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Randomized Controlled Trial
. 2012 Apr;21(4):681-90.
doi: 10.1007/s00586-011-2145-3. Epub 2012 Jan 13.

Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up

Christian Hellum  1 , Lars Gunnar Johnsen, Øyvind Gjertsen, Linda Berg, Gesche Neckelmann, Oliver Grundnes, Ivar Rossvoll, Jan Sture Skouen, Jens Ivar Brox, Kjersti Storheim; Norwegian Spine Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up

Christian Hellum et al. Eur Spine J. 2012 Apr.

Abstract

Purpose: A prospective study to evaluate whether certain baseline characteristics can predict outcome in patients treated with disc prosthesis or multidisciplinary rehabilitation.

Methods: Secondary analysis of 154 patients with chronic low back pain (LBP) for at least 1 year and degenerative discs originally recruited for a randomized trial. Outcome measures were Oswestry Disability Index (ODI) dichotomized to < or ≥15 points improvement and whether subjects were working at 2-year follow-up. A multiple logistic regression analysis was used.

Results: In patients treated with disc prosthesis, long duration of LBP and high Fear-Avoidance Beliefs for work (FABQ-W) predicted worse ODI outcome [odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.2-3.2 and OR = 1.7, CI 1.2-2.4 for every 5 years or 5 points]. Modic type I or II predicted better ODI outcome (OR = 5.3, CI 1.1-25.3). In patients treated with rehabilitation, a high ODI, low emotional distress (HSCL-25), and no daily narcotics predicted better outcome for ODI (OR = 2.5, CI 1.4-4.5 for every 5 ODI points, OR = 2.1, CI 1.1-5.1 for every 0.5 HSCL points and OR = 23.6, CI 2.1-266.8 for no daily narcotics). Low FABQ-W and working at baseline predicted working at 2-year follow-up after both treatments (OR = 1.3, CI 1.0-1.5 for every 5 points and OR = 4.1, CI 1.2-13.2, respectively).

Conclusions: Shorter duration of LBP, Modic type I or II changes and low FABQ-W were the best predictors of success after treatment with disc prosthesis, while high ODI, low distress and not using narcotics daily predicted better outcome of rehabilitation. Low FABQ-W and working predicted working at follow-up.

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Figures

Fig. 1
Fig. 1
The Oswestry Disability Index (ODI) ranges from 0 to 100, with lower scores indicating less severe symptoms. a ODI during follow-up of patients with ODI at baseline <55 points, b ODI during follow-up of patients with ODI at baseline ≥55 points
See this image and copyright information in PMC

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