A stiff and straight back preoperatively is associated with a good outcome 2 years after lumbar disc surgery

BACKGROUND AND PURPOSE The degree of lumbar lordosis and reduced lumbar mobility are regarded as important clinical features in patients with low back pain, and in lumbar disc herniation A more stiff back preoperatively in a proportion of patients has been shown to be associated with sequestered disc herniation. The main aim of this study was to investigate whether there was any correlation between lumbar lordosis and flexion on the one hand in patients with lumbar disc herniation who were scheduled for surgery, and postoperative pain and disability on the other. Our second aim was to determine the patterns of postoperative improvement in pain, perceived disability, and flexion/lordosis for 2 years after surgery. METHODS Pain (VAS), disability (DRI), lumbar flexion and lordosis (Debrunner's kyfometer) were measured pre- and postoperatively in 80 patients who underwent microscopic lumbar disc surgery. RESULTS Patients with preoperative hyperlordosis had more severe pain and more disability postoperatively than patients with hypolordosis. The level of pain did not change much from 2-6 weeks postoperatively until 2 years, while the perceived disability did not reach a steady state until 6 months after surgery. INTERPRETATION Patients with a stiff and flat back have a good prognosis after lumbar disc surgery, and in most cases the pain will reach the 2-year level during the first 2-6 weeks, while the physical restoration measured by the lumbar flexion and lordosis, and the perceived disability, will continue to improve over the first 6 months after surgery.