The distress and risk assessment method (DRAM) - Failure to predict the outcome of lumbar discectomy

Our aim was to judge the influence of preoperative psychological disturbanc e on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was a ssessed using the Oswestry disability index and psychological disturbance t he Distress and Risk Assessment Method (DRAM) score. Patients were classifi ed as normal, at risk or distressed, and the outcome of surgery in the thre e groups was compared at a follow-up of six months. The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires, Postoperative disability scores at six months were not significantly different in the three risk groups. Psyc hological disturbance improved after surgery. Our study suggests that the e arly outcome of lumbar discectomy is not affected by preoperative psycholog ical disturbance. We conclude that a patient with a symptomatic prolapsed i ntervertebral disc should not be denied surgery on the basis of preoperativ e psychological assessment.