Determinantes clínicos com influência no prognóstico da discectomia lombar: análise multifatorial

inappropriate patient selection and timing for lumbar disc surgery are still the the major causes of failures. objective: we evaluated the clinical outcome and predictive factors that influence the prognosis of patients submitted to lumbar discectomy using a multivariate analysis model. methods: we report a prospective series of 68 patients with herniated lumbar disc who underwent limited discectomy during 2003 to 2007. the average follow-up period was 3.9±0.1 years. clinical findings were evaluated using japonese orthopaedic association assessment scoring system (joa=29). results: excellent and good postoperative improvement rates were obtained in 75% of the patients. male gender and preponderance of subjective symptoms over clinical signs were associated with better clinical outcomes and faster return to work. waiting time for surgery had no consistent effect on the outcome. the need for immediate surgery was questionable in the absence of significant neurological disturbance (joa for clinical signs >3/6). joa scoring had predictive value for preoperative assessment for lumbar disc surgery, i.e. preoperative joa >15 (low initial disability) correlated with poor surgery outcome. conclusions: joa scoring is easily performed for patients and clinicians, standardizes subjective data and presents high predictive value of patients' outcome after lumbar discectomy.