New Dissertation: Long-Term Results and Predictors of Outcome in Lumbar Disc Surgery - With Special Attention to the Impact of Hypofibrinolysis, Psychological Distress and the Extent of the Surgical Intervention

In this propsective cohort study of 122 patients with sciatica and herniated lumbar disc, aiming to assess long-term results and predictors of outcome of surgery, 70% of the patients were shown to have a satisfactory outcome seven years postoperatively. Preoperative hypofibrinolysis and psychological distress were associated with increased amount of peridural scar tissue formation, as assessed seven years after surgery by magnetic resonance imaging (MRI). The extent of the surgical intervention had minor impact on the clinical outcome. The MRI investigation indicated, however, that scar tissue was related to the extent of the surgical intervention and the clinical outcome of surgery, with less scar in patients with good outcome and in those having undergone smaller operations. Women were shown to have poorer outcome than men. Preoperative smoking habits and overweight were not associated with the clinical outcome. However, these variables were strongly associated with impaired fibrinolytic activity. Indirectly they may thus have had a negative impact on the surgical outcome. All these factors should be taken into consideration while evaluating and selecting patients for lumbar disc surgery.