| Low back pain is a major problem in industrialized countries. In 3-5% of all back-related disorders there is a relatively clear pathogenic explanation for the pain, such as a lumbosacral radicular syndrome (LRS) caused by a herniated lumbar disc, with a clear recommendation for surgery to remove the disc material. About 30% of patients of these patients still have residual complaints at longer term follow-up. The main goal of the present thesis was to identify at an early postoperative stage risk factors of residual disability, pain and loss of work capacity at 6 weeks and 6 months after surgery for LRS, and to develop a screening tool to identify patients at risk. We focus on factors that possibly give direction to postoperative treatment which would enable us to better match treatment with patient characteristics. We prospectively studied 277 patients. Results regarding the outcome showed that about 50% of the patients suffer from residual disability, pain, or loss of work capacity at 6 months after surgery for LRS. More pain-related fear of movement/(re)injury, passive pain coping, and negative outcome expectancies independently predicted disability, pain work capacity 6 months after surgery, taking into account the role of a wide range of control variables including demographic variables, preoperative disability and pain intensity, neurological deficits, intake of analgesics, duration of complaints, and pain intensity 3 days postoperatively. Additionally, in the subgroup of 182 patients who had a paid job before surgery the work-related factor of physical work-load (lifting heavy objects, repeated heavy arm tasks and longstanding standing and kneeling labor) predicted reduced work capacity at 6 months follow-up. A screening tool has been developed to identify patients at risk of residual complaints after surgery for LRS.The study supports the to evaluate the effectiveness of tailored cognitive-behavioral and work-related interventions in patients at risk of residual complaints after surgery for LRS. |
