Artikel
Psychosocial predictorsfor the success oflumbar discsurgery
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Autoren
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Kay Mursch
- Zentralklinik, Neurochirurgie, Bad Berka, Deutschland
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Johannes Lutz
- Zentralklinik, Interdisziplinäre Schmerztherapie, Bad Berka, Deutschland
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Martin Mothes-Lasch
- Zentralklinik, Interdisziplinäre Schmerztherapie, Bad Berka, Deutschland
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Elisabeth Sens
- Zentralklinik, Interdisziplinäre Schmerztherapie, Bad Berka, Deutschland
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Heinrich Böhm
- Zentralklinik, Wirbelsäulenchirurgie, Bad Berka, Deutschland
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Julianne Behnke-Mursch
- Zentralklinik, Neurochirurgie, Bad Berka, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: According to accepted guidelines, mostpatients suffering from acute sciatica should be treated conservatively. On the other hand,even patients lacking severe neurological deficits may meetthe criteria for microsurgical treatment after failure of non-surgical therapy. These patients have to be advised and selected carefully because the success of an operation may not only depend on surgical accuracy but also on other,oftenpsychosocial factors.
In this multidisciplinaryprospective study, we investigated the influence of psychosocial factors on the success of lumbar disc operations.
Methods: One hundred and seven patients operated on lumbar disc herniation (microsurgically or minimally-invasive) because ofsciatic pain were included in our study. No patientsuffered from a disabling palsy or vegetative dysfunction.
These patientswere examined in the immediate pre- and postoperativecourse andafter 3, 6 and 12 months postoperatively.The evaluation includedquestionnaires, neurological examinations and structured interviews.
Preoperatively, weinvestigatedlevels of depression (measured by BDI II), disability (Oswestry disability Index(ODI)) and psychological stress (SCL-90).
The operation was consideredas successful, when three out of four criteria were fulfilled: low pain level (measured by NRS), high patient satisfaction (numeric rating scale (NRS)), good quality of life (Fragen zum Wohlbefinden (FW7)) and low grade of disability (ODI).
Results: After 12 months,69%of patients metthe criteria of a successful operation. Compared to patients in which theoperationhad to be classified as unsuccessful,theirpreoperativelevelsof depression, disability and psychological stress were significantly (p>0,05) lower.
Conclusion: A high percentage ofsurgeries for sciatica canbe considered as successful.However, wefoundasignificantinfluence of psychosocial factors on outcome. Patients suffering from preoperative depression, disability and psychological stress were less likely to profit from an operation.
These data may help, whenthe decisionfor disc surgery is a matter of debate.
