To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation. A retrospective study was conducted using prospectively collected data and patient-reported outcome measures, including the Oswestry Disability Index (ODI), between 2008 and 2019. Postoperative sRDH was identified from clinical notes and the centre’s MRI database, with all imaging providers in the region checked for missing events. The Kaplan-Meier method was used to calculate five-year sRDH incidence. Cox proportional hazards model was used to identify independent variables predictive of sRDH, with any variable not significant at the p < 0.1 level removed. Hazard ratios (HRs) were calculated with 95% confidence intervals (CIs).Aims
Methods
We reviewed the impact of the use of routine perioperative counselling on patients outcomes and experience when undergoing operative deformity correction for adolescent idiopathic scoliosis. Between January 2006 and December 2008, 28 consecutive patients underwent operative deformity correction for adolescent idiopathic scoliosis. 26 of these were seen at the initial presentation to clinic by a voluntary counsellor with experience of a family member having undergone scoliosis correction after they had been identified as being likely to require operative intervention. Most patients were only seen once preoperatively by the counsellor but several were seen on multiple occasions. Most patients were offered the opportunity to meet a post-operative patient who had previously had scoliosis correction surgery. SRS 22 questionnaires were completed pre and post-operatively. All curves were classified using the Lenke classification and pre and post operative Cobb angles were recorded. All patients and their parents were followed up at a mean interval of 3 years with a telephone survey regarding how they felt the input from a counsellor impacted on their experience.Objective
Methods
Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score. Patients were classified as normal, at risk or distressed, and the outcome of surgery in the three groups was compared at a follow-up of six months. The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires. Postoperative disability scores at six months were not significantly different in the three risk groups. Psychological disturbance improved after surgery. Our study suggests that the early outcome of lumbar discectomy is not affected by preoperative psychological disturbance. We conclude that a patient with a symptomatic prolapsed intervertebral disc should not be denied surgery on the basis of preoperative psychological assessment.
