Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis

Rushton, Alison; Heneghan, Nicola R; Heymans, Martijn W.; Staal, J. Bart; Goodwin, Peter

doi:10.1007/s00586-019-06272-y

Cited by 18 publications

(20 citation statements)

References 28 publications

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“…The subgroups identified for back pain were similar to those of leg pain both in class membership and trajectory, although more patients belonged to the poor subgroup compared to the excellent subgroup for this outcome measure. While a synthesis of results for back pain in the literature describes notable improvement that is preserved over time, the subgroups provide evidence of a considerable 30.6% of patients with a much less beneficial recovery 28 . Unlike the pain subgroups, those for disability indicated that nearly the entire patient population (95.3%) experienced an excellent-fair pattern of recovery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy

Wang

Hébert

Abraham

et al. 2022

Sci Rep

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This retrospective study of prospectively collected data aimed to identify unique pain and disability trajectories in patients following lumbar discectomy surgery. Patients of this study population presented chiefly with lumbar radiculopathy and underwent discectomy surgery from thirteen sites enrolled in the CSORN registry. Outcome variables of interest included numeric rating scales for leg/back pain and modified Oswestry disability index scores at baseline, 3, 12, and 24 months post-operatively. Latent class growth analysis was used to identify distinct courses in each outcome. Data from 524 patients revealed three unique trajectories for leg pain (excellent = 18.4%, good = 55.4%, poor = 26.3%), disability (excellent = 59.7%, fair = 35.6%, poor = 4.7%) and back pain (excellent = 13.0%, good = 56.4%, poor = 30.6%). Construct validity was supported by statistically significant differences in the proportions of patients attaining the criteria for minimal important change (MIC; 30%) or clinical success in disability (50% or Oswestry score ≤ 22) (p < 0.001). The variable proportions of patients belonging to poor outcome trajectories shows a disconnect between improved disability and persistence of pain. It will be beneficial to incorporate this information into the realm of patient expectation setting in concert with future findings of potential factors predictive of subgroup membership.

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Section: Discussionmentioning

confidence: 99%

Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy

Wang

Hébert

Abraham

et al. 2022

Sci Rep

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“…В качестве важного фактора, определяющего нарушение функциональной активности через 6 мес после операции, отмечено ее нарушение до операции. Полученные данные совпадают с результатами систематического анализа, согласно которым инвалидность пациентов, перенесших поясничную дискэктомию, определяется степенью их инвалидности и интенсивности поясничной боли перед операцией [20]. В качестве факторов, ухудшающих функциональное состояние после операции, отмечены также низкий уровень образования, неудовлетворенность выполняемой работой, длительный период заболевания [21], продолжительный период боли в ноге [22] и длительный период существенного снижения функциональной активности до операции [23].…”

Section: Reduction Of Pain Intensity According To Vas (Points) In Groups Of Patients With and Without Kinesitherapy After Lumbar Discectounclassified

“…К таким вопросам относятся время и длительность занятий, выбор определенных упражнений, частота контроля со стороны специалиста по кинезитерапии. Требуются новые крупные исследования, посвященные оценке влияния различных факторов на восстановление функциональных возможностей у пациентов, перенесших поясничную дискэктомию [20].…”

Section: Improvement Of In Activities Of Daily Living According To Rms (Points) In Groups Of Patients With and Without Kinesitherapy Afteunclassified

Rehabilitation of patients after lumbar microdiscectomy

Prokopovich

Парфенов

2021

RJTAO

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Objective: to investigate movement-based therapy (kinesitherapy) effectiveness in the rehabilitation of patients after lumbar microdiscectomy.Patients and methods. We enrolled 90 patients (33 men and 57 women, mean age — 59.78±12.0 years) after lumbar microdiscectomy due to the ineffectiveness of conservative management of discogenic lumbosacral radiculopathy. One-half of the participants (45 patients: 15 men and 30 women, mean age — 60.24±12.0 years) underwent kinesitherapy under the supervision of a physician; in other 45 patients (18 men and 27 women, mean age — 59.33±11.0 years), kinesitherapy was not included in the radiculopathy treatment protocol. We assessed pain intensity with visual analogue scale (VAS) and disability using the Roland-Morris scale (RMS) before surgery, ten days after the surgery, and 1, 3, and 6 months after surgery.Results and discussion. We observed a significant decrease in pain intensity - up to 4 points on the VAS, and an improvement in activities of daily living up to 10 points on the RMS 10 days after microdiscectomy. After six months, there was a decrease in pain intensity according to the VAS to 2 points in the kinesitherapy group and to 3 points in the group without kinesitherapy (p=0.088), as well as an improvement in activities of daily living according to RMS up to 5 points in the kinesitherapy group and up to 8 points in the group without kinesitherapy (p=0.003). Reoperations were required in two of 45 patients in the group without kinesitherapy (4.4%) and in one of 45 patients (2.2%) in the kinesitherapy group (p≥0.05).Conclusion. Kinesitherapy can improve functional recovery in patients after lumbar microdiscectomy.

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“…Нарушение функциональной активности через 6 мес после операции во многом определялось ее нарушением до операции, что согласуется с результатами систематического анализа, согласно которым инвалидность пациентов после поясничной дискэктомии определяется степенью их инвалидности и интенсивности поясничной боли перед операцией [19]. В наблюдаемой группе пациентов мы не анализировали ряд других показателей, способных ухудшить функциональное состояние после операции, в частности низкий уровень образования, неудовлетворенность выполняемой работой, длительный период заболевания [20], продолжительный период боли в ноге [21] и длительный период существенного снижения функциональной активности до операции [22].…”

Section: Original Articleunclassified

Issues of optimization of management of patients with discogenic lumbosacral radiculopathy

Prokopovich

Parfenov

2021

Consilium Medicum

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Background. Discogenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pain, but more often accompanied by a long disabilities. To improve patient management with DLSR, the study of conservative and surgical management of patients in real clinical practice is required. Aim. Optimization of patient management aimed at surgical treatment. Materials and methods. Surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR was suffered by 90 patients (33 men, 57 women, average age 59.7812 years). The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 63 weeks. The intensity of pain was evaluated on a visual analog scale (VAS), disability on Oswestry Disability Index (ODI) and RolandMorris Disability Questionnaire (RMDQ) before the operation, after 10 days, 1, 3 and 6 months after surgery. Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. After microdiskectomy after 10 days, significant reliable (p0.01) decrease in pain with 7 (95% confidence interval CI 78) to 4 (95% CI 34) points for VAS and reduction of disability with 13 (95% CI 1216) to 9 (95% CI 711) RMDQ points, from 63 (95% CI 6165) to 32 (95% CI 3034) % by ODI. After 1, 3 and 6 months, a further decrease in pain was observed [6 months to 3 (95% CI 23) points for VAS] and a decrease in disability [6 months to 5 (95% CI 47) points for RMDQ and up to 18 (95% CI 1719) % on ODI]. To reduce the intensity of pain 6 months after the operation, it was significantly (p0.05) influenced the initial intensity of pain according to VAS and conducting kinesitherapy after the operation. To reduce the disability in RMDQ after 6 months, the initial disability in RMDQ and the conduct of kinesitherapy after surgery was significantly (p0.05) influenced. Conclusion. Patients with DLSR should be informed about the favorable course of the disease, the possibilities of natural (without surgical intervention) of the regression of the disc hernia; after performing surgical treatment, it is advisable to the kinesitherapy, capable of improving the functional recovery of patients.

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Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis

Cited by 18 publications

References 28 publications

Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy

Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy

Rehabilitation of patients after lumbar microdiscectomy

Issues of optimization of management of patients with discogenic lumbosacral radiculopathy

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