Outcomes and Presurgery Correlates of Lumbar Discectomy in Utah Workers Compensation Patients
M. Scott De Berard, Ph.D., and Alan Colledge, M.D., et al
The Spine Journal 9 (2009 193-203)

The authors examined long-term multi-dimensional outcomes of lumbar discectomy within a cohort of Workers Compensation patients from Utah and identified presurgical biopsychosocial factors relating to poor outcomes.  They studied 271 workers from Utah who underwent lumbar discectomy from 1994 to 1999, and a total of 134 patients were surveyed at the time of follow-up.  Analysis of patient satisfaction, back pain related dysfunction and the Short Form Health Survey-36 subscales indicated approximately 25% of patients experience poor outcomes.  Older age, number of comorbid health conditions, assign case manager, ligation and time delay from injury to surgery were consistently statistical significant predictors of poor outcomes.  The authors concluded that this study suggests that compensated back surgery patients are at greater risk for poor lumbar discectomy outcomes than non-compensated patients. Presurgery correlates of poor outcomes may be useful identifying high risk compensation patients.  The authors found that presurgical diagnoses were often non-predictable outcomes, and a diagnostic severity index based on presurgical imaging studies was not predictive of lumbar fusion in patient outcomes.  They found that other demographic and psychosocial risk factors were shown to be more consistently predictive of patient outcomes. 

They found that approximately 40% of compensated lumbar discectomy patients were somewhat to extremely dissatisfied with their results and 13% were disabled at the time of the study follow-up. 25% of patients exceeded the clinical cutoff for poor outcomes on the Rowland and Morris D.Q.  In general, most outcome variables were predicted by age at time of injury, depression, number of comorbid health conditions, and whether a case manager was assigned, a lawyer, and time delay from injury to surgery.  They found an interesting finding in an association of poor outcomes with patient assignment and nurse case mangers. They further noted that litigation among compensated low back patients appear to be a consistent factor associated with poor clinical outcomes.   They found it now appears appropriate to begin studies examining the differences among litigated versus non-litigated patients in terms of psychosocial and behavioral characteristics that might place them at higher risk for poor outcomes.