Evaluating Predictive Value of Preoperative Clinical and Imaging Findings on the Short-Term Outcome of Surgery in Patients Undergoing Lower Lumbar Discectomy

Abstract

Objective: The most common indications for spinal surgery are low back pain and associated disabilities caused by disc herniation. Given the high prevalence of low back pain, the critical nature of pain assessment in these patients, and knowledge about the influencing and predisposing factors, we sought to evaluate the clinical and radiologic findings associated with pain relief and postoperative recovery in patients who underwent bilateral lumbar discectomy.Methods: From March 2016 to October 2020, a prospective cohort study was conducted. This study included adult patients with symptomatic disc herniation in the L4-L5 and L5-S1 segments who were candidates for bilateral discectomy. Before and after surgery, patients were evaluated for lumbar and radicular pain and the Oswestry Disability Index (ODI) score and at the four, 12, and 24-week follow-up. Meanwhile, a variety of demographic, clinical, and radiologic factors was collected and statistically analyzed.Results: This study enrolled 30 patients. The average age of the patients was 41.2 years, with 22 males and eight females. Twelve of these patients had disc involvement in the L4-L5 region, while 18 had disc involvement in the L5-S1 region. Statistical analysis revealed that radicular pain and disability associated with low back pain significantly decreased following surgery (P=0.001). However, there was no significant reduction in back pain (P>0.05). Patients with a higher body mass index (BMI) and neurological claudication had a lower reduction in radicular pain (P<0.05). Moreover, a higher BMI and the presence of instability pain are associated with an increased likelihood of postoperative lumbar pain relief (P<0.01). Among the radiological variables, increased disc height was associated with a more rapid recovery from low back disability (P=0.003). Furthermore, a larger diameter of paraspinal muscles at the level of the herniated disc was associated with a more rapid improvement of lower back pain (P=0.021). Conclusion:The use of discectomy in patients with lumbar disc herniation significantly alleviates postoperative and follow-up radicular pain. Age, BMI, neurological claudication, instability pain, and paraspinal muscle diameter played a role in postoperative pain relief. Increased disc height was associated with a more rapid decline in the ODI score. Future studies with larger sample sizes are recommended.

Changes in Disc Height as a Prognostic Factor in Patients Undergoing Microscopic Discectomy

“…Iorio-Morin et al [ 12 ] also identified the following six clinical factors associated with poor back pain improvement after surgery : low expectations, not working, low level of education, female sex, and being married. Additionally, Tabibkhooei et al [ 26 ] reported that higher BMI and neurological claudication are predictive factors for poor reduction in back pain. In the present study, we found that a greater reduction in DH after surgery was associated with greater improvement in postoperative back pain.…”

Messung der Bandscheibenhöhen in der Lendenwirbelsäule. Vergleich von Proiektionsradiographie und Kernspintomografie, Messmethode und Bestimmung der Inter-Observer-Reliabilität

“…Knowing the radiological "normal values" of the lumbar intervertebral disc height is relevant for a number of clinical issues. On the one hand, intervertebral disc height is an important predictor for the development and prognosis of a herniated disc [23,24,25,26,27,28].…”

“…Die Kenntnis der radiologischen "Normalwerte" der lumbalen Bandscheibenhöhen ist für eine Reihe von klinischen Fragestellungen relevant. Die Bandscheibenhöhe ist einerseits ein wichtiger Prädiktor für die Entstehung und die Prognose eines Bandscheibenvorfalls [23,24,25,26,27,28].…”