Outcome evaluation of the operative management of lumbar disc herniation causing sciatica

Object. The authors conducted a study to assess health-related quality of life (HRQOL) and the appropriateness of surgery in patients who have undergone elective lumbar discectomy. Methods. The study involved a prospective cohort of 82 surgically treated patients with lumbar disc herniation causing lower-extremity radiculopathy. An independent study coordinator recorded demographic data and administered the North American Spine Society (NASS) lumbar spine instrument and the Short Form-36 (SF-36) before treatment, and at 6 months and 1 year after surgery. The HRQOL results were also compared with normative data for the NASS and SF-36. The influence of baseline variables on HRQOL was determined using regression modeling. The InterQual Indicators for Surgery and Procedures (ISP) were used to compare surgeon practice patterns with standardized indications for surgery. The NASS neurogenic symptom (NSS) and pain/disability scores (PDSs) showed very significant improvement at 6 months and little change between 6 months and 1 year. The SF-36 physical function and bodily pain scale scores were associated with the greatest improvement. Interestingly, the 1-year NASS (NSS and PDS) and SF-36 (only PCS) scores remained lower than those of age-matched normative data. Other than preoperative HRQOL scores, the only other variable that inversely influenced HRQOL was the duration of time between symptom onset and surgery. Ninety-five percent of ISP forms were completed, and 97% of the indications recorded by the surgeon matched the criteria. Conclusions. The reporting of standardized outcomes in association with indications for surgery is feasible and may help elucidate the ideal rate for discectomy.