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Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients
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- Beck, Joel (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för ortopedi,Institute of Clinical Sciences, Department of Orthopaedics
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- Westin, Olof (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för ortopedi,Institute of Clinical Sciences, Department of Orthopaedics
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- Brisby, Helena, 1965 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för ortopedi,Institute of Clinical Sciences, Department of Orthopaedics
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- 2021
- 2021
- Engelska.
- Ingår i: Journal of Neurosurgery-Spine. - 1547-5654. ; 34, s. 759-767
- Tidskriftsartikel (refereegranskat)
Abstract
Ämnesord
Stäng
- OBJECTIVE Sciatica is the hallmark symptom of a lumbar disc herniation (LDH). Up to 90% of LDH patients recover within 12 weeks regardless of treatment. With continued deteriorating symptoms and low patient quality of life, most surgeons recommend surgical discectomy. However, there is not yet a clear consensus regarding the proper timing of surgery. The aim of this study was to evaluate how the duration of preoperative leg pain (sciatic neuralgia) is associated with patient-reported levels of postoperative leg pain reduction and other patient-reported outcome measures (PROMs) in a prospectively collected data set from a large national cohort. METHODS All patients aged 18?65 years undergoing a lumbar discectomy during 2013?2016 and registered in Swespine (the Swedish national spine registry) with 1 year of postoperative follow-up data were included in the study (n = 6216). The patients were stratified into 4 groups according to preoperative pain duration: < 3, 3?12, 12?24, or > 24 months. Patient results assessed with the numeric rating scale (NRS) for leg pain (rated from 0 to 10), global assessment of leg pain, EQ-5D, Oswestry Disability Index (ODI), and patient satisfaction with the final surgical outcome were analyzed and compared with preoperative values and between groups. RESULTS A significant improvement was seen 1 year postoperatively regardless of preoperative pain duration (change in NRS score: mean ?4.83, 95% CI ?4.73 to ?4.93 in the entire cohort). The largest decrease in leg pain NRS score (mean ?5.59, 95% CI ?5.85 to ?5.33) was seen in the operated group with the shortest sciatica duration (< 3 months). The patients with a leg pain duration in excess of 12 months had a significantly higher risk of having unchanged radiating leg pain 1 year postoperatively compared with those with < 12-month leg pain duration at the time of surgery (OR 2.41, 95% CI 1.81?3.21, p < 0.0001). CONCLUSIONS Patients with the shortest leg pain duration (< 3 months) reported superior outcomes in all measured parameters. More significantly, using a 12-month pain duration as a cutoff, patients who had a lumbar discectomy with a preoperative symptom duration < 12 months experienced a larger reduction in leg pain and were more satisfied with their surgical outcome and perception of postoperative leg pain than those with > 12 months of sciatic leg pain.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Ortopedi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Orthopaedics (hsv//eng)
Nyckelord
- lumbar disc herniation
- sciatica
- surgical timing
- time to surgery
- nonoperative treatment
- Neurosciences & Neurology
- Surgery
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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- Journal of Neurosurgery-Spine (Sök värdpublikationen i LIBRIS)
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- Av författaren/redakt...
- Beck, Joel
- Westin, Olof
- Brisby, Helena, ...
- Baranto, Adad, 1 ...
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- MEDICIN OCH HÄLSOVETENSKAP
- MEDICIN OCH HÄLS ...
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- Göteborgs universitet
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