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Research ArticleLumbar Spine

Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation

Gregory I. Sacks, Vincent Destefano, Susan M. Fiore, Raphael P. Davis, Samuel Ahknoukh and Harry M. Mushlin
International Journal of Spine Surgery September 2024, 8650; DOI: https://doi.org/10.14444/8650
Gregory I. Sacks
1 Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
BS
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Vincent Destefano
1 Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
BE
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Susan M. Fiore
2 Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, NY, USA
MS
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Raphael P. Davis
2 Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, NY, USA
MD
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Samuel Ahknoukh
3 Department of Orthopedic Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
MD
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Harry M. Mushlin
2 Department of Neurosurgery, Stony Brook University Hospital, Stony Brook, NY, USA
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  • For correspondence: Harry.Mushlin@stonybrookmedicine.edu
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    Table 1

    Baseline characteristics of patients undergoing surgical management of lumbar disc herniation.

    Characteristic N (%)
    Age, y, mean (SD)47.0 (15.5)
    Female sex54 (43.9%)
    BMI, mean (SD)28.8 (5.3)
    Race/ethnicity
     Caucasian104 (84.6%)
     Hispanic10 (8.1%)
     Asian2 (1.6%)
     African American2 (1.6%)
     Native Hawaiian or other Pacific Islander3 (2.4%)
    Medical history
     Diabetes mellitus15 (12.2%)
     Liver/kidney disease6 (4.9%)
     Alcohol use75 (61.0%)
     Current smoker18 (14.6%)
     Cannabis use8 (6.5%)
     Osteoporotic disease4 (3.3%)
     Rheumatoid arthritis1 (0.8%)
     Multiple sclerosis1 (0.8%)
    Surgical history
     Prior spine surgery17 (13.8%)
     Prior decompression6 (4.9%)
     Prior fusion9 (7.3%)
     Prior “other spine surgery”2 (1.6%)
     Cervical6 (4.9%)
     Thoracic1 (0.8%)
     Lumbar8 (6.5%)
    Level of injury
     L1–L21 (0.8%)
     L2–L36 (4.9%)
     L2–L41 (0.8%)
     L3–L416 (13.0%)
     L3–L51 (0.8%)
     L4–L539 (31.7%)
     L4–S16 (4.9%)
     L5–S153 (43.1%)
    Preoperative symptoms
     Preoperative back pain91 (74.0%)
     Preoperative radicular pain116 (94.3%)
     Preoperative neurological symptoms90 (73.2%)
     Preoperative NRS, mean (SD)7.0 (2.4)
    Time from symptom onset to surgery (wk), mean (SD)39.7 (56.8)
    Prior management
     Procedural intervention89 (72.4%)
     Physical therapy47 (38.2%)
     Acupuncture9 (7.3%)
     Chiropractic19 (15.4%)
    Surgical technique
     Use of intraoperative microscope22 (17.9%)
     Open microdiscectomy103 (83.7%)
     Tubular (MIS) microdiscectomy15 (12.2%)
     Decompression w/out discectomy3 (2.4%)
     Fat graft45 (36.6%)
    Dural tear/CSF leak3 (2.4%)
    Operative time, min, mean (SD)79.0 (38.1)
    • Abbreviations: BMI, body mass index; CSF, cerebrospinal fluid; MIS, minimally invasive surgery; NRS, Numerical Rating System.

    • Note: Data presented as n (%) unless otherwise noted.

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    Table 2

    Bivariate analysis of outcomes after surgical treatment for lumbar disc herniation.

    VariableOutcome
    Absolute Change Threshold (3.5 points)Resolution of Radicular PainResolution of Neurological Symptoms
    SuccessFailure P SuccessFailure P SuccessFailure P
    Total42 (41.2%)60 (58.8%)-43 (37.1%)73 (62.9%)-31 (34.4%)59 (65.6%)-
    Age, y47 ± 15.148 ± 16.60.8776b 48 47 ± 15.747 ± 15.60.6518b 43 ± 17.949 ± 13.70.0611b
    Female sex18 (41.9%)25 (58.1%)>0.99a 20 (40.8%)29 (59.2%)0.560a 16 (39.0%)25 (61.0%)0.505a
    BMI28 ± 5.029 ± 5.30.4132b 29 ± 5.229 ± 5.50.7526b 28 ± 4.429 ± 5.70.3399b
    Medical/surgical history
     Diabetes mellitus4 (28.6%)10 (71.4%)0.388a 6 (40.0%)9 (60.0%)0.783a 2 (22.2%)7 (77.8%)0.713a
     Current smoker5 (35.7%)9 (64.3%)0.774a 9 (56.3%)7 (43.8%)0.101a 3 (33.3%)6 (66.7%)>0.99
     Osteoporotic disease2 (50.0%)2 (50.0%)>0.99a 4 (100.0%)0 (0.0%) 0.017a 3 (100.0%)0 (0.0%) 0.038a
     Prior spine surgery1 (7.7%)12 (92.3%) 0.013a 5 (29.4%)12 (70.6%)0.592a 5 (33.3%)10 (66.7%)>0.99a
     Prior fusion surgery0 (0.0%)7 (100.0%) 0.039a 4 (44.4%)5 (55.6%)0.724a 4 (50.0%)4 (50.0%)0.439a
    Level of injury
     L2–L33 (60.0%)2 (40.0%)0.400a 3 (50.0%)3 (50.0%)0.669a 1 (50.0%)1 (50.0%)>0.99a
     L3–L44 (26.7%)11 (73.3%)0.265a 8 (50.0%)8 (50.0%)0.274a 6 (50.0%)6 (50.0%)0.327a
     L5–S121 (52.5%)19 (47.5%)0.068a 14 (28.0%)36 (72.0%)0.085a 15 (39.5%)23 (60.5%)0.501a
    History of injury
     Preoperative back pain27 (37.5%)45 (62.5%)0.275a 36 (42.4%)49 (57.6%)0.055a 23 (35.4%)42 (64.6%)0.810a
     Time from symptom onset to surgery, wk28 ± 31.855 ± 72.30.0584b 38 ± 59.437 ± 49.60.5971b 33 ± 39.225 ± 26.00.5034b
     Preoperative NRS8 ± 1.76 ± 2.6 0.0002b 7 ± 2.67 ± 2.30.1886b 7 ± 2.47 ± 2.50.9548b
    Preoperative physical therapy11 (26.8%)30 (73.2%) 0.032 a 9 (20.9%)34 (79.1%) 0.021 a 5 (17.2%)24 (82.8%) 0.026 a
    Operative time, min72 ± 40.684 ± 38.6 0.016b 80 ± 37.879 ± 39.50.5932b 71 ± 24.381 ± 40.10.4085b
    Surgical technique
    Use of intraoperative microscope7 (38.9%)11 (61.1%)>0.99a 9 (40.9%)13 (59.1%)0.809a 4 (23.5%)13 (82.4%)0.399a
    Open microdiscectomy38 (44.7%)47 (55.3%)0.176a 35 (36.5%)61 (63.5%)0.802a 27 (35.1%)50 (64.9%)>0.99a
    Tubular (MIS) microdiscectomy3 (23.1%)10 (76.9%)0.229a 5 (33.3%)10 (66.7%)>0.99a 3 (27.3%)8 (72.7%)0.742a
    Decompression without discectomy1 (33.3%)2 (66.7%)>0.99a 2 (66.7%)1 (33.3%)0.554a 0 (0.0%)1 (100.0%)>0.99a
    Fat graft16 (43.2%)21 (56.8%)0.835a 15 (36.6%)26 (63.4%)>0.99a 13 (38.2%)21 (61.8%)0.649a
    • Abbreviations: BMI, body mass index; MIS, minimally invasive surgery.

    • Note: Data presented as n (%) or mean ± SD. Boldface indicates statistically significant findings at P < 0.05.

    • ↵a Fisher Exact.

    • ↵b Mann-Whitney U Test.

    • View popup
    Table 3

    Multivariate analysis of outcomes after surgical treatment for lumbar disc herniation.

    VariableOutcome
    Absolute Change Threshold (3.5pt)Resolution of Radicular PainResolution of Neurological Symptoms
    OR (95% CI) P OR (95% CI) P OR (95% CI) P
    Age1.003 (0.966–1.041)0.8660.995 (0.961–1.031)0.7930.952 (0.910–0.995) 0.030
    Osteoporotic disease------
    Prior spine surgery0.119 (0.011–1.231)0.074----
    L5–S1--0.483 (0.153–1.529)0.216--
    Preoperative back pain0.559 (0.154–2.029)0.377----
    Time from symptom onset to surgery0.987 (0.971–1.004)0.1361.000 (0.988–1.012)0.9821.013 (0.992–1.035)0.219
    Preoperative NRS1.554 (1.182–2.041) 0.002 1.214 (0.985–1.497)0.0691.126 (0.877–1.445)0.352
    Preoperative physical therapy0.252 (0.073–0.873) 0.030 0.196 (0.062–0.621) 0.006 0.177 (0.037–0.842) 0.030
    Operative time0.991 (0.977–1.005)0.2110.994 (0.983–1.006)0.3500.989 (0.969–1.008)0.256
    • Abbreviation: NRS, Numerical Rating System.

    • Note: Boldface indicates statistically significant findings at P < 0.05.

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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
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1 Apr 2025
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Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation
Gregory I. Sacks, Vincent Destefano, Susan M. Fiore, Raphael P. Davis, Samuel Ahknoukh, Harry M. Mushlin
International Journal of Spine Surgery Sep 2024, 8650; DOI: 10.14444/8650

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Predictive Factors for Outcomes Following Surgical Treatment of Lumbar Disc Herniation
Gregory I. Sacks, Vincent Destefano, Susan M. Fiore, Raphael P. Davis, Samuel Ahknoukh, Harry M. Mushlin
International Journal of Spine Surgery Sep 2024, 8650; DOI: 10.14444/8650
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