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Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation

Suri, Pradeep, MD, MS∗,†; Pearson, Adam M., MD, MS; Zhao, Wenyan, PhD; Lurie, Jon D., MD, MSc§,¶; Scherer, Emily A., PhD§; Morgan, Tamara S., MA; Weinstein, James N., DO, MS

doi: 10.1097/BRS.0000000000001894
EPIDEMIOLOGY
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SDC

Study Design. Secondary analysis of data from a concurrent randomized trial and cohort study.

Objective. The aim of this study was to determine risks and predictors of recurrent pain following standard open discectomy for subacute/chronic symptomatic lumbar disc herniation (SLDH).

Summary of Background Data. Most previous studies of recurrence after discectomy do not explicitly define pain resolution and recurrence, and do not account for variable durations of time at risk for recurrence.

Methods. We used survival analysis methods to examine predictors of leg pain recurrence. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of leg pain recurrence using Kaplan-Meier survival curves, and examined predictors of recurrence using Cox proportional hazards models. We used similar methods to examine LBP recurrence.

Results. One- and three-year cumulative risks of leg pain recurrence were 20% and 45%, respectively. One- and three- year leg pain recurrence risks were substantially lower in participants with complete initial resolution of leg pain (17% and 41%, respectively) than in those without (27% and 54%, respectively). In multivariate analyses, complete leg pain resolution (adjusted hazard ratio [aHR] 0.69; 95% confidence interval [CI] 0.52–0.90), smoking (aHR 1.68 [95% CI 1.22–2.33]), and depression (aHR 1.74 [95% CI 1.18–2.56]) predicted leg pain recurrence. The 1- and 3-year risk of LBP recurrence was 29% and 65%, respectively. LBP recurrence risk at 3 years was substantially lower in participants with complete initial resolution of LBP than in those without, but not at 1 year.

Conclusion. Recurrence of leg pain and LBP is common after discectomy for SLDH. Cumulative risks of both leg pain and LBP recurrence were generally lower in participants achieving complete initial resolution of pain post-discectomy.

Level of Evidence: 2

Seattle Epidemiologic Research and Information Center and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA

Department of Rehabilitation Medicine, University of Washington, Seattle, WA

Department of Orthopaedics, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH

§Department of Medicine, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH

The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.

Address correspondence and reprint requests to Pradeep Suri, MD, MS, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108. E-mail: pradeep.suri@va.gov

Received 01 July, 2016

Accepted 19 August, 2016

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01-AR45444) and the Office of Research on Women's Health, the National Institutes of Health, and the National Institute of Occupational Safety and Health, the Centers for Disease Control and Prevention funds were received in support of this work. The Multidisciplinary Clinical Research Center in Musculoskeletal Diseases is funded by NIAMS (P60--AR048094 and P60-AR062799). Dr. Suri's participation in this study was funded by VA Puget Sound Health Care System.

Relevant financial activities outside the submitted work: consultancy, grants, stocks, travel/accommodations/meeting expenses.

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