Outcomes following discectomy for lumbar disc herniation in patients with substantial back pain

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  • 1 Center for Spine Surgery & Research, Middelfart Hospital, Middelfart;
  • 2 Center for Rheumatology and Spine Diseases, Rigshospitalet–Glostrup; and
  • 3 Department of Orthopaedic Surgery, Regionshospitalet Silkeborg, Denmark
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OBJECTIVE

Patients with lumbar disc herniation (LDH) typically present with lower-extremity radiculopathy. However, there are patients who have concomitant substantial back pain (BP) and are considered candidates for fusion. The purpose of this study was to determine if patients with LDH and substantial BP improve with discectomy alone.

METHODS

The DaneSpine database was used to identify 2399 patients with LDH and baseline BP visual analog scale (VAS) scores ≥ 50 who underwent a lumbar discectomy at one of 3 facilities between June 2010 and December 2017. Standard demographic and surgical variables and patient-reported outcomes, including BP and leg pain (LP) VAS scores (0–100), Oswestry Disability Index (ODI), and European Quality of Life–5 Dimensions Questionnaire (EQ-5D) at baseline and 12 months postoperatively, were collected.

RESULTS

A total of 1654 patients (69%) had 12-month data available, with a mean age of 48.7 years; 816 (49%) were male and the mean BMI was 27 kg/m2. At 12 months postoperatively, there were statistically significant improvements (p < 0.0001) in BP (72.6 to 36.9), LP (74.8 to 32.6), ODI (50.9 to 25.1), and EQ-5D (0.25 to 0.65) scores.

CONCLUSIONS

Patients with LDH and LP and concomitant substantial BP can be counseled to expect improvement in their BP 12 months after surgery after a discectomy alone, as well as improvement in their LP.

ABBREVIATIONS BP = back pain; EQ-5D = European Quality of Life–5 Dimensions Questionnaire; LBP = low-back pain; LDH = lumbar disc herniation; LP = leg pain; MCID = minimal clinically important difference; ODI = Oswestry Disability Index; PRO = patient-reported outcome; SCB = substantial clinical benefit; SPORT = Spine Patient Outcomes Research Trial; VAS = visual analog scale.

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Contributor Notes

Correspondence Simon Thorbjørn Sørensen: Center for Spine Surgery & Research, Middelfart Hospital, Middelfart, Denmark. simonthorbjorn@gmail.com.

INCLUDE WHEN CITING Published online July 10, 2020; DOI: 10.3171/2020.4.SPINE191382.

Disclosures Dr. Carreon reports being an employee of Norton Healthcare; being a consultant to the National Spine Health Foundation; reports that the Spine Center of Southern Denmark has received financial support from Hospital Lillebaelt Research Committee, Hospital Lillebaelt Development Committee, SDU faculty scholarship, Gangstedsfonden, The Danish Rheumatism Association, Region Syddanmarks Ph.D. Fund, Region Syddanmarks Research Funds, Region Sjælland and Region Syddanmarks common research funds, The Free Research Council, The A.P. Møller Fund of Advanced Medicine, Inger Goldmanns Fund, IMK Almene Fund, Aase and Ejnar Danielsens Fund, Overlæge Jørgen Werner Schous og hustru, Else-Marie Schou, født Wonge’s Fund, Cerapedics, The Fund of Advanced Chiropractic Research and Postgraduate Education, Eli Lilly, Kroghs Donation, Ortotech, Guildal Foundation, and Janssen-Cilag A/S; and being a member of the Editorial Advisory Board for Spine Deformity, The Spine Journal, and Spine, and a member of the University of Louisville IRB.

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