Back pain improves significantly following discectomy for lumbar disc herniation

Background context: Although lumbar disc herniation (LDH) classically presents with lower extremity radiculopathy, there are patients who have substantial associated back pain.

Purpose: The present study aims to determine if patients with LDH with substantial back pain improve with decompression alone.

Study design: This is a longitudinal observational cohort study.

Patient sample: Patients enrolled in the Quality and Outcomes Database with LDH and a baseline back pain score of ≥5 of 10 who underwent single- or two-level lumbar discectomy only.

Outcome measures: Back and leg pain scores (0-10), Oswestry Disability Index (ODI), and EuroQoL 5D were measured.

Methods: Standard demographic and surgical variables were collected, as well as patient-reported outcomes at baseline and at 3 and 12 months postoperatively.

Results: The mean age of the cohort was 49.8 years and 1,195 (52.8%) were male. Mean body mass index was 30.1 kg/m². About half of the patients (1,103, 48.8%) underwent single-level discectomy and the other half (1,159, 51.2%) had two-level discectomy. Average blood loss was 44 cc. Most of the patients (2,217, 98%) were discharged home with routine postoperative care. The average length of stay was 0.53 days. At 3 and 12 months postoperatively, there were statistically significant (p<.000) improvements in back pain (from 7.7 to 2.9 to 3.2), leg pain (from 7.5 to 2.3 to 2.5), and ODI (from 26.2 to 11.6 to 11.2). Patients with a single-level discectomy, compared with patients with a two-level discectomy, had similar improvements in 3- and 12-month back pain, leg pain, and ODI scores.

Conclusions: Patients with LDH who have substantial back pain can be counseled to expect improvement in their back pain scores 12 months after a discectomy.