Predictors of an unfavorable outcome 1.5 and 12 years after a first, uncomplicated lumbar disc surgery.

PURPOSE: To identify predictors of both intermediate and long-term unfavorable outcomes after first time, uncomplicated lumbar disc surgery. METHODS: Patients (n = 120) who had undergone lumbar disc surgery were followed up 1.5 and 12 years thereafter. Baseline assessments were carried out 5-8 days after surgery. Clinical outcome was assessed in both follow-ups using the Low Back Pain Rating Scale. Statistical analysis included binary logistic and linear regression. RESULTS: Unfavorable outcomes were found in 50.5 % (1.5 years) and 52.6 % (12 years) of patients available for follow-up examination. Low pre-operative physical activity and severe pain in the first week after surgery were predictive of an unfavorable post-operative outcome at both follow-ups. CONCLUSIONS: Identified predictors suggest that particular emphasis should put on comprehensive post-operative care at large and encouragement to adapt a physically active lifestyle in particular in rehabilitation concepts after first time uncomplicated lumbar disc surgery.

Twelve-year follow-up of a randomized controlled trial of comprehensive physiotherapy following disc herniation operation.

OBJECTIVE: To evaluate the long-term effects of postoperative comprehensive physiotherapy starting one week after lumbar disc surgery. DESIGN: Twelve-year follow-up of a three-armed, randomized, controlled, single-blinded clinical trial. SETTING: Department of Physical Medicine & Rehabilitation. PARTICIPANTS: Of 111 patients following first-time, uncomplicated lumbar disc surgery who participated in the original study and completed the treatment originally allocated, 74 ((67%; 29 (73%) physiotherapy, 22 (58%) sham therapy, 23 (68%) no therapy) completed a 12-year follow-up examination. INTERVENTIONS: In the original study, patients had been randomly assigned to comprehensive physiotherapy, sham intervention (neck massage), or no therapy. MEASURES: Low Back Pain Rating Scale; best score 0, worst score 130 points). RESULTS: At 12 years after surgery, the group participating in comprehensive physiotherapy had significantly better functional outcomes, as rated on the Low Back Pain Rating Score, than the untreated group (mean difference: -13.2 (95% CI: (-25.4; -1.0)). Equally, there was a clinically relevant, non-significant difference between the sham therapy and no therapy (mean difference: -12.5 (95%CI: -26.1; 1.1)). Consequently, the Low Back Pain Rating Score outcome did not differ between physiotherapy and sham therapy (mean difference: -0.7 (95%CI: -14.2; 12.8)). CONCLUSIONS: Participating in a comprehensive physiotherapy program following lumbar disc surgery may be associated with better long-term health benefits over no intervention, but may not be superior to sham therapy.