Skip to main content

Advertisement

Log in

Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. van den Eerenbeemt KD, Ostelo RW, van Royen BJ, Peul WC, van Tulder MW (2010) Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature. Eur Spine J 19:1262–1280

    Article  PubMed  Google Scholar 

  2. Blumenthal S, McAfee PC, Guyer RD, Hochschuler SH, Geisler FH, Holt RT, Garcia R Jr, Regan JJ, Ohnmeiss DD (2005) A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes.[erratum appears in Spine. 2005 Oct 15;30(20):2356]. Spine 30:1565–1575

    Article  PubMed  Google Scholar 

  3. Zigler J, Delamarter R, Spivak JM, Linovitz RJ, Danielson GO III, Haider TT, Cammisa F, Zuchermann J, Balderston R, Kitchel S, Foley K, Watkins R, Bradford D, Yue J, Yuan H, Herkowitz H, Geiger D, Bendo J, Peppers T, Sachs B, Girardi F, Kropf M, Goldstein J (2007) Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease. Spine 32:1155–1162

    Article  PubMed  Google Scholar 

  4. Berg S, Tullberg T, Branth B, Olerud C, Tropp H (2009) Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up. Eur Spine J 18:1512–1519

    Article  PubMed  Google Scholar 

  5. Fritzell P, Berg S, Borgstrom F, Tullberg T, Tropp H (2011) Cost effectiveness of disc prosthesis versus lumbar fusion in patients with chronic low back pain: randomized controlled trial with 2-year follow-up. Eur Spine J 20:1001–1011

    Article  PubMed  Google Scholar 

  6. Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, Ingebrigtsen T, Eriksen HR, Holm I, Koller AK, Riise R, Reikeras O (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 28:1913–1921

    Article  PubMed  Google Scholar 

  7. van der Hulst M, Vollenbroek-Hutten MM, Ijzerman MJ (2005) A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation-or, back school treatment outcome in patients with chronic low back pain. Spine 30:813–825

    Google Scholar 

  8. Macedo LG, Maher CG, Latimer J, McAuley JH (2009) Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther 89:9–25

    Article  PubMed  Google Scholar 

  9. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20:19–39

    Article  PubMed  Google Scholar 

  10. Zindrick MR, Tzermiadianos MN, Voronov LI, Lorenz M, Hadjipavlou A (2008) An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. Spine 33:1262–1269

    Article  PubMed  Google Scholar 

  11. Hagg O, Fritzell P, Ekselius L, Nordwall A (2003) Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish Lumbar Spine Study. Eur Spine J 12:22–33

    PubMed  CAS  Google Scholar 

  12. Hellum C, Johnsen LG, Storheim K, Nygaard OP, Brox JI, Rossvoll I, Ro M, Sandvik L, Grundnes O (2011) Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ 342:d2786

    Article  PubMed  Google Scholar 

  13. Fairbank JCTM, Pynsent PBP (2000) The Oswestry Disability Index. Spine 25:2940–2953 (review)

    Article  PubMed  CAS  Google Scholar 

  14. Statistics Norway (1984) Standard Classifications of Socioeconomic Status

  15. Statistics Norway (1998) Standard Classification of Occupations

  16. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L (1974) The Hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci 19:1–15

    Article  PubMed  CAS  Google Scholar 

  17. Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168

    Article  PubMed  CAS  Google Scholar 

  18. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  19. Uden A, Astrom M, Bergenudd H (1988) Pain drawings in chronic back pain. Spine 13:389–392

    Article  PubMed  CAS  Google Scholar 

  20. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199

    PubMed  CAS  Google Scholar 

  21. Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A (1999) The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J 8:396–401

    Article  PubMed  CAS  Google Scholar 

  22. Aprill C, Bogduk N (1992) High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 65:361–369

    Article  PubMed  CAS  Google Scholar 

  23. Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A (2000) Low back pain in relation to lumbar disc degeneration. Spine 25:487–492

    Article  PubMed  CAS  Google Scholar 

  24. Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral endplate signal (modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 48:748–754

    Article  PubMed  CAS  Google Scholar 

  25. Masharawi Y, Kjaer P, Bendix T, Manniche C, Wedderkopp N, Sorensen JS, Peled N, Jensen TS (2008) The reproducibility of quantitative measurements in lumbar magnetic resonance imaging of children from the general population. Spine 33:2094–2100

    Article  PubMed  CAS  Google Scholar 

  26. Hosmer DW, Lemeshow S, May S (2008) Applied Survival Analysis. Regression Modelilng of Time-to-Event Data. John Wiley & Sons, Inc, Hoboken

    Book  Google Scholar 

  27. Esposito P, Pinheiro-Franco JL, Froelich S, Maitrot D (2006) Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease. Results of a cohort study including 60 patients. Neurochirurgie 52:315–322

    Article  PubMed  Google Scholar 

  28. Siepe CJ, Mayer HM, Heinz-Leisenheimer M, Korge A (2007) Total lumbar disc replacement: different results for different levels. Spine 32:782–790

    Article  PubMed  Google Scholar 

  29. Siepe CJ, Hitzl W, Meschede P, Sharma AK, Khattab MF, Mayer MH (2009) Interdependence between disc space height, range of motion and clinical outcome in total lumbar disc replacement. Spine (Phila Pa 1976) 34:904–916

    Article  Google Scholar 

  30. Guyer RD, Siddiqui S, Zigler JE, Ohnmeiss DD, Blumenthal SL, Sachs BL, Hochschuler SH, Rashbaum RF (2008) Lumbar spinal arthroplasty: analysis of one center’s twenty best and twenty worst clinical outcomes. Spine 33:2566–2569

    Article  PubMed  Google Scholar 

  31. Bertagnoli R, Kumar S (2002) Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J 11(Suppl 2):S131–S136

    PubMed  Google Scholar 

  32. Campbell JN, Meyer RA (2006) Mechanisms of neuropathic pain. Neuron 52:77–92

    Article  PubMed  CAS  Google Scholar 

  33. Brage S, Sandanger I, Nygard JF (2007) Emotional distress as a predictor for low back disability: a prospective 12-year population-based study. Spine (Phila Pa 1976) 32:269–274

    Article  Google Scholar 

  34. Crisostomo RA, Schmidt JE, Hooten WM, Kerkvliet JL, Townsend CO, Bruce BK (2008) Withdrawal of analgesic medication for chronic low-back pain patients: improvement in outcomes of multidisciplinary rehabilitation regardless of surgical history. Am J Phys Med Rehabil 87:527–536

    Article  PubMed  Google Scholar 

  35. Nemes S, Jonasson JM, Genell A, Steineck G (2009) Bias in odds ratios by logistic regression modelling and sample size. BMC Med Res Methodol 9:56

    Article  PubMed  Google Scholar 

  36. Martell BA, O’Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR, Fiellin DA (2007) Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med 146:116–127

    PubMed  Google Scholar 

  37. Linton SJ, Hallden K (1998) Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 14:209–215

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We want to thank the patients participated in the study, the South Eastern Norway Regional Health Authority and EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, through the Norwegian Back Pain Association, for financial support, The Coast Hospital for Physical Medicine and Rehabilitation, Stavern, for videos and material for instructions on the rehabilitation intervention, Hege Andresen at St.Olavs Hospital, Trondheim, for data coordination, Astrid Woodhouse and Kirsti Vanvik from St.Olavs Hospital for performing the 2-year control and Prof. Leiv Sandvik for statistical counseling and support. Financial support was received from the South Eastern Norway Regional Health Authority and EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, through the Norwegian Back Pain Association.

Conflict of interest

All authors involved declare that they have no conflict of interests and no financial disclosures to report.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Christian Hellum.

Additional information

Additional investigators of the Norwegian Spine Study Group who participated in the study are listed in the “Appendix.”

Appendix

Appendix

From University Hospital North Norway, Tromsø (included n = 8 patients): Department of Orthopedic Surgery: Odd-Inge Solem, MD, Department of Neurosurgery: Jens Munch-Ellingsen, MD, PhD, and from Department of Physical Medicine and Rehabilitation Franz Hintringer, MD, Anita Dimmen Johansen, ergonomist, Guro Kjos, PT.

From Trondheim University Hospital, Trondheim (included n = 21 patients): National centre for spinal disorders, Department of Neurosurgery: Øystein P Nygaard, PhD, Hege Andresen, RN, Helge Rønningen, MD, Professor, Kjell Arne Kvistad, MD, PhD, and from Multidiscipline spinal unit, Dep. of Physical Medicine and Rehabilitation; Bjørn Skogstad, MD, Janne Birgitte Børke, PT, MSc, Erik Nordtvedt, PT, Magne Rø, MD, Gunnar Leivseth, MD, Professor.

From Haukeland University Hospital, Bergen (included n = 64 patients): Kysthospitalet in Hagevik, Department of Orthopedic Surgery: Sjur Braaten, MD, Turid Rognsvåg, PT, MSc, Gunn Odil Hirth Moberg, secretary, and From The Outpatient Spine Clinic. Department of Physical Medicine and Rehabilitation: Lars Geir Larsen, PT, Vibeche Iversen, RN, Ellen H Haldorsen, cand, psychol, PhD, Elin Karin Johnsen, RN, Kristin Hannestad, PT;

From Stavanger University Hospital, Stavanger (included n = 27 patients): Department of Orthopedic Surgery: Endre Refsdal, MD.

From Oslo University Hospital, Oslo (included n = 53 patients): Department of Orthopaedics: Vegard Slettemoen, RN, Kenneth Nilsen, RN, Kjersti Sunde, RN, Helenè E Skaara, PT, MSc, and from Department of Physical Medicine and Rehabilitation: Anne Keller, MD, PhD, Berit Johannessen, PT, Anna Maria Eriksdotter, PT, MSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hellum, C., Johnsen, L.G., Gjertsen, Ø. et al. Predictors of outcome after surgery with disc prosthesis and rehabilitation in patients with chronic low back pain and degenerative disc: 2-year follow-up. Eur Spine J 21, 681–690 (2012). https://doi.org/10.1007/s00586-011-2145-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-2145-3

Keywords

Navigation