Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients

Joel Beck MD 1 , Olof Westin MD, PhD 1 , 2 , Helena Brisby MD, PhD 1 , 2 , and Adad Baranto MD, PhD 1 , 2
View More View Less
  • 1 Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; and
  • 2 Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Sciatica is the hallmark symptom of a lumbar disc herniation (LDH). Up to 90% of LDH patients recover within 12 weeks regardless of treatment. With continued deteriorating symptoms and low patient quality of life, most surgeons recommend surgical discectomy. However, there is not yet a clear consensus regarding the proper timing of surgery. The aim of this study was to evaluate how the duration of preoperative leg pain (sciatic neuralgia) is associated with patient-reported levels of postoperative leg pain reduction and other patient-reported outcome measures (PROMs) in a prospectively collected data set from a large national cohort.

METHODS

All patients aged 18–65 years undergoing a lumbar discectomy during 2013–2016 and registered in Swespine (the Swedish national spine registry) with 1 year of postoperative follow-up data were included in the study (n = 6216). The patients were stratified into 4 groups according to preoperative pain duration: < 3, 3–12, 12–24, or > 24 months. Patient results assessed with the numeric rating scale (NRS) for leg pain (rated from 0 to 10), global assessment of leg pain, EQ-5D, Oswestry Disability Index (ODI), and patient satisfaction with the final surgical outcome were analyzed and compared with preoperative values and between groups.

RESULTS

A significant improvement was seen 1 year postoperatively regardless of preoperative pain duration (change in NRS score: mean −4.83, 95% CI −4.73 to −4.93 in the entire cohort). The largest decrease in leg pain NRS score (mean −5.59, 95% CI −5.85 to −5.33) was seen in the operated group with the shortest sciatica duration (< 3 months). The patients with a leg pain duration in excess of 12 months had a significantly higher risk of having unchanged radiating leg pain 1 year postoperatively compared with those with < 12-month leg pain duration at the time of surgery (OR 2.41, 95% CI 1.81–3.21, p < 0.0001).

CONCLUSIONS

Patients with the shortest leg pain duration (< 3 months) reported superior outcomes in all measured parameters. More significantly, using a 12-month pain duration as a cutoff, patients who had a lumbar discectomy with a preoperative symptom duration < 12 months experienced a larger reduction in leg pain and were more satisfied with their surgical outcome and perception of postoperative leg pain than those with > 12 months of sciatic leg pain.

ABBREVIATIONS GA = global assessment; LDH = lumbar disc herniation; NRS = numeric rating scale; ODI = Oswestry Disability Index; PROM = patient-reported outcome measure; RCT = randomized controlled trial; Swespine = Swedish spine register; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Joel Beck: Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. joel.beck@gu.se.

INCLUDE WHEN CITING Published online February 12, 2021; DOI: 10.3171/2020.8.SPINE20602.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Andersson G. The epidemiology of spinal disorders. In: Frymoyer JW, ed. The Adult Spine: Principles and Practice. Lippincott-Raven; 1997.

    • Search Google Scholar
    • Export Citation
  • 2

    Weber H. Lumbar disc herniation. A controlled, prospective study with ten years of observation. Spine (Phila Pa 1976). 1983;8(2):131140.

    • Search Google Scholar
    • Export Citation
  • 3

    Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse. Cochrane Database Syst Rev. 2007;(2):CD001350.

  • 4

    Schoenfeld AJ, Bono CM. Does surgical timing influence functional recovery after lumbar discectomy? A systematic review. Clin Orthop Relat Res. 2015;473(6):19631970.

    • Search Google Scholar
    • Export Citation
  • 5

    Rihn JA, Hilibrand AS, Radcliff K, Duration of symptoms resulting from lumbar disc herniation: effect on treatment outcomes: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2011;93(20):19061914.

    • Search Google Scholar
    • Export Citation
  • 6

    Weinstein JN, Lurie JD, Tosteson TD, Surgical versus nonoperative treatment for lumbar disc herniation: four-year results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008;33(25):27892800.

    • Search Google Scholar
    • Export Citation
  • 7

    Støttrup CC, Andresen AK, Carreon L, Andersen MO. Increasing reoperation rates and inferior outcome with prolonged symptom duration in lumbar disc herniation surgery—a prospective cohort study. Spine J. 2019;19(9):14631469.

    • Search Google Scholar
    • Export Citation
  • 8

    Bailey CS, Rasoulinejad P, Taylor D, Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. N Engl J Med. 2020;382(12):10931102.

    • Search Google Scholar
    • Export Citation
  • 9

    Nygaard OP, Kloster R, Solberg T. Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg. 2000;92(2)(suppl):131134.

    • Search Google Scholar
    • Export Citation
  • 10

    von Elm E, Altman DG, Egger M, The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007;45(4):247251.

    • Search Google Scholar
    • Export Citation
  • 11

    Strömqvist B, Fritzell P, Hägg O, Swespine: the Swedish spine register: the 2012 report. Eur Spine J. 2013;22(4):953974.

  • 12

    Mixter W, Barr J. Rupture of the intervertebral disc with involvement of the spinal canal. New Engl J Med. 1934;211:210215.

  • 13

    Williams RW. Microlumbar discectomy: a conservative surgical approach to the virgin herniated lumbar disc. Spine (Phila Pa 1976). 1978;3(2):175182.

    • Search Google Scholar
    • Export Citation
  • 14

    Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931939.

    • Search Google Scholar
    • Export Citation
  • 15

    Tullberg T, Isacson J, Weidenhielm L. Does microscopic removal of lumbar disc herniation lead to better results than the standard procedure? Results of a one-year randomized study. Spine (Phila Pa 1976). 1993;18(1):2427.

    • Search Google Scholar
    • Export Citation
  • 16

    Parai C, Hägg O, Lind B, Brisby H. The value of patient global assessment in lumbar spine surgery: an evaluation based on more than 90,000 patients. Eur Spine J. 2018;27(3):554563.

    • Search Google Scholar
    • Export Citation
  • 17

    Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):29402952.

  • 18

    EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199208.

  • 19

    Siccoli A, Staartjes VE, de Wispelaere MP, Schröder ML. Association of time to surgery with leg pain after lumbar discectomy: is delayed surgery detrimental? J Neurosurg Spine. 2019;32(2):160167.

    • Search Google Scholar
    • Export Citation
  • 20

    Haugen AJ, Brox JI, Grøvle L, Prognostic factors for non-success in patients with sciatica and disc herniation. BMC Musculoskelet Disord. 2012;13:183.

    • Search Google Scholar
    • Export Citation
  • 21

    Lurie JD, Tosteson TD, Tosteson ANA, Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976). 2014;39(1):316.

    • Search Google Scholar
    • Export Citation
  • 22

    Solberg TK, Sørlie A, Sjaavik K, Would loss to follow-up bias the outcome evaluation of patients operated for degenerative disorders of the lumbar spine? Acta Orthop. 2011;82(1):5663.

    • Search Google Scholar
    • Export Citation
  • 23

    Endler P, Ekman P, Hellström F, Minor effect of loss to follow-up on outcome interpretation in the Swedish spine register. Eur Spine J. 2020;29(2):213220.

    • Search Google Scholar
    • Export Citation
  • 24

    Elkan P, Lagerbäck T, Möller H, Gerdhem P. Response rate does not affect patient-reported outcome after lumbar discectomy. Eur Spine J. 2018;27(7):15381546.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1172 1172 259
Full Text Views 119 119 19
PDF Downloads 90 90 15
EPUB Downloads 0 0 0