to strengthen their back muscles.

• #2 Inpatient or Outpatient Rehabilitation after Herniated Disc Surgery? – Setting-Specific Preferences, Participation and Outcome of Rehabilitation | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089200

  The great majority of herniated disc patients participate in rehabilitation after surgery. Our findings indicate a pre-selection of disc surgery patients with better health status in OPR and with poorer health status in IPR settings. […] More precisely, more impaired and distressed patients before rehabilitation might not benefit as much from their rehabilitation treatment than less impaired and distressed patients.

• #2 Outcome prediction following lumbar disc surgery: a longitudinal study of outcome trajectories, prognostic factors, and risk models in: Journal of Neurosurgery: Spine Volume 42 Issue 1 (2024) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/42/1/article-p33.xml

  Patients with lumbar radiculopathy experience heterogeneous postoperative trajectories of pain and disability after lumbar discectomy. Individual preoperative factors are associated with postoperative outcomes and can be combined within a multivariable risk model to predict overall patient outcome. These results may inform clinical practice but require external validation before confident clinical implementation.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921966/

  Carefully selected patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operatively treated patients; there was little to no degradation of outcomes in either group (operative and non-operative) from 4 to 8 years. […] In patients with a herniated disc confirmed by imaging and leg symptoms persisting for at least 6 weeks, surgery was superior to non-operative treatment in relieving symptoms and improving function. […] In the longitudinal intention-to-treat analysis, all the outcomes showed small advantages for surgery, but only the secondary outcomes of sciatica bothersomeness, satisfaction with symptoms, and self-rated improvement were statistically significant. […] The persistent small benefit in the surgery group over time has made the overall intention-to-treat comparison more statistically significant over time despite high levels of cross-over.

• #3

  https://link.springer.com/article/10.1007/s00586-021-07033-6

  Most patients with lumbar disc herniations requiring surgery have concomitant back pain. […] The purpose of the current study was to evaluate the outcome of surgery for lumbar disc herniations in patients with no preoperative back pain (NBP) compared to those reporting low back pain (LBP). […] At the one-year follow-up, 89% of the patients in the NBP group were completely pain free or much better compared with 76% in the LBP group. […] Patients without preoperative back pain are good candidates for LDH surgery. […] 13% of patients without preoperative back pain develop clinically significant back pain one-year after surgery. […] The findings of our study suggest that the surgical outcome is more favorable in LDH patients if back pain is absent preoperatively. […] A substantially larger proportion of the NBP patients are pain free or much better with regards to leg pain after surgery compared with the LPB patients (87 vs 76%). […] Patients with LDH without back pain are good candidates for surgery. […] To conclude, patients with no preoperative back pain seem to have a better outcome following LDH as compared to patients with concomitant back pain and with a higher degree of patient satisfaction.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921966/

  The as-treated analysis combining the randomized and observational cohorts, which carefully controlled for potentially confounding baseline factors, showed significantly greater improvement in pain, function, satisfaction, and self-rated progress over 8 years compared to patients treated non-operatively. […] The non-operative group, however, also showed substantial improvements over time, with 54% reporting being satisfied with their symptoms and 73% satisfied with their care after 8 years.

Zobacz więcej