Inferior Outcome of Lumbar Disc Surgery in Women Due to Inferior Preoperative Status: A Prospective Study in 11,237 Patients

Study Design. Analysis of prospectively collected data in a national register. Objective. The aim of this study was to, in a nationwide perspective, evaluate whether there exist sex differences in outcome of lumbar disc herniation (LDH) surgery and whether the gender-specific referral pattern influence the outcome. Summary of Background Data. Previous studies infer that women are referred to LDH surgery with inferior clinical status than men. Whether the surgical outcome is different in men and women is debated. Methods. We found in the validated Swedish National Spine Surgical Register, 11,237 patients aged 13 to 89 years who between years 2000 and 2010 were registered in SweSpine with LDH surgery and with both preoperative and 1 year postoperative data. The register includes data on sex, age, smoking habits, walking distance, consumption of analgesics, back and leg pain (Visual Analogue Scale; VAS), quality of life (EuroQol; EQ5D and Short Form-36 Questionnaire; SF-36), and disability (Oswestry Disability Index; ODI). We evaluated sex discrepancies in response to surgery and 1 year postoperative outcome. Results. All end point variables improved markedly with a similar rate in both men and women (all P < 0.001). As women preoperatively reported higher consumption of analgesics, more impaired walking distance, more back and leg pain, inferior quality of life and higher disability than men (all P < 0.001) and improvement by surgery was similar in both sex, women reported 1 year after surgery still higher consumption of analgesics, more impaired walking distance, more back and leg pain, inferior quality of life, and higher disability (all P < 0.001). Conclusion. Surgery for LDH confers great improvements in both sex. Because women are scheduled for surgery with an inferior clinical status than men and the improvement is similar in both sex, the 1 year postoperative outcome is inferior in women than in men. Level of Evidence: 2

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