Introduction: A systematic literature review and prospective cohort study was performed to determine the incidence of recurrent degenerative back-pain after discectomy and quantify its effect on patients’ pain, disability, and quality of life.
Methods: Literature review: A systematic MEDLINE search was performed to identify all studies reporting outcomes after discectomy for herniated lumbar disc (HLD). The incidence of recurrent or persistent back-pain or leg-pain, same-level recurrent disc herniation, and rate of reoperation was assessed. Prospective study: All patients undergoing discectomy for HLD were enrolled into our institution's prospective registry. Patients with 1-year or more of clinical outcomes postoperatively were included. Baseline, 3-month, 1-year, and 2-year postoperative pain, disability, and quality of life were prospectively assessed. Patients were examined to identify those who had delayed onset of new low back dysfunction as compared to their 3-month levels based on MCID scores.
Results: Literature review: The incidence of short-term and long-term recurrent back or leg-pain was 14.2% and 13.9%, respectively. The incidence of same-level recurrent HLD was 5.3%. The rate of reoperation was 4.4% (5% fusion, 95% discectomy). Prospective cohort study: 115 patients surpassed 12-months from surgery. One-year and two-year outcomes were available in 103 (90%) and 30 (85%) patients, respectively. At all time points, patient reported outcomes measures were significantly improved versus baseline. At 1-year follow-up 23 (22%) patients and at 2-year follow-up 8 (26%) patients reported clinically significant worsening of low back-pain or disability compared to 3-month levels.
Conclusions: Lumbar discectomy is a highly effective procedure. The incidence of two-year, same-level HLD requiring revision discectomy was nearly 6% in both analyses. Two-year recurrent low back-pain after discectomy may occur in 15% to 25% of patients. While delayed recurrent back-pain occurs not infrequently, the level of pain and disability remains far less than that experienced at the time of prior disc herniation and index surgery.
Patient Care: This research shows discectomy to be highly effective at improving pain, disability, and quality of life for patients with symptomatic lumbar disc herniation. It sets in stone epidemiological values that were previously undefined, allowing surgeons to effectively communicate the incidence of persistent back pain or leg pain, same-level recurrent disc herniation, and rate of reoperation for recurrent disc herniation with patients. Lastly, it helps surgeons understand the ways in which patients can progress after discectomy for lumbar herniated disc. It is important to know that although a subset of patients will have recurrent pain one to two years after discectomy, this pain will be less that that experienced at the time of prior disc herniation and index surgery.
Learning Objectives: The learning objectives are two-fold. Firstly, through a systematic literature review, we show: 1) the short-term incidence of post-discectomy recurrent back pain (6 months to 2 years postoperatively), 2) the long-term incidence of post-discectomy recurrent back pain (>2 years postoperatively), 3) the incidence of same-level recurrent disc herniation, and 4) the rate of reoperation for same-level recurrent herniation for first time single-level lumbar discectomy. Secondly, through the use of our prospective longitudinal spinal outcomes registry, we quantify the effect that discectomy for first time herniated lumbar disc has on patients’ pain, disability, and quality of life.