Journal Article

Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale

Koyama, Keita, Aoki, Yasuchika, Nakagawa, Koichi, Shiga, Yasuhiro, Kono, Mamoru, Inoue, Masahiro, Eto, Fumihiko, Akatsu, Yorikazu, Funayama, Toru, Miura, Kousei, Eguchi, Yawara, Nakajima, Arata, Akazawa, Tsutomu, Shibao, Yosuke, Ohtori, Seiji, Koda, Masao, Orita, Sumihisa, Inage, Kazuhide, Furuya, Takeo, Mataki, Kentaro, Yamazaki, Masashi, Takahashi, Hiroshi, Sonobe, Masato, Abe, Tetsuya, Noguchi, Hiroshi, Saito, Junya, Maki, Satoshi

2021

Overview

Background Several authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally. Methods We included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition. Results Before surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting ( p  = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy ( p  < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing ( p  = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade ( p  = 0.002) or Modic type ( p  = 0.025). Conclusions Improvement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Arthritis / Back pain / Care and treatment / Clinical diagnostics and imaging / Complications and side effects / Decompression / Degenerative disc disease / Diagnosis / Discectomy / Diskectomy - adverse effects / Epidemiology / Hernia / Humans / Internal Medicine / Intervertebral Disc Displacement - complications / Intervertebral Disc Displacement - diagnostic imaging / Intervertebral Disc Displacement - surgery / Intervertebral discs / Intervertebral disk / Intervertebral disk displacement / Low back pain / Low Back Pain - diagnostic imaging / Low Back Pain - etiology / Lumbar disc herniation / Lumbar Vertebrae - diagnostic imaging / Lumbar Vertebrae - surgery / Magnetic resonance imaging / Medicine / Medicine & Public Health / Musculoskeletal diseases / Orthopedics / Osteoarthritis / Patients / Radicular low back pain / Rehabilitation / Research Article / Residual low back pain / Rheumatology / Risk factors / Sports Medicine / Surgery / Treatment Outcome / Visual Analog Scale