Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery

Abstract

Purpose Most patients with lumbar disc herniations requiring surgery have concomitant back pain. The purpose of the current study was to evaluate the outcome of surgery for lumbar disc herniations in patients with no preoperative back pain (NBP) compared to those reporting low back pain (LBP). Methods 15,418 patients surgically treated due to LDH with primary discectomy from 1998 until 2020 were included in the study. Self-reported low back pain assessed with a numerical rating scale (NRS) was used to dichotomize the patients in two groups, patients without preoperative back pain (NBP, NRS = 0, n = 1333, 9%) and patients with preoperative low back pain (LBP, NRS > 0, n = 14,085, 91%). Patient reported outcome measures (PROMs) collected preoperatively and one-year postoperatively were used to evaluate differences in outcomes between the groups. Results At the one-year follow-up, 89% of the patients in the NBP group were completely pain free or much better compared with 76% in the LBP group. Significant improvement regarding leg pain was seen in all measured PROMs in both groups oneyear after surgery. In the NBP group, 13% reported clinically significant back pain (NRS difference greater than Minimally Clinical Important Difference (MICD)) at the one-year follow-up. Conclusions Patients without preoperative back pain are good candidates for LDH surgery. 13% of patients without preoperative back pain develop clinically significant back pain one-year after surgery.

Predictive Factors for Residual Low Back Pain Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Lumbar Disc Herniation

“…There are often 2 types of presentation when treating patients with LDH: predominant leg pain with back pain, and predominant back pain with leg pain. The leg pain-predominant patients seem to have a better outcome with our surgical treatment; however, the LBP-predominant patients seem to be less responsive [ 27 ]. The baseline LBP may become important in assessing these patients’ middle- or long-term follow-up and prognosis, and it may serve as an argument to advise more extensive treatment and rehabilitation postoperatively.…”

Additional operations after surgery for lumbar disc prolapse

“…3 The outcome is generally favourable when the chief complaint is sciatica. 1,2,4,25 Serious complications are uncommon, and the satisfaction rates are high. 3,26,27 Although most patients experience a rapid decrease in pain and disability over the three months after surgery, some experience moderate leg pain and disability after five years.…”