Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale.
Lumbar disc herniation
Radicular low back pain
Residual low back pain
Visual analog scale
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
11 Feb 2021
11 Feb 2021
Historique:
received:
28
07
2020
accepted:
25
01
2021
entrez:
12
2
2021
pubmed:
13
2
2021
medline:
15
5
2021
Statut:
epublish
Résumé
Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally. We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition. Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting (p = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy (p < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing (p = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade (p = 0.002) or Modic type (p = 0.025). Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.
Sections du résumé
BACKGROUND
BACKGROUND
Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally.
METHODS
METHODS
We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition.
RESULTS
RESULTS
Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting (p = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy (p < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing (p = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade (p = 0.002) or Modic type (p = 0.025).
CONCLUSIONS
CONCLUSIONS
Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.
Identifiants
pubmed: 33573617
doi: 10.1186/s12891-021-04015-z
pii: 10.1186/s12891-021-04015-z
pmc: PMC7879619
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
167Références
Spine (Phila Pa 1976). 2006 Apr 20;31(9):1026-31
pubmed: 16641780
Pain Res Treat. 2012;2012:680496
pubmed: 23213514
J Neurol Neurosurg Psychiatry. 2017 Dec;88(12):1008-1016
pubmed: 28550071
PLoS One. 2016 Nov 7;11(11):e0166031
pubmed: 27820861
Orthop Traumatol Surg Res. 2013 Feb;99(1 Suppl):S187-96
pubmed: 23352565
Eur Spine J. 2014 May;23(5):1021-43
pubmed: 24442183
Spine (Phila Pa 1976). 2015 Jan 1;40(1):E29-34
pubmed: 25341981
Spine (Phila Pa 1976). 1986 Mar;11(2):107-10
pubmed: 3704799
J Orthop Sci. 2017 Jul;22(4):641-646
pubmed: 28392347
Spine (Phila Pa 1976). 2010 Dec 1;35(25):2224-31
pubmed: 21102297
Arthritis Res Ther. 2014 Jul 28;16(4):R159
pubmed: 25069717
BMC Musculoskelet Disord. 2019 Mar 4;20(1):100
pubmed: 30832643
Biomed Res Int. 2018 Aug 7;2018:9073460
pubmed: 30175149
Spine Surg Relat Res. 2018 Jan 27;2(1):11-17
pubmed: 31440640
Spine (Phila Pa 1976). 2010 Jun 1;35(13):E596-600
pubmed: 20461034
BMC Musculoskelet Disord. 2015 Aug 20;16:213
pubmed: 26289077
Spine (Phila Pa 1976). 2001 Sep 1;26(17):1873-8
pubmed: 11568697
Clin Orthop Relat Res. 2015 Jun;473(6):1988-99
pubmed: 25694267
Medicine (Baltimore). 2018 Feb;97(5):e9807
pubmed: 29384882
J Bone Joint Surg Am. 2004 May;86(5):893-6
pubmed: 15118028
Radiology. 1988 Jan;166(1 Pt 1):193-9
pubmed: 3336678
Spine Surg Relat Res. 2017 Dec 20;1(1):1-6
pubmed: 31440605