Article

Health-related quality of life (HRQoL) instruments have
been of increasing interest for evaluation of medical treatments over the past
10-15 years. In this prospective, long-term follow-up study we investigated the
influence of preoperative factors and the change in HRQoL over time after lumbar
disc herniation surgery. METHODS: 117 patients surgically treated for lumbar disc
herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL
instrument (EQ-5D) preoperatively, after 2 years
(96 patients) and after 7 years
(89 patients). Baseline data (age, sex, duration of leg pain, surgical level) and
degree of leg and back pain (VAS) were obtained preoperatively.
The mean age was
39 (18-66) years, 54% were men, and the surgical level was L5-S1 in 58% of the
patients. The change in EQ-5D score at the 2-year follow-up was analyzed by
testing for correlation and by using a multiple regression model including all
baseline factors (age, sex, duration of pain, degree of leg and back pain, and
baseline EQ-5D score) as potential predictors.
RESULTS: 85% of the patients
reported improvement in EQ-5D two years after surgery and this result remained at
the long-term follow-up. The mean difference (change) between the preoperative
EQ-5D score and the 2-year and 7-year scores was 0.59 (p < 0.001) and 0.62 (p <
0.001), respectively. However, the HRQoL for this patient group did not reach the
mean level of previously reported values for a normal population of the same age
range at any of the follow-ups. The changes in EQ-5D score between the 2- and
7-year follow-ups were not statistically significant (mean change 0.03, p = 0.2).
There was a correlation between baseline leg pain and the change in EQ-5D at the
2-year (r = 0.33, p = 0.002) and 7-year follow-up (r = 0.23, p = 0.04). However,
when using regression analysis the only statistically significant predictor for
change in EQ-5D was baseline EQ-5D score. INTERPRETATION: Our findings suggest
that HRQoL (as measured by EQ-5D) improved 2 years after lumbar disc herniation
surgery, but there was no further improvement after 5 more years. Low quality of
life and severe leg pain at baseline are important predictors of improvement in
quality of life after lumbar disc herniation surgery.

Langue : ANGLAIS