Introduction: Long-term post-discectomy degenerative disc disease and low back pain is a well-recognized pathology, however, its patient-centered characterization and quantification is lacking. We performed a systematic literature review and prospective longitudinal study to determine the incidence of recurrent degenerative back pain and quantify its effect on patients’ pain, disability, and quality of life.
Methods: Literature review: A MEDLINE search was performed to identify studies reporting outcomes after primary lumbar discectomy. Incidence of recurrent back pain, same-level recurrent disc herniation, and rate of reoperation was assessed. Prospective study: All patients undergoing primary lumbar discectomy were enrolled into our prospective spine registry. PROs were prospectively assessed at baseline, 3-month, 1-year, and 2-years. The threshold of deterioration used to classify recurrent back pain was the minimum clinically important difference (MCID) in NRS-BP or ODI.
Results: Literature review: Ninety studies met the inclusion criteria, yielding a total of 21,180 patients for analysis. The incidence of short-term(6-24mo) and long-term(>24mo) recurrent back pain was 14.2% and 13.9%. The two-year incidence of recurrent disc herniation was 5.3% and rate of reoperation was 4.4%, Table 1. Prospective study: All PROs significantly improved at all follow-up time points. At 1-year and 2-year follow-up, 22% and 26% patients reported clinically significant (MCID) worsening of low back pain (NRS: 5.3±2.5 vs 2.7±2.8, p<0.05) or disability (ODI%: 32±18 vs 21±18, p<0.05) compared to 3-month levels, Figure 1. Despite this decline, post-operative back pain and disability remained moderately improved from baseline in these patients.
Conclusions: In a systematic literature review and prospective outcomes study, lumbar discectomy was highly effective at improving PROs. The incidence same-level disc herniation requiring reoperation was 6%. Two-year recurrent low back pain may occur in 15% to 25% of patients depending on the level of recurrent pain considered clinically significant.
Patient Care: Our study shows that lumbar discectomy was highly effective at improving PROs. Two-year recurrent low back pain may occur in 15% to 25% of patients depending on the level of recurrent pain considered clinically significant.
Learning Objectives: At the end of the session, participants should be able to: 1) Understand that lumbar discectomy is a highly effective procedure; 2) Determine the recurrence rates associated with lumbar diskectomy