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, 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, Odd-Inge Solem, Jens Munch-Ellingsen, Franz Hintringer, Anita Dimmen Johansen, Guro Kjos, Øystein P Nygaard, Hege Andresen, Helge Rønningen, Kjell Arne Kvistad, Bjørn Skogstad, Janne Birgitte Børke, Erik Nordtvedt, Magne Rø, Gunnar Leivseth, Sjur Braaten, Turid Rognsvåg, Gunn Odil Hirth Moberg, Lars Geir Larsen, Vibeche Iversen, Ellen H Haldorsen, Elin Karin Johnsen, Kristin Hannestad, Endre Refsdal, Vegard Slettemoen, Kenneth Nilsen, Kjersti Sunde, Helenè E Skaara, Anne Keller, Berit Johannessen, Anna Maria Eriksdotter, Christian Hellum, 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, Odd-Inge Solem, Jens Munch-Ellingsen, Franz Hintringer, Anita Dimmen Johansen, Guro Kjos, Øystein P Nygaard, Hege Andresen, Helge Rønningen, Kjell Arne Kvistad, Bjørn Skogstad, Janne Birgitte Børke, Erik Nordtvedt, Magne Rø, Gunnar Leivseth, Sjur Braaten, Turid Rognsvåg, Gunn Odil Hirth Moberg, Lars Geir Larsen, Vibeche Iversen, Ellen H Haldorsen, Elin Karin Johnsen, Kristin Hannestad, Endre Refsdal, Vegard Slettemoen, Kenneth Nilsen, Kjersti Sunde, Helenè E Skaara, Anne Keller, Berit Johannessen, Anna Maria Eriksdotter
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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Source: PubMed