PMID- 32764173
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230619
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 33
IP  - 6
DP  - 2020 Aug 7
TI  - How do high preoperative pain scores impact the clinical course and outcomes for 
      patients undergoing lumbar microdiscectomy?
PG  - 772-778
LID - 10.3171/2020.5.SPINE20373 [doi]
AB  - OBJECTIVE: Preoperative pain assessment is often used to gauge the amount of 
      disability in patients with lumbar disc herniation. How high preoperative pain 
      scores impact the clinical course and outcomes of patients after lumbar 
      microdiscectomy is not always clear. Here, the authors aimed to determine whether 
      patients reporting higher preoperative pain scores have worse outcomes after 
      lumbar microdiscectomy than those reporting lower preoperative scores. METHODS: 
      The authors performed a retrospective review of patients with symptomatic lumbar 
      disc herniations that had failed to improve with nonsurgical methods and who had 
      undergone tubular lumbar microdiscectomy. Health-related quality of life (HRQOL) 
      scores had been collected in the preoperative and postoperative period. The 
      anatomical severity of disease was graded based on lumbar disc health (Pfirrmann 
      classification), facet degeneration, thecal sac cross-sectional area, and disc 
      herniation grade. Data on each patient's narcotic consumption and length of stay 
      were collected. A Student t-test and chi-square test were used to compare 
      patients with high preoperative pain scores (HP cohort) and those with lower 
      preoperative scores (non-HP cohort). RESULTS: One hundred thirty-eight patients 
      were included in this analysis. The 47 patients in the HP cohort had taken more 
      preoperative opioids (12.0 +/- 21.2 vs 3.6 +/- 11.1 morphine equivalent doses, p = 
      0.01). However, there was no statistically significant difference in Pfirrmann 
      classification (p > 0.15), facet grade (p > 0.11), thecal sac cross-sectional 
      area (p = 0.45), or disc herniation grade (p = 0.39) between the HP and non-HP 
      cohorts. The latter cohort had statistically significant higher preoperative 
      PROMIS scores (36.5 +/- 7.0 vs 29.9 +/- 6.4, p < 0.001), SF-12 mental component 
      summary scores (48.7 +/- 11.5 vs 38.9 +/- 16.1, p < 0.001), and SF-12 physical 
      component summary scores (PCS; 32.4 +/- 8.6 vs 27.5 +/- 10.0, p = 0.005), but a lower 
      Oswestry Disability Index (56.4 +/- 22.1 vs 35.4 +/- 15.5, p < 0.001). There were 
      only two time points after microdiscectomy when the HP cohort had worse HRQOL 
      scores: at the 2-week follow-up for SF-12 PCS scores (32.4 +/- 8.6 vs 29.3 +/- 7.1, p 
      = 0.03) and the 12-week follow-up for PROMIS scores (45.2 +/- 9.5 vs 39.5 +/- 7.1, p 
      = 0.01). All other postoperative HRQOL measurements were similar between the two 
      cohorts (p > 0.05). CONCLUSIONS: A patient's perceived severity of disease often 
      does not correlate with the actual clinical pathology on imaging. Although 
      patients who report high pain and have a symptomatic lumbar disc herniation may 
      describe their pain as more extreme, they should be counseled that the outcomes 
      of microdiscectomy are positive.
FAU - Virk, Sohrab
AU  - Virk S
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
FAU - Vaishnav, Avani S
AU  - Vaishnav AS
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
FAU - Mok, Jung Kee
AU  - Mok JK
AD  - 2Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New 
      York.
FAU - McAnany, Steven
AU  - McAnany S
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
AD  - 2Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New 
      York.
FAU - Iyer, Sravisht
AU  - Iyer S
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
AD  - 2Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New 
      York.
FAU - Albert, Todd J
AU  - Albert TJ
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
AD  - 2Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New 
      York.
FAU - Gang, Catherine Himo
AU  - Gang CH
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
FAU - Qureshi, Sheeraz A
AU  - Qureshi SA
AD  - 1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York; and.
AD  - 2Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New 
      York.
LA  - eng
PT  - Journal Article
DEP - 20200807
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
OTO - NOTNLM
OT  - health-related quality-of-life scores
OT  - herniated disc
OT  - lumbar spine
OT  - microdiscectomy
OT  - pain
OT  - pain catastrophizing
EDAT- 2020/08/09 06:00
MHDA- 2020/08/09 06:01
CRDT- 2020/08/09 06:00
PHST- 2020/03/17 00:00 [received]
PHST- 2020/05/06 00:00 [accepted]
PHST- 2020/08/09 06:01 [medline]
PHST- 2020/08/09 06:00 [pubmed]
PHST- 2020/08/09 06:00 [entrez]
AID - 2020.5.SPINE20373 [pii]
AID - 10.3171/2020.5.SPINE20373 [doi]
PST - epublish
SO  - J Neurosurg Spine. 2020 Aug 7;33(6):772-778. doi: 10.3171/2020.5.SPINE20373.