Back pain is also improved by lumbar disc herniation surgery

Niyaz Hareni; Fredrik Strömqvist; Björn Strömqvist; Freyr Gauti Sigmundsson; Björn E Rosengren; Magnus K Karlsson

doi:10.1080/17453674.2020.1815981

Authors

Niyaz Hareni Department of Orthopaedics, Varberg Hospital, Varberg, Departments of Clinical Sciences and Orthopedics, Lund University
Fredrik Strömqvist Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
Björn Strömqvist Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
Freyr Gauti Sigmundsson Department of Orthopedics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Björn E Rosengren epartments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
Magnus K Karlsson Departments of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden

DOI:

https://doi.org/10.1080/17453674.2020.1815981

Abstract

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.