Review Question - QID 4462

Age > 41 years, absence of joint problems, and married status are associated with improved treatment effects in patients having surgery for lumbar disc herniation.

Lumbar disc herniations are a common cause of low back and leg pain. In the vast majority (>90%) the symptoms improve with nonoperative treatment within 3 months. However, a subset of patients have persistent pain and require surgery. Variables have been associated with outcomes with surgical treatment. The most frequently described is that workers compensation patients have worse surgical outcomes.

Weinstein et al. in the SPORT study found that in a combined as-treated analysis at 4 years, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than nonoperatively treated patients in all primary and secondary outcomes except work status.

Pearson et al. in the SPORT study found the following patient characteristics were associated with improved treatment effects with surgical intervention for lumbar disc herniation: age > 41 years, absence of joint problems, a high school education or less, no worker’s compensation, duration of symptoms for over 6 months, being married, worsening symptom trend at baseline, and Mental Component Score (MCS) of less than 35.

Nguyen et al. looked at a cohort of Worker's Compensation patients and their outcomes following lumbar fusion. They found lumbar fusion for the diagnoses of disc degeneration, disc herniation, and/or radiculopathy in a Workers Compensation setting is associated with significant increase in disability, opiate use, prolonged work loss, and poor RTW status.

Illustration A shows the two most common positions of a lumbar disc herniation (paracentral-blue and foraminal-red). Illustration B shows a paracentral disc herniation at L4/5 on an axial MRI and shows how it affects the descending (L5) nerve root. Illustration C shows a foraminal disc herniation at L4/5 on an axial MRI, and how it affects the exiting (L4) nerve root.

Incorrect Answers:
Answer 1: Worsening symptoms at baseline and Mental Component Score (MCS) < 35 are associated with improved treatment effects.
Answer 2: Duration of symptoms > 6 mos and Mental Component Score (MCS) < 35 are associated with improved treatment effects.
Answer 3: Married and absence of worker compensation claim are associated with improved treatment effects.
Answer 4: Age > 41 years are associated with improved treatment effects.