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Bispebjerg Hospital - a part of Copenhagen University Hospital
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Patients With Persistent Low Back Pain and Nerve Root Involvement: To Operate, Or Not To Operate, That Is The Question

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  1. Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing: A Cross-Sectional MRI Study

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  2. Occupational and other predictors of herniated lumbar disc disease-a 33-year follow-up in the Copenhagen male study

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  3. Maximal isometric strength of the cervical musculature in 100 healthy volunteers

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  1. Positional changes in lumbar disc herniation during standing or lumbar extension: a cross-sectional weight-bearing MRI study

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy

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  3. Retention in physically demanding jobs of individuals with low back pain: study protocol for a randomised controlled trial

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STUDY DESIGN: Prospective cohort study.

OBJECTIVE: The aims of this study were to evaluate the outcome of surgical and nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after 2 years and to identify predictors for nonsuccess.

SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted.

METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Nonsuccess was defined as a Roland-Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and magnetic resonance imaging findings.

RESULTS: Rates of nonsuccess at 2 years were approximately 30% in surgically treated patients with LHD, approximately about 60% in patients with LSS for disability, and 30% and 40%, respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male sex (odds ratio [OR] 2.04, 95% confidence interval [CI]: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01).

CONCLUSION: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male sex, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made.

LEVEL OF EVIDENCE: 3.

Original languageEnglish
JournalSpine
Volume45
Issue number7
Pages (from-to)483-490
Number of pages8
ISSN0362-2436
DOIs
Publication statusPublished - Apr 2020

    Research areas

  • low back pain surgery, lumbar disc herniation, lumbar spinal stenosis, outcome, prognostic factors

ID: 59158052