Surgery for Lumbar Disc Herniation: Surgeon's Clinical Judgment Versus Actual Improvement in Patient Reported Outcomes.

Study DesignLongitudinal Cohort.ObjectivesTo determine if a surgeon's clinical judgment can predict clinical outcomes after surgery for LDH.MethodsSurgeons provided an opinion on outcomes in patients with lumbar disc herniation (LDH) with a series of seven faces denoting the Global Perceived Effect (GPE) as "Very bad" (GPE1), "Bad" (GPE2), "Fairly bad"(GPE3), "No change"(GPE4), "Fairly good" (GPE5), "Good" (GPE6) and "Very Good" (GPE7). Standard demographic, surgical and outcomes were collected prior to and 1 year after surgery. Patients were then stratified based on the surgeon's clinical judgement and change in 1 year outcome measures were compared.ResultsOf 153 subjects, 110 (72%) had 1 year data with 0 GP1, 1 GPE2, 4 GPE3, 5 GPE4, 36 GPE5, 48 GPE6 and 16 GPE 7. Only patients in GPE3 to GPE7 were included in the analysis. There was no difference in demographic or surgical parameters among the GPE groups. Improvements in ODI, EQ5D and SF36PCS were greatest in the GPE7 followed by the GPE6 and GPE5. GPE5 and GPE4 had similar improvements, while GPE3 had less improvement than GPE4. Improvement in VAS back and leg pain was similar the GPE7, GPE6 and GPE5 group, with less improvement seen in the GPE4 and GPE3 groups.ConclusionsThe current study shows that although the significance of mathematical modeling, artificial intelligence and machine learning as an analytical way of predicting outcomes, it is crucial not to underestimate the value of clinical intuition in patient counseling and predicting clinical outcomes after surgery for LDH.