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

Abstract

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.

Bipolar radiofrequency ablation of the superomedial (SM), superolateral (SL) and inferomedial (IM) genicular nerves for chronic osteoarthritis knee pain: a randomized double-blind placebo-controlled trial with 12-month follow-up

“…Whereas some might interpret this as evidence against performing prognostic blocks, one large retrospective study found that individuals who experienced >80% relief on GNB obtained better outcomes than those who received between 50% and 79% relief9; this suggests that our 50% cut-off threshold may have been too low. Third, we failed to exclude patients with secondary gain, mild psychopathology, sleep dysfunction, high degrees of disease burden, and the substantial proportion of subjects with possible nociplastic overlay to their KOA, all of whom are more likely to fail interventional treatments 11 28 30 39–44. We also included individuals within a wide age spectrum, as inclusivity enhances generalization.…”

Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register

“…33 34 35 Socioeconomic status, psychiatric comorbidity, and low education level were also associated with less favorable outcomes after surgery. 27 36…”

“…[33][34][35] Socioeconomic status, psychiatric comorbidity, and low education level were also associated with less favorable outcomes after surgery. 27,36 In summary, prediction of outcome after lumbar diskectomy is dependent on various factors such as leg and back pain, disability, analgesic consumption, prior surgeries, and radiologic findings.…”

Risk Factors, Prevention, and Primary and Secondary Management of Sciatica: An Updated Overview

“…Analyzing the treatment outcomes of sciatica patients is difficult because every study has a different set of parameters to determine success; thus, the results are either misinterpreted or hyped. Patients with chronic pain (lasting more than six months) typically experience worse outcomes from surgery than patients with acute pain (less than six months) [ 44 ]. Some studies have reported a cure rate of more than 75%, while others reported cure rates of less than 50% from surgical interventions.…”