Concomitant back pain as a predictor of outcome after single level lumbar micro-decompressive surgery – A study of 995 patients

Gagan, S; Aljawadi, Ahmed; Choudhry, Muhammad; Fischer, Benjamin E.; Divecha, Hiren; Leach, John; Arnall, Frances; Verma, Rajat; Yasin, Naveed; Mohammad, Saeed; Siddique, Irfan

doi:10.1016/j.jor.2019.08.013

Cited by 6 publications

(7 citation statements)

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“…Whether muscle quality is a risk factor for disc herniation for clinical populations on Earth is unknown. However, the literature shows that the incidence of disc herniation and multifidus muscle atrophy in relation to low back pain are both most likely to occur in the lower lumbar spine [27,30,31].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

et al. 2022

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BACKGROUND CONTEXT: For chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight. PURPOSE: To examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6-months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology. STUDY DESIGN: This is a prospective longitudinal study. PATIENT SAMPLE: Our sample included a cohort of twelve astronaut crewmembers. OUTCOME MEASURES: From 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral end plate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm 2 ), multifidus lean muscle cross-sectional area (cm 2 ), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (˚), maximum lateral bending ROM (˚), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI. METHODS: Advanced imaging data from 3T MRI were collected at three separate time points in relation to spending 6-months in space: (1) within a year before launch ("pre-flight"), (2) within a FDA device/drug status: Not applicable.

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Section: Discussionmentioning

confidence: 99%

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

et al. 2022

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“…The severity and extent of pain is not a direct correlation of the size of the disc and degree of neural compression but rather a combination of various factors, such as chronicity, size, and the type of materials herniated in the prolapsed intervertebral disc. It is possible that a small disc herniation pressing on dorsal root ganglion can lead to severe pain while a large chronic central disc herniation is asymptomatic [16][17][18]. Cauda equina and conus medullaris are an uncommon emergent presentations of a prolapsed intervertebral disc, which are associatedwith high canal compromised disc herniations.…”

Section: Clinical Findingsmentioning

confidence: 99%

Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease

Kim

Jang

2020

IJMS

163

117

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With an aging population, there is a proportional increase in the prevalence of intervertebral disc diseases. Intervertebral disc diseases are the leading cause of lower back pain and disability. With a high prevalence of asymptomatic intervertebral disc diseases, there is a need for accurate diagnosis, which is key to management. A thorough understanding of the pathophysiology and clinical manifestation aids in understanding the natural history of these conditions. Recent developments in radiological and biomarker investigations have potential to provide noninvasive alternatives to the gold standard, invasive discogram. There is a large volume of literature on the management of intervertebral disc diseases, which we categorized into five headings: (a) Relief of pain by conservative management, (b) restorative treatment by molecular therapy, (c) reconstructive treatment by percutaneous intervertebral disc techniques, (d) relieving compression and replacement surgery, and (e) rigid fusion surgery. This review article aims to provide an overview on various current diagnostic and treatment options and discuss the interplay between each arms of these scientific and treatment advancements, hence providing an outlook of their potential future developments and collaborations in the management of intervertebral disc diseases.

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“…2009 [14] Imaging study of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation 5 Fraser et al…”

Section: [1]mentioning

confidence: 99%

“…A recent study on the predictors of outcome of lumbar disc herniation reported that severe baseline back pain was a predictor of poor outcome whether the patients were managed surgically or treated conservatively, but those that were managed conservatively had an even worse outcome; the conclusion was that surgery had a greater treatment effect [28]. More recently, a study of 995 patients by Sethi et al concluded that patients with lower back pain of 6 or more on VAS are at increased risk of poor outcome following MID [5]. All the above studies have suggested that the greater the preoperative back pain (with sciatica), the worse the outcome.…”

Section: Clinical and Surgical Variablesmentioning

confidence: 99%

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Sciatica Presentations and Predictors of Poor Outcomes Following Surgical Decompression of Herniated Lumbar Discs: A Review Article

Aljawadi

Gagan²,

Islam

et al. 2020

Cureus

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Pain associated with sciatica is one of the most common indications for surgery. The annual rate of discectomy has increased over recent years, with a significant number of patients reporting a poor outcome or symptom recurrence after surgery. This study aims to evaluate the predictors of poor outcome for patients undergoing lumbar discectomy for sciatica. A comprehensive search was conducted to find relevant literature published between 1985 and 2019. All literature with a clear methodology were included. Many factors that affect postoperative recovery after lumbar discectomy have been reported. Some evidence suggests that sociodemographic factors, including female gender, smoking, increased age, low socioeconomic status, and low education level may be associated with less favorable outcomes after surgery. Symptom duration does not appear to be associated with a significant difference in long-term outcomes; however, early surgery (within one year) may result in a faster postoperative recovery with better early results. Furthermore, patients who had discectomy for predominant leg pain had better outcomes compared to those who had the surgery for back pain as the main presentation. There was no evidence to suggest a correlation between the size of the herniated disc and long-term outcomes of sciatica; however, a higher anatomical level of herniation (L1-2, L2-3) was associated with poorer outcomes compared to the lower level of herniation (L3-4, L4-5). A few studies suggested slow postoperative recovery correlates with unemployment and depression. We recommend that the predictors of postoperative outcomes should be taken into consideration when selecting or counseling patients for lumbar disc decompression.

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Concomitant back pain as a predictor of outcome after single level lumbar micro-decompressive surgery – A study of 995 patients

Cited by 6 publications

References 30 publications

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease

Sciatica Presentations and Predictors of Poor Outcomes Following Surgical Decompression of Herniated Lumbar Discs: A Review Article

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