Postoperative recovery patterns following discectomy surgery in patients with lumbar radiculopathy

Abstract

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.

Postoperative Evaluation of Pain and Disability in Patients Undergoing Spinal Discectomy

“…SDS is considered to be a highly helpful therapy for a significant number of patients, whether performed with a surgical process that is minimally invasive or extensive open technique, despite there being some difference in outcome [ 15 - 16 ]. According to the study, between 30% and 70% of patients report that their pain persisted after surgery, indicating that many patients did not experience good postoperative outcomes [ 17 - 18 ]. According to research done on other spinal surgical procedures, such as decompression for spinal stenosis [ 19 ], several disabilities and pain patterns may be present within a larger patient group with SDS.…”

“…In this study, the mean postoperative VAS score for leg pain at three-month follow-up was 4.3±1. Despite the fact that there is evidence to support the benefits of rehabilitation after lumbar disc surgery, its application seems to be low, and there is little agreement among doctors and academics regarding the best practices [16,17]. As a result, it is difficult to determine the best strategy for rehabilitating this population.…”

“…According to research, approximately 30-70% of patients say that pain persists after surgery, indicating that plenty of people do not have a positive postoperative result trajectory [12,13]. Multiple impairments and pain trends might be present within a larger patient group having SDS, according to studies conducted in other surgical procedures of the spine including decompression for spinal stenosis [14][15][16][17][18][19]. The most prevalent type of pain among adults is low back pain (LBP), which affects eight out of 10 people at some point in their lifetime.…”

Analysis of Conservative Treatment Trends for Lumbar Disc Herniation with Radiculopathy in Korea: A Population-Based Cross-Sectional Study

“…Furthermore, even for surgical candidates with radiculopathy or a sizeable affected area of the herniated disc, the outcomes of conservative management were not inferior to those of surgery [ 16 , 17 ]. In particular, patients with lumbar radiculopathy face postoperative complications, such as a high risk of pain and functional disability, resulting in poor postoperative prognosis [ 18 ]. Therefore, for patients who are reluctant to undergo surgical treatment due to fear of surgery, expectations of spontaneous improvement, and lack of certainty regarding the long-term benefits of the surgery [ 17 ], conservative treatment is considered to be a suitable primary treatment [ 1 , 2 , 3 , 17 ].…”