J Neurol Surg A Cent Eur Neurosurg 2023; 84(02): 123-127
DOI: 10.1055/s-0041-1739233
Original Article

Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register

Yessika De Leon Benito Revollo
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
2   Neuro Research Office, Kantonsspital Aarau, Aarau, Switzerland
Hermien Atassi
2   Neuro Research Office, Kantonsspital Aarau, Aarau, Switzerland
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
› Author Affiliations


Background Lumbar disk herniation (LDH) typically causes leg pain and neurologic deficits, but can also be a source of low back pain (LBP). Lumbar microdiskectomy (LMD) is among the most common neurosurgical procedures to relieve radicular symptoms. It is important for both surgeon and patient to understand potential predictors of outcome after LMD. The aim of this study was to investigate if the presence and intensity of preoperative LBP, the ODI score, and analgesic intake can predict the outcome of patients undergoing LMD.

Methods This is a single-center retrospective study based on the analysis of prospectively acquired data of patients in the SwissDisc Registry. A total of 685 surgeries on 640 patients who underwent standardized LMD at our institution to treat LDH were included in this study. We performed multivariable linear regression analysis to determine preoperative predictors for patient outcomes based on the Oswestry Disability Index (ODI) scores, recorded on average 39.77 (±33.77) days after surgery.

Results Our study confirmed that surgery overall improves patient degree of disability as measured by ODI score. Following model selection using Aikake Information Criterion (AIC), we observed that higher preoperative ODI scores (β: 0.020 [95% CI: 0.008 to 0.031]) and higher number of analgesic medication usage by patients prior to surgery (β: 0.236 [95% CI: 0.057 to 0.415]) were both associated with an increased postoperative ODI score.

Conclusion LDH surgery generally improves patient degree of disability. The analysis of patients with a high preoperative ODI score and increased intake of analgesics before surgery predicted a worsening of patients' disability after LMD in this subgroup.

Publication History

Received: 22 October 2020

Accepted: 14 May 2021

Article published online:
12 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Clark R, Weber RP, Kahwati L. Surgical management of lumbar radiculopathy: a systematic review. J Gen Intern Med 2020; 35 (03) 855-864
  • 2 Balaara A, Xu XF, Huang YH, Dapeng L. Predictors of the outcome of lumbar disc herniation following classical surgery: laminotomy with discectomy. Orthopade 2017; 46 (06) 530-537
  • 3 Hebert JJ, Fritz JM, Koppenhaver SL, Thackeray A, Kjaer P. Predictors of clinical outcome following lumbar disc surgery: the value of historical, physical examination, and muscle function variables. Eur Spine J 2016; 25 (01) 310-317
  • 4 Vialle LR, Vialle EN, Suárez Henao JE, Giraldo G. Lumbar disc herniation. Rev Bras Ortop 2015; 45 (01) 17-22
  • 5 Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. J Neurol Neurosurg Psychiatry 2002; 72 (05) 630-634
  • 6 Hoy D, Bain C, Williams G. et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012; 64 (06) 2028-2037
  • 7 Sethi G, Aljawadi A, Choudhry MN. et al. Concomitant back pain as a predictor of outcome after single level lumbar micro-decompressive surgery: a study of 995 patients. J Orthop 2019; 16 (06) 478-482
  • 8 Skolasky RL, Scherer EA, Wegener ST, Tosteson TD. Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial. Spine J 2018; 18 (08) 1318-1324
  • 9 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25 (22) 2940-2952 , discussion 2952
  • 10 Wetzel O, Rey S, Perren C, Fandino J, Kienzler J. Swiss Disc Registry (SDR): The Register of Patients undergoing Surgical Treatment of lumbar Disc Herniation in Switzerland. J Neurol Surg A Cent Eur Neurosurg 2017; 78: S1-S22
  • 11 Mapi Research Trust. Oswestry Disability Index (ODI). Available at: https://mapi-trust.org/questionnaires/odi/
  • 12 R Development Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2010
  • 13 van Buuren S, Groothuis-Oudshoorn K. MICE: multivariate imputation by chained equations in R. J Stat Softw 2011; 1 (03) 2011
  • 14 Schomaker M, Heumann C. Model selection and model averaging after multiple imputation. Comput Stat Data Anal 2014; 71: 758-770
  • 15 Hey HWD, Luo N, Chin SY. et al. The predictive value of preoperative health-related quality-of-life scores on postoperative patient-reported outcome scores in lumbar spine surgery. Global Spine J 2018; 8 (02) 156-163
  • 16 Casimiro M. Short-term outcome comparison between full-endoscopic interlaminar approach and open minimally invasive microsurgical technique for treatment of lumbar disc herniation. World Neurosurg 2017; 108: 894-900 .e1
  • 17 Shen Z, Zhong ZM, Wu Q, Zheng S, Shen X, Chen J. predictors for poor outcomes after percutaneous endoscopic lumbar discectomy: a retrospective study of 241 patients. World Neurosurg 2019; 126: e422-e431
  • 18 Kleinstück FS, Grob D, Lattig F. et al. The influence of preoperative back pain on the outcome of lumbar decompression surgery. Spine 2009; 34 (11) 1198-1203
  • 19 Stienen MN, Joswig H, Smoll NR. et al. Short- and long-term outcome of microscopic lumbar spine surgery in patients with predominant back or predominant leg pain. World Neurosurg 2016; 93: 458-465.e1
  • 20 Cobo Soriano J, Sendino Revuelta M, Fabregate Fuente M, Cimarra Díaz I, Martínez Ureña P, Deglané Meneses R. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. Eur Spine J 2010; 19 (11) 1841-1848
  • 21 Strömqvist F, Strömqvist B, Jönsson B, Gerdhem P, Karlsson MK. Predictive outcome factors in the young patient treated with lumbar disc herniation surgery. J Neurosurg Spine 2016; 25 (04) 448-455
  • 22 Strömqvist F, Strömqvist B, Jönsson B, Karlsson MK. Surgical treatment of lumbar disc herniation in different ages-evaluation of 11,237 patients. Spine J 2017; 17 (11) 1577-1585
  • 23 Zanoli G, Strömqvist B, Jönsson B. Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine 2001; 26 (21) 2375-2380
  • 24 den Boer JJ, Oostendorp RA, Beems T, Munneke M, Evers AW. Continued disability and pain after lumbar disc surgery: the role of cognitive-behavioral factors. Pain 2006; 123 (1-2): 45-52
  • 25 Wang H, Zhou Y, Li C, Liu J, Xiang L. Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy. J Neurosurg Spine 2015; 23 (03) 320-325
  • 26 Wright AK, Sikora M, Leveque JC. Characterizing the risk of long-term opioid utilization in patients undergoing lumbar spine surgery. Spine 2020; 45 (01) E54-E60
  • 27 O'Donnell JA, Anderson JT, Haas AR. et al. Preoperative opioid use is a predictor of poor return to work in workers' compensation patients after lumbar diskectomy. Spine 2018; 43 (08) 594-602
  • 28 Hassan Hashisha RK, Ali SM, Awad TE. Impact of tramadol abuse on clinical outcome of lumbar discectomy patients'. Neurotoxicology 2019; 75: 9-13
  • 29 Hong X, Shi R, Wang YT, Liu L, Bao JP, Wu XT. Lumbar disc herniation treated by microendoscopic discectomy: prognostic predictors of long-term postoperative outcome. Orthopade 2018; 47 (12) 993-1002
  • 30 Wankhade UG, Umashankar MK, Reddy BS. Functional outcome of lumbar discectomy by fenestration technique in lumbar disc prolapse: return to work and relief of pain. J Clin Diagn Res 2016; 10 (03) RC09-RC13
  • 31 Pieber K, Salomon N, Inschlag S, Amtmann G, Resch KL, Ebenbichler G. Predictors of an unfavorable outcome 1.5 and 12 years after a first, uncomplicated lumbar disc surgery. Eur Spine J 2016; 25 (11) 3520-3527
  • 32 Nygaard OP, Kloster R, Solberg T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg 2000; 92 (2, Suppl): 131-134
  • 33 Silverplats K, Lind B, Zoëga B. et al. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J 2010; 19 (09) 1459-1467
  • 34 Johansson AC, Öhrvik J, Söderlund A. Associations among pain, disability and psychosocial factors and the predictive value of expectations on returning to work in patients who undergo lumbar disc surgery. Eur Spine J 2016; 25 (01) 296-303
  • 35 den Boer JJ, Oostendorp RA, Beems T, Munneke M, Oerlemans M, Evers AW. A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery. Eur Spine J 2006; 15 (05) 527-536
  • 36 Aljawadi A, Sethi G, Islam A, Elmajee M, Pillai A. sciatica presentations and predictors of poor outcomes following surgical decompression of herniated lumbar discs: a review article. Cureus 2020; 12 (11) e11605