Abstract
Abstract
Purpose
To conduct a meta-analysis to describe clinical course of pain and disability in adult patients post-lumbar discectomy (PROSPERO: CRD42015020806).
Methods
Sensitive topic-based search strategy designed for individual databases was conducted. Patients (> 16 years) following first-time lumbar discectomy for sciatica/radiculopathy with no complications, investigated in inception (point of surgery) prospective cohort studies, were included. Studies including revision surgery or not published in English were excluded. Two reviewers independently searched information sources, assessed eligibility at title/abstract and full-text stages, extracted data, assessed risk of bias (modified QUIPs) and assessed GRADE. Authors were contacted to request raw data where data/variance data were missing. Meta-analyses evaluated outcomes at all available time points using the variance-weighted mean in random-effect meta-analyses. Means and 95% CIs were plotted over time for measurements reported on outcomes of leg pain, back pain and disability.
Results
A total of 87 studies (n = 31,034) at risk of bias (49 moderate, 38 high) were included. Clinically relevant improvements immediately following surgery (> MCID) for leg pain (0–10, mean before surgery 7.04, 50 studies, n = 14,910 participants) and disability were identified (0–100, mean before surgery 53.33, 48 studies, n = 15,037). Back pain also improved (0–10, mean before surgery 4.72, 53 studies, n = 14,877). Improvement in all outcomes was maintained (to 7 years). Meta-regression analyses to assess the relationship between outcome data and a priori potential covariates found preoperative back pain and disability predictive for outcome.
Conclusion
Moderate-level evidence supports clinically relevant immediate improvement in leg pain and disability following lumbar discectomy with accompanying improvements in back pain.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Surgery
Reference36 articles.
1. NICE (2016) Low back pain and sciatica in over 16s: assessment and management, NICE guideline [NG59]. National Institute for Health and Care Excellence, London
2. Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG, Buchbinder R, Hartvigsen J, Cherkin D, Foster NE, Maher CG, Underwood M, van Tulder M, Anema JR, Chou R, Cohen SP, Menezes Costa L, Croft P, Ferreira M, Ferreira PH, Fritz JM, Genevay S, Gross DP, Hancock MJ, Hoy D, Karppinen J, Koes BW, Kongsted A, Louw Q, Öberg B, Peul WC, Pransky G, Schoene M, Sieper J, Smeets RJ, Turner JA, Woolf A (2018) Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet 391(10137):2368–2383. https://doi.org/10.1016/s0140-6736(18)30489-6
3. Oosterhuis T, Costa LOP, Maher CG, de Vet HCW, van Tulder MW, Ostelo RWJG (2014) Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003007.pub3
4. Ostelo RWGM, de Vet HC et al (2004) Economic evaluation of a behavioral-graded activity program compared to physical therapy for patients following lumbar disc surgery. Spine 29:615–622
5. Orgaan CB (2008) The lumbosacral radicular syndrome. Centraal Begeleidings Orgaan Report. Dutch Institute for Healthcare Improvement