Quality Reports

The Spine Center at DHMC treats patients who have herniated disc. Herniated disc is one of the most common conditions seen at the Spine Center.

This Quality Report shares information about how we care for our patients and how they respond to treatment. The goal of this report is to help people make more informed decisions about their care. You can use the information to better understand the treatments for herniated disc and help form questions to ask your doctor.

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• ABOUT OUR PATIENTS
  
  Learn more about patients who participated in SPORT more... at the Spine Center at DHMC. This information was collected before treatment when patients signed up for the study. Patients were randomly put into one of two treatment groups. One group was treated surgically. The other group got non-operative treatment.
  • Patients with lumbar herniated disc
    • Number of patients

      Surgical		Non-operative
      113		53

    • Average age (in years)

      39.5

      41.8

    • Percent of patients who are female

      43%

      45%

    • Percent of patients who have at least some college education

      58%

      72%

  • Work status
    • Percent of patients who work full or part time

      Surgical		Non-operative
      50%		64%

    • Percent of patients who do not work due to disability

      19%

      19%

    • Percent of patients who do not work for reasons other than disability (such as retirement)

      31%

      17%

    • Percent of patients who are on Worker's Compensation

      28%

      21%

  • Other associated medical conditions (comorbidities)
    • Percent of patients who have a diagnosis of depression

      Surgical		Non-operative
      16%		19%

    • Percent of patients who have a joint problem (such as knee or hip pain)

      11%

      21%

    • Percent of patients who have some other medical condition (such as diabetes or hypertension)

      42%

      55%

  • Clinical findings
    • Percent of patients who have any neurological deficit

      Surgical		Non-operative
      80%		87%

    • Percent of patients with numbness

      63%

      62%

    • Percent of patients with weakness

      38%

      45%

  • Herniation Level
    • L2-L3/L3-L4

      Surgical		Non-operative
      7%		13%

    • L4-L5

      42%

      42%

    • L5-S1

      50%

      45%

• SURGICAL TREATMENTS AND EVENTS
  
  Learn more about surgery for SPORT patients with lumbar herniated disc more... at DHMC. This section has information about the kind of surgery performed, the hospital stay, and complications of surgery.
  • Surgery and hospital stay
    • Average length of operation (hours:minutes)

      1:25

    • Average amount of blood loss (cc)

      72

    • Average length of hospital stay (days)

      0.7

  • Complications during surgery"
    • Dural leak/spinal fluid leak

      % of Surgery Patients

      4%

    • Other

      2%

    • Infection

      0%

    • Paralysis

      0%

    • None

      94%

    • Post-operative mortality (death within 3 months of surgery)

      0%

  • Additional surgery (cumulative)*
    • Additional surgeries within 1 year

      % of Surgery Patients

      4%

    • Additional surgeries within 2 years

      6%

    • Additional surgeries within 3 years

      7%

    • Additional surgeries within 4 years

      8%

    • * All additional surgeries (a total of nine) were for recurrent disc herniation
• TREATMENT OUTCOMES
  
  Learn about how SPORT patients with lumbar herniated disc did over time more... at DHMC. This section shows how patients did after their surgical or non-operative treatment. The information was gathered with surveys that patients filled out at their Spine Center appointments.
  • Bodily Pain
    • This chart shows the Bodily Pain Score, which measures how much pain the patient has and how much it interferes with activities. A higher bodily pain score means that a patient has less pain.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      The Bodily Pain score is from a survey called the SF-36. The SF-36 is a standardized way to look at how people are feeling mentally and physically.

      This chart shows:
      - These results are raw scores, not percentages; a higher score is better.
      - After treatment, the surgical patients had higher scores than the patients who had non-operative treatment.

  • Physical Function
    • This chart shows the Physical Functioning Score, which measures how the patient does on various activities, such as walking, bending and lifting.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      The physical function score is from a survey called the SF-36. The SF-36 is a standardized way to look at how people are feeling mentally and physically.

      This chart shows:
      - These results are raw scores, not percentages; a higher score is better.
      - After treatment, the surgical patients had higher scores than the patients who had non-operative treatment.

  • Disability Index
    • This chart shows the Disability Score, which measures how much disability the patient has. The score measures disability from spine conditions on pain, personal care, lifting, walking, driving, and recreation.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      The questions are from a survey called the Oswestry Disability Index (ODI). The ODI is a condition-specific survey for patients who have spine problems.

      This chart shows:
      - These results are raw scores, not percentages; a lower score is better.
      - After treatment, the surgical patients had lower scores than the patients who had non-operative treatment.

  • Sciatica Bothersomeness Index
    • This chart shows the Sciatica Bothersomeness, which measures how much the patient is bothered by pain, numbness and tingling in the low back, groin, leg, and foot.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      This chart shows:
      - These results are raw scores, not percentages; a lower score is better.
      - After treatment, the surgical patients had lower scores than the patients who had non-operative treatment.

  • Satisfaction with Symptoms
    • Patients are asked, "If you had to spend the rest of your life with the symptoms you have now, how would you feel about it?"

      This chart shows the percent of patients who responded that they are very or somewhat satisfied with their current symptoms.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      This chart shows:
      - Satisfaction with symptoms; a higher score is better.
      - After treatment, the surgical patients had higher scores than the patients who had non-operative treatment.

  • Satisfaction With Care
    • Patients are asked, "Overall, how satisfied are you with the care you received for your spine-related problem?"

      This chart shows the percent of patients who responded that they are very or somewhat satisfied with their care.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      This chart shows:
      - Satisfaction with care; a higher score is better.
      - After treatment, the surgical patients had higher scores than the patients who had non-operative treatment.

  • Self-Rated progress
    • Patients are asked, "How would you rate your progress with your spine-related problem since your last study visit?"

      This chart shows the percent of patients who responded that they have had a major improvement since their last visit.

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      This chart shows:
      - Self-rated progress; a higher score is better.
      - After treatment, the surgical patients had higher scores than the patients who had non-operative treatment.

  • Work Status
    • Patients are asked if they are working at the time of their visit.

      This chart shows the percent of patients who responded that they are working either full or part time.

      We do not expect 100% of patients to be working since some chose not to work (they are retired or students, etc).

      We get the results from the questionnaires filled out by the participants in SPORT who have lumbar herniated disc.

      This chart shows:
      - The percent of patients working full and part time.
      - After treatment, a higher percent of the surgical patients are working than the patients who had non-operative treatment.

• MAKING DECISIONS ABOUT TREATMENT
  
  Learn about how patients with lumbar herniated disc made decisions about treatment more... at DHMC. This section has information about how good information leads to good decisions. Patients who are eligible for surgery to treat lumbar herniated disc are referred to the Center for Shared Decision Making.
  • Overview

    • For some patients with herniated disc in the lumbar spine, surgery is an option for treatment. Those patients are referred to the Center for Shared Decision Making at DHMC.

      The Center for Shared Decision Making is a free service to assist our patients in making a healthcare decision. The center offers one-on-one counseling, videos, audiotapes, booklets, CD-ROMS, and websites, as well as take-home decision aids.

      If you are facing a decision about treatment for lumbar herniated disc, or any other healthcare decision, we encourage you to visit the Center for Shared Decision Making at DHMC. Call (603) 650-5578 for more information.

      Below is information about lumbar herniated disc patients who visited the Center for Shared Decision Making to help them in their decisions about treatment options. The information is gathered from surveys filled out after watching a video on treatment options.
      
      

      Between January 2006 and December 2007, a total of 1075 DHMC Spine Center patients borrowed videos about treatment decisions for lumbar herniated discs and 427 of those patients filled out a survey after watching the video.

      The average age of those patients was 50 years old.

  • Patient Response to herniated disc video
    • After watching a video about lumbar herniated disc treatment options, patients filled out a survey.

      Most patients felt that the video had clear information.

      Most patients felt the information was unbiased.

      Most patients would recommend the video to others.

  • Factors in making a good decision
    • Part of making a good decision is understanding the treatment options, the risks and benefits of those options, and knowing which benefits are more important to you.

      After watching a video about herniated disc treatment options, patients filled out a survey.

      Most patients responded that they knew the treatment options and the risks and benefits for each option.

      Most patients responded that they were clear about which benefits mattered to them.

  • Results after watching treatment options video

    • After watching the video, 17% of patients changed their minds about which treatment option they preferred.

      After watching the video, more patients are choosing the treatment that is best for them and fewer patients are unsure about their decision.