The Journal of Bone and Joint Surgery, Vol 72, Issue 2 230-237, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Elective discectomy for herniation of a lumbar disc. Additional experience with an objective method
DM Spengler, EA Ouellette, M Battie and J Zeh
University of Washington Medical Center, Seattle.
An objective evaluation for the assessment of patients who have persistent
low-back pain and sciatica was tested in eighty-four patients who were
operated on by one of us (D.M.S.). In this scoring system, there are four
major categories for preoperative assessment: neurological signs,
sciatic-tension signs, psychological factors, and imaging studies. When the
preoperative scores of the eighty-four patients were correlated with the
findings at operation, the three patients who had the lowest scores were
the only ones in whom the operative findings were negative. As shown by
statistical analysis, the score for imaging studies correlated best with
the operative findings. In contrast, in the sixty-one patients who were
followed sufficiently to determine the clinical outcome, the psychological
score was the best predictor of the outcome of treatment. On the basis of
these studies, we concluded that the use of this objective scoring system
reduced the incidence of negative findings at exploration of the disc and
improved the clinical result after elective discectomy. The higher the
score was preoperatively, the more likely the patient was to have a good
result after discectomy.
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