Back pain is also improved by lumbar disc herniation surgery

• Published in: Acta orthopaedica Vol. 92; no. 1; pp. 4 - 8
• Main Authors: Hareni, Niyaz, Strömqvist, Fredrik, Strömqvist, Björn, Sigmundsson, Freyr Gauti, Rosengren, Björn E, Karlsson, Magnus K
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.01.2021; Medical Journals Sweden
• Subjects: Adult; Back Pain - surgery; Clinical Medicine; Female; Humans; Intervertebral Disc Degeneration - surgery; Intervertebral Disc Displacement - surgery; Kirurgi; Klinisk medicin; Lumbar Vertebrae - surgery; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Pain Measurement; Sciatica - surgery; Surgery; Surveys and Questionnaires; Young Adult
• ISSN: 1745-3674; 1745-3682; 1745-3682
• DOI: 10.1080/17453674.2020.1815981

Background and purpose - Indication for lumbar disc herniation (LDH) surgery is usually to relieve sciatica. We evaluated whether back pain also decreases after LDH surgery. Patients and methods - In the Swedish register for spinal surgery (SweSpine) we identified 14,097 patients aged 20-64 years, with pre- and postoperative data, who in 2000-2016 had LDH surgery. We calculated 1-year improvement on numeric rating scale (rating 0-10) in back pain (N back ) and leg pain (N leg ) and by negative binomial regression relative risk (RR) for gaining improvement exceeding minimum clinically important difference (MCID). Results - N leg was preoperatively (mean [SD]) 6.7 (2.5) and N back was 4.7 (2.9) (p < 0.001). Surgery reduced N leg by mean 4.5 (95% CI 4.5-4.6) and N back by 2.2 (CI 2.1-2.2). Mean reduction in N leg ) was 67% and in N back 47% (p < 0.001). Among patients with preoperative pain ≥ MCID (that is, patients with significant baseline pain and with a theoretical possibility to improve above MCID), the proportion who reached improvement ≥ MCID was 79% in N leg and 60% in N back . RR for gaining improvement ≥ MCID in smokers compared with non-smokers was for N leg 0.9 (CI 0.8-0.9) and ­N back 0.9 (CI 0.8-0.9), and in patients with preoperative duration of back pain 0-3 months compared with > 24 months for N leg 1.3 (CI 1.2-1.5) and for N back 1.4 (CI 1.2-1.5). Interpretation - LDH surgery improves leg pain more than back pain; nevertheless, 60% of the patients with significant back pain improved ≥ MCID. Smoking and long duration of pain is associated with inferior recovery in both N leg and N back .