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Willems S1
1VU Medical Center, MOVE, Eindhoven, Netherlands
Background: Lumbar microdiscectomy followed by post-operative physiotherapy is a common treatment for patients with lumbar radiculopathy when conservative treatment fails. Findings reveal that most patients recover, however, a considerable percentage of people remains having pain and disability. Good prognostic models for recovery which use currently gathered information from clinical practice are scare.
Purpose: To develop and internally validate prognostic models for recovery following lumbar microdiscectomy based on commonly collected data at baseline.
Methods: We included 298 patients with lumbar disc herniation who underwent microdiscectomy followed by postoperative physiotherapy. Outcomes were (poor) recovery, pain and disability at 12 months' follow-up. Based on findings from previous studies, potential prognostic factors were selected from commonly captured variables at baseline. The association between baseline characteristics and outcomes was evaluated using multivariable logistic regression analyses.
Results: At 12 months, 75.8% of the participants had recovered. Variables in the model for recovery included: younger age, leg pain greater than back pain, higher reported disability and no disc herniation at L3-L4. The model for poor recovery included: lower educational level, prior back surgery and disc herniation at L3-L4. After internal validation, the explained variance (Nagelkerke R2) was 0.06 and the Area Under the Curve (AUC) ~0.65 for both models.
Conclusion(s): The outcome following microdiscectomy and postoperative physiotherapy cannot be predicted accurately by the commonly captured demographic and physical factors.
Implications: The prognostic models found are not useful for clinical practice. The value of psychosocial factors should be considered and further investigated to improve the discriminative ability of prognostic models in the future.
Keywords: Microdiscectomy, radiculopathy, prognostic model
Funding acknowledgements: Non
Purpose: To develop and internally validate prognostic models for recovery following lumbar microdiscectomy based on commonly collected data at baseline.
Methods: We included 298 patients with lumbar disc herniation who underwent microdiscectomy followed by postoperative physiotherapy. Outcomes were (poor) recovery, pain and disability at 12 months' follow-up. Based on findings from previous studies, potential prognostic factors were selected from commonly captured variables at baseline. The association between baseline characteristics and outcomes was evaluated using multivariable logistic regression analyses.
Results: At 12 months, 75.8% of the participants had recovered. Variables in the model for recovery included: younger age, leg pain greater than back pain, higher reported disability and no disc herniation at L3-L4. The model for poor recovery included: lower educational level, prior back surgery and disc herniation at L3-L4. After internal validation, the explained variance (Nagelkerke R2) was 0.06 and the Area Under the Curve (AUC) ~0.65 for both models.
Conclusion(s): The outcome following microdiscectomy and postoperative physiotherapy cannot be predicted accurately by the commonly captured demographic and physical factors.
Implications: The prognostic models found are not useful for clinical practice. The value of psychosocial factors should be considered and further investigated to improve the discriminative ability of prognostic models in the future.
Keywords: Microdiscectomy, radiculopathy, prognostic model
Funding acknowledgements: Non
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Elisabeth hospital tilburg
Ethics committee: The Medical Ethics Review Board of the Elisabeth Hospital Tilburg
Ethics number: (METC-T2012)
All authors, affiliations and abstracts have been published as submitted.
