How do high preoperative pain scores impact the clinical course and outcomes for patients undergoing lumbar microdiscectomy?

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  • 1 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and
  • 2 Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York
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OBJECTIVE

Preoperative pain assessment is often used to gauge the amount of disability in patients with lumbar disc herniation. How high preoperative pain scores impact the clinical course and outcomes of patients after lumbar microdiscectomy is not always clear. Here, the authors aimed to determine whether patients reporting higher preoperative pain scores have worse outcomes after lumbar microdiscectomy than those reporting lower preoperative scores.

METHODS

The authors performed a retrospective review of patients with symptomatic lumbar disc herniations that had failed to improve with nonsurgical methods and who had undergone tubular lumbar microdiscectomy. Health-related quality of life (HRQOL) scores had been collected in the preoperative and postoperative period. The anatomical severity of disease was graded based on lumbar disc health (Pfirrmann classification), facet degeneration, thecal sac cross-sectional area, and disc herniation grade. Data on each patient’s narcotic consumption and length of stay were collected. A Student t-test and chi-square test were used to compare patients with high preoperative pain scores (HP cohort) and those with lower preoperative scores (non-HP cohort).

RESULTS

One hundred thirty-eight patients were included in this analysis. The 47 patients in the HP cohort had taken more preoperative opioids (12.0 ± 21.2 vs 3.6 ± 11.1 morphine equivalent doses, p = 0.01). However, there was no statistically significant difference in Pfirrmann classification (p > 0.15), facet grade (p > 0.11), thecal sac cross-sectional area (p = 0.45), or disc herniation grade (p = 0.39) between the HP and non-HP cohorts. The latter cohort had statistically significant higher preoperative PROMIS scores (36.5 ± 7.0 vs 29.9 ± 6.4, p < 0.001), SF-12 mental component summary scores (48.7 ± 11.5 vs 38.9 ± 16.1, p < 0.001), and SF-12 physical component summary scores (PCS; 32.4 ± 8.6 vs 27.5 ± 10.0, p = 0.005), but a lower Oswestry Disability Index (56.4 ± 22.1 vs 35.4 ± 15.5, p < 0.001). There were only two time points after microdiscectomy when the HP cohort had worse HRQOL scores: at the 2-week follow-up for SF-12 PCS scores (32.4 ± 8.6 vs 29.3 ± 7.1, p = 0.03) and the 12-week follow-up for PROMIS scores (45.2 ± 9.5 vs 39.5 ± 7.1, p = 0.01). All other postoperative HRQOL measurements were similar between the two cohorts (p > 0.05).

CONCLUSIONS

A patient’s perceived severity of disease often does not correlate with the actual clinical pathology on imaging. Although patients who report high pain and have a symptomatic lumbar disc herniation may describe their pain as more extreme, they should be counseled that the outcomes of microdiscectomy are positive.

ABBREVIATIONS HP = high pain; HRQOL = health-related quality of life; MCS = mental component summary; MI = minimally invasive; ODI = Oswestry Disability Index; PCS = physical component summary; VAS = visual analog scale.

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Contributor Notes

Correspondence Sheeraz A. Qureshi: Hospital for Special Surgery, New York, NY. sheerazqureshimd@gmail.com.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.SPINE20373.

Disclosures Dr. Iyer has received research support from Innovasis for the study described, has received speakers fees from Globus Medical Inc., and has served as an advisory board member for Healthgrades. Dr. McAnany has been a consultant for Medicrea, Medtronic Sofamor Danek USA Inc., NuVasive Inc., Stryker, Titan Spine, and Zimmer Biomet. Dr. Albert has been a consultant for NuVasive Inc.; receives royalties from DePuy Synthes Spine, Elsevier, JP Medical Publishers, Springer, Thieme Medical Publishers, and Zimmer Biomet; holds patents with DePuy Synthes Spine and Zimmer Biomet; has served on the scientific advisory board/other office for the American Orthopaedic Association, Back Story LLC, Scoliosis Research Society, and Spine Universe; has ownership interest in Augmedics, Bonovo Orthopedics, Inc., CytoDyn Inc., Innovative Surgical Designs, Inc., InVivo Therapeutics, Morphogenesis, Paradigm Spine LLC, Physician Recommended Nutriceuticals, Precision Orthopedics, Pulse Equity, Spinicity, Strathspey Crown, and Surg.IO LLC. Dr. Qureshi receives royalties from Globus Medical Inc. and Stryker K2M; has direct stock ownership in Avaz Surgical and Vital 5 (past relationship); has been a consultant for Paradigm Spine, Globus Medical Inc., and Stryker K2M; has served on the scientific advisory board/other office for the Association of Bone and Joint Surgeons, the Cervical Spine Research Society, Healthgrades, the International Society for the Advancement of Spine Surgery, LifeLink.com Inc., the Minimally Invasive Spine Study Group, the North American Spine Society, Simplify Medical Inc., the Society of Minimally Invasive Spine Surgery, and Spinal Simplicity LLC; has served on the editorial board of the Annals of Translational Medicine and Contemporary Spine Surgery; has received honoraria from AMOpportunities and RTI Surgical Inc.; and has received speakers fees from Globus Medical Inc.

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