Use of neuropathic pain questionnaires in predicting persistent postoperative neuropathic pain following lumbar discectomy for radiculopathy

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Failed-back surgery syndrome has been historically used to describe extremity neuropathic pain in lumbar disease despite structurally corrective spinal surgery. It is unclear whether specific preoperative pain characteristics can help determine which patients may be susceptible to such postoperative disabling symptoms.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This prospective study analyzed surgical microdiscectomy patients treated for lumbar, degenerative, painful radiculopathy. Clinical parameters included general demographics, preoperative and postoperative clinical examination status, self-reported pain and disability scores, and neuropathic pain scores. The screening tests for neuropathic pain were the Douleur Neuropathique 4 and Leeds Assessment of Neuropathic Symptoms and Signs, with correlation tested for ordinal score and screen positivity. Multiple logistic regression analysis was used to define predictors of postoperative symptomatology.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Twelve percent of the 250 patients with radiculopathy who underwent microdiscectomy experienced persistent postoperative neuropathic pain (PPNP) with only modest, if any, relief of leg pain. The condition was highly associated with abnormal preoperative screen results for neuropathic pain, but not sex, smoking status, or preoperative pain severity (α = 0.05). Good correlation was seen between the 2 screening tests used in this study for both absolute ordinal score (Spearman ρ = 0.84; p &lt; 0.001) and the threshold for terming the patient as having neuropathic pain features (Spearman ρ = 0.48; p &lt; 0.001). Younger age at treatment also correlated with a higher likelihood of developing PPNP (p = 0.03).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This population exhibited a low overall frequency of PPNP. Higher neuropathic pain screening scores correlated strongly with likelihood of significant postoperative leg pain. Further work is required to develop more accurate prognostication tools for radiculopathy patients undergoing structural spinal surgery.</jats:p></jats:sec>

Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis

“…The findings reflect a high reported success rate for lumbar discectomy compared to RCT data [3] if based on leg pain as the measured outcome, with success clear for patients immediately following surgery. This is interesting and contrasts previous findings that the presence of features of neuropathic pain accompanied by higher scores of neuropathic pain was associated with persistent leg pain [35]. Mean disability prior to surgery was 53.33, illustrating a moderate level of disability.…”

Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta‐analysis of cohort studies

“…Furthermore, none of the included studies reported if participants had neuropathic pain characteristics, such as dysaesthesia (impaired sensation) and allodynia (pain resulting from a stimulus which would not normally provoke pain). Previous research has shown that higher scores of neuropathic pain and the presence of neuropathic pain features are associated with persistent postoperative leg pain (Shamji and Shcharinsky, ). It is unclear if included studies are screened for these characteristics, and could have potentially included participants more likely to develop failed back surgery syndrome.…”

Incidence, Management, and Cost of Complications After Transforaminal Endoscopic Decompression Surgery for Lumbar Foraminal and Lateral Recess Stenosis: A Value Proposition for Outpatient Ambulatory Surgery

“…Clearly, the lumbar transforaminal endoscopic decompression procedure is by far less burdensome to the patient and realizes direct cost savings not just by virtue of being carried out in an ASC, but also due to its much lower individual complication rates in areas where disproportionate expenditures can easily be accumulated once inpatient management of complications is required. In other words, the most common complications and sequelae of lumbar transforaminal endoscopic decompression were distinctly different from those reported with inpatient microdiscectomy [6][7][8][9][10][11][12][13] and were managed in an outpatient office setting and, thus, never registered as additional claims since acute postoperative care measures were covered and included in the 90-day global payment period during the first 6 postoperative weeks.…”