Feelings About Work and The Outcome of Lumbar Discectomy

Surgical decompression for prolapsed/herniated lumbar intervertebral disc is the most frequently performed spinal intervention. This recent study explored psychological assessments, in particular the psychosocial aspects of work, in predicting the outcome of lumbar discectomy. The authors also assessed general medical data and utilized MRI scanning to identify abnormalities. Their hope was that these varied assessments would help predict postoperative outcome and return to work status.

46 patients who had lumbar discectomy surgery were followed for two years. Before the operation the authors evaluated the patients' low back pain history, performed a physical, and ran the MRI examinations. All patients reported at least radicular leg pain. 27 patients had minor neurological deficits and 11 had major deficits.

Two years later, with questionnaires, the authors investigated the patients':

• Work-related mental stress
• Job Satisfaction
• Job Resignation
• Support Network at Work
• Level of Pain Relief
• Disability in Daily Activities
• Return to "any" work
• Surgical Outcome

The authors found that a high occurrence of job resignation, which is a feeling of dissatisfaction coupled with feeling forced to accept the job as it is, predicted disability in daily activities. Other significant predictors of disability and pain relief were MRI-identified nerve root compromise and neural compromise. The authors found that in most patients, the pain is likely to subside after resolution of the neurological problem. In cases where the irritation persists, however, "disc protrusion could be the initiating factor for low back and leg pain, but psychological factors might be more relevant in perpetuating pain."

Yet, psychological aspects—not physical findings—played a vital role in predicting return to work. Since occupational mental stress, job satisfaction, and depression were major predictors, the authors then considered working conditions, rather than low back pain, as influencing return to work status. They write:

"These findings indicate that patients with stressful work conditions do not tend to return to work even if the discectomy was successful from a surgical point of view. Improvements in working conditions, particularly from the psychological point of view, could play a significant role in the rehabilitation of a patient after discectomy, a finding which needs further attention and evaluation...Furthermore, this study highlights the importance of psychological aspects of work which should be taken more into account, in further research. It also implies that psychologically favorable working conditions may be an important preventive factor for chronic disability."

Schade V, Semmer N, Main C, Hora J, Boos N. The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain 1999;80:239-249.