Diagnosis and prognosis in lumbar disc herniation

In a prospective 2-year followup study of 160 consecutive patients undergoing primary surgery for suspected lumbar disc herniation, the authors studied the diagnostic and prognostic factors by using stepwise logistic regression analysis. When the different factors were entered in the same order as presented clinically, history and pain analysis contained most of the predictive information available. When all factors were entered simultaneously in the computations, the following factors (in order of relative importance) predicted relief of sciatica after 2 years: rupture of the anulus (as opposed to bulging disc or negative exploration), no preoperative comorbidity, and male gender. The following factors predicted return to work at 2 years: no preoperative comorbidity, duration of sciatica less than 7 months, education or vocational training in addition to compulsory school, age younger than 41 years, male gender, and no previous nonspinal surgery. Return to work does not seem to be a valid result parameter in lumbar disc surgery. The most important physical signs were root tension tests and lumbar range of motion, whereas neurologic signs were of secondary importance. Many people have asymptomatic herniations, and today supersensitive diagnostic imaging is widely available. Thus, the importance of clinical evaluation has increased, and most of the relevant information can be obtained by listening to the patient. A simple anamnesis apparently is a good alternative to psychologic tests in surgical triage.