Patients with radiating leg pain duration of less than 3 months may be more satisfied with surgical outcomes and have more positive perceptions of their postoperative leg pain following lumbar discectomy compared with patients who experienced longer duration of pain. This is according to research published in the Journal of Neurosurgery: Spine.
Researchers conducted a prospective national cohort study using data collected from the Swedish Swespine registry between 2013 and 2017 in order to evaluate postoperative reduction in leg pain among patients who underwent lumbar disc herniation surgery. Participants were stratified into 1 of 4 groups based on preoperative leg pain duration: less than 3 months, 3 to 12 months, 12 to 24 months, and more than 24 months. Preoperative sciatica duration was self-reported.
All included participants answered a preoperative and 1-year postoperative questionnaire as part of their inclusion in the Swespine database. The numeric rating scale was used to evaluate both pre- and postoperative pain, while the 1-year follow-up included a qualitative, single-item leg pain question as well as a global assessment.
The total patient cohort included 6216 patients (44.3% women; mean body mass index, 26.4 kg/m2) with first-time surgical discectomy and 1 year of follow-up data. Surgery on L5-S1 was the most common (52.1%) followed by L4-L5 (42%), and L3-L4 and sacral levels combined (5.9%). Preoperative sciatica duration was between 3 and 12 months in 58% of patients, while 15% had pain for 3 months, 15% had pain for 12 to 24 months, and 12% had pain for longer than 2 years.
Patients in the entire study group experienced an improvement in postoperative radiating leg pain, regardless of the duration or intensity of their preoperative pain (residual mean numeric rating scale score, 2.16; mean decrease, -4.83; 95% CI, -4.73 to -4.93; P <.0001). The greatest improvement in this score was observed in the group with leg pain duration of less than 3 months (mean, -5.59; 95% CI, -5.85 to -5.33). Score improvements in the 3 to 12 months, 12 to 24 months, and more than 24-months groups were slightly less (-5.00, -4.19, and -3.85, respectively).
Using a Fisher nonparametric permutation test, the researchers compared the stratified groups and found a significant between-group difference, except between the 12 to 24 months and more than 24 months groups (P =.11).
Overall, 36.61% of participants rated their postoperative sciatic leg pain as “completely recovered.” An additional 40.54% described “major improvement,” 13.76% described “some” improvement, and 8.13% described unchanged or worsening pain. A significant between-group difference in global assessment score was noted: Among patients with pain duration of 12 months or more, a larger proportion of patients had unchanged or worse radiating leg pain.
Within the cohort, the overall surgical satisfaction at the 1-year postoperative follow-up was 80.1%; 13.5% of patients were uncertain and 6.4% were dissatisfied.
Study limitations include a lack of data about the particular reasons for the pain duration from symptom initiation to surgery and the high number of patients lost to follow-up typical of register studies.
“Patients with the shortest preoperative leg pain duration (<3 months) reported superior outcomes in all measured parameters,” the researchers concluded. “More significantly, using 12 months of pain duration as a cutoff…patients who had a lumbar discectomy with a preoperative symptom duration [less than] 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 [more than] 12 months of sciatic leg pain.”
Beck J, Westin O, Brisby H, Baranto A. Association of extended duration of sciatic leg pain with worse outcome after lumbar disc herniation surgery: a register study in 6216 patients. J Neurosurg Spine. Published online February 12, 2021. doi:10.3171/2020.8.SPINE20602