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Background: Lumbar disc disease is a very common condition with a substantial socioeconomic impact. Studies have shown the importance of a multilevel assessment of this disease, as its course is influenced by many factors. Most follow-up studies use the degree of physical impairment to measure the outcome of a certain treatment. This remains unsatisfactory, as physical impairment itself seems to be influenced by the social, psychological and personal condition of a patient. We believe that an overall quality of life assessment is required to evaluate success of treatment. The SF-36 questionnaire seemed appropriate, as it provides consistent data of a patient's overall health status. To ensure measurement of disability due to back pain we combined the SF-36 with the NASS (North American Spine Society) questionnaire, an instrument specific for lumbar spine disorders., Method: One year after the last outpatient consultation in our neurosurgical clinic, a SF-36 questionnaire was sent to 636 patients with conservatively treated lumbar disc disease. We used the Mann Whitney Test to compare patient's data with a standard group. The demographics of the standard group were matched with the study cohort., Findings: A total of 486 patients (66.5% males and 33.5% females), mean age 49 years (range 21-82 years), returned the questionnaire. The SF-36 data was usable in 76.4% of the patients. Statistical testing reported a significant impact of the disease on all 8 items of the SF-36 questionnaire. The "Role Functioning - Physical (RF)" item was the most, the "Mental Health (MH)" item the less affected. No statistical difference was found between males and females regarding the impact on single items. The NASS scores were also affected suggesting that lumbar back disorder was the influencing factor for the low SF-36 scores., Conclusions: Besides impairment in the execution of daily physical tasks, patients with lumbar disc disease also showed a significant impact on the "Mental Health (MH)" item. Early SF-36 assessment could identify subjects with high probability of prolonged recovery and development of chronic pain syndromes. In these patients, an early rheumatologic, rehabilitative and psychiatric treatment might be the key to improve their coping abilities and should become an integral part of the treatment strategy.

In reports of diagnostic methods in disorders of the spine focus is centred on diagnostic resolution, while psychological effects and patients' discomfort are often disregarded. To get a comprehensive picture of the appropriateness of a new technology the latter factors need to be explored and included in an assessment. In a prospective study, eight patients with signs of lumbar disc herniation underwent myelography, computed tomography and magnetic resonance imaging. A structured patient interview on attitudes to these technologies was carried out after all three examinations had been carried out. Myelography was most often reported painful and unpleasant among the three modalities. Discomfort due to magnetic resonance imaging stem from the narrow calibre of the machine and the noise. In computed tomography immobilization was the main reason for discomfort. Altogether most patients preferred computed tomography. In view of the fact that myelography must be considered as diagnostically inferior to the other two examinations, the reported discomfort from myelography indicates that computed tomography and magnetic resonance imaging should be the primary examinations for patients with lumbar disc herniation.

57 patients who underwent surgery for slipped lumbar disc for the first time were examined prospectively 6 months after surgery for the purpose of deciding the correlation between the outcome of surgery and social and psychological factors. The following factors were found to be of importance: Female sex, action for damages, prolonged disease of the back; prolonged, current attack, report of long-term illness, pathological pain producing, anxiety, depression and multiple somatic complaints revealed by Minnesota Multiple Personality Inventory (MMPI), severe pain reported immediately post-operatively, employment and the presence of complete herniation at surgery. A closer study revealed 3 factors which were important independently and which explained the other factors: Admission of symptom scale (Ad) in the MMPI, the duration of the current attack and whether the patient was employed. On this basis we define a group with severe psychological and social strain (PASS), 57% of which had a poor outcome. 5% of the rest of the patients had a poor outcome. With the pre-operative assessment of whether or not the patients are under severe psychological and social strain, the outcome of surgery could be predicted correctly in 86% of the patients.