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The association between pain scores and disc height change following discectomy surgery in lumbar disc herniation patients: a systematic review and meta-analysis

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Abstract

Purpose

To evaluate the impact of discectomy on disc height (DH) in lumbar disc herniation (LDH) patients following discectomy surgery and address the association of DH change with pain score change.

Methods

We searched three online databases for randomized controlled trials (RCTs) and observational studies. In LDH patients, eligible for discectomy surgery, the changes in pre- and post-operative back and/or leg pain score and DH and/or disc height index (DHI) were considered as primary outcomes. Standardize mean difference (SMD) and their 95% confidence intervals (CI) were evaluated. The GRADE approach was used to summarize the strength of evidence.

Results

Two RCTs and sixteen observational studies were included in the analysis of 893 LDH patients undergoing discectomy surgery. The mean overall follow-up was 211 weeks. There was a statistically significant reduction in DH (14.4% reduction: SMD =  −0.74 (95% CI =  −0.86 to −0.61)) and DHI (11.5% reduction: SMD =  −0.81 (95% CI =  −0.97 to −0.65)) following discectomy surgery. There was a significant relationship between the reduction in DH and decrease in back pain score (r = 0.68, (95% CI = 0.07–1.30), p = 0.034) after discectomy surgery. No significant relationship between DHI change and decrease in clinical pain scores (back and leg pain) could be established.

Conclusion

Discectomy surgery produces significant and quantifiable reductions in DH and DHI. Additionally, the reduction in DH is responsible for the decrease in back pain scores post discectomy, but further studies will improve understanding and aid preoperative counselling.

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References

  1. Maher C, Underwood M, Buchbinder R (2017) Non-specific low back pain. Lancet 389:736–747. https://doi.org/10.1016/S0140-6736(16)30970-9

    Article  PubMed  Google Scholar 

  2. Walker BF, Muller R, Grant WD (2003) Low back pain in Australian adults: the economic burden. Asia Pac J Public Health 15:79–87. https://doi.org/10.1177/101053950301500202

    Article  CAS  PubMed  Google Scholar 

  3. Victoria AaO (2013) A problem worth solving: the rising cost of musculoskeletal conditions in Australia: a report/produced by arthritis and osteoporosis victoria; based on analysis by deloitte access economics. https://www.msk.org.au/wp-content/uploads/2018/07/APWS-PLS.pdf

  4. Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, Cho CH, DePalma MJ, Dougherty P 2nd, Fernand R, Ghiselli G, Hanna AS, Lamer T, Lisi AJ, Mazanec DJ, Meagher RJ, Nucci RC, Patel RD, Sembrano JN, Sharma AK, Summers JT, Taleghani CK, Tontz WL Jr, Toton JF, North American Spine S (2014) An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J 14:180–191. https://doi.org/10.1016/j.spinee.2013.08.003

    Article  PubMed  Google Scholar 

  5. Haines SJ, Jordan N, Boen JR, Nyman JA, Oldridge NB, Lindgren BR (2002) Discectomy strategies for lumbar disc herniation: results of the LAPDOG trial. J Clin Neurosci 9:411–417. https://doi.org/10.1054/jocn.2002.1120

    Article  PubMed  Google Scholar 

  6. Thomé C, Barth M, Scharf J, Schmiedek P (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271–278. https://doi.org/10.3171/spi.2005.2.3.0271

    Article  PubMed  Google Scholar 

  7. Barrios C, Ahmed M, Arrótegui J, Björnsson A, Gillström P (1990) Microsurgery versus standard removal of the herniated lumbar disc. A 3-year comparison in 150 cases. Acta Orthop Scand 61:399–403

    Article  CAS  PubMed  Google Scholar 

  8. Silverplats K, Lind B, Zoëga B, Halldin K, Gellerstedt M, Brisby H, Rutberg L (2010) Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up. Eur Spine J 19:1459–1467. https://doi.org/10.1007/s00586-010-1433-7

    Article  PubMed  PubMed Central  Google Scholar 

  9. McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ (2009) A prospective cohort study of close interval computer tomography and magnetic resonance imaging after primary lumbar discectomy. Spine Phila Pa 1976 34:2044–2051. https://doi.org/10.1097/BRS.0b013e3181b34a9a

    Article  PubMed  Google Scholar 

  10. Barth M, Diepers M, Weiss C, Thome C (2008) 2-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine Phila Pa 1976 33:273–279. https://doi.org/10.1097/BRS.0b013e31816201a6

    Article  PubMed  Google Scholar 

  11. Beattie PF, Meyers SP (1998) Magnetic resonance imaging in low back pain: general principles and clinical issues. Phys Ther 78:738–753. https://doi.org/10.1093/ptj/78.7.738

    Article  CAS  PubMed  Google Scholar 

  12. Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K (2001) Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine Phila Pa 1976 26:652–657

    Article  CAS  PubMed  Google Scholar 

  13. Barth M, Diepers M, Weiss C, Thome C (2008) 2-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine Phila Pa 1976 33:273–279. https://doi.org/10.1097/BRS.0b013e31816201a6

    Article  PubMed  Google Scholar 

  14. Farfan HF (1973) Mechanical disorders of the low back. Lea & Febiger, Philadelphia

    Google Scholar 

  15. Pope MH, Hanley EN, Matteri RE, Wilder DG, Frymoyer JW (1977) Measurement of intervertebral disc space height. Spine Phila Pa 1976 2:282–286

    Article  Google Scholar 

  16. Inoue H, Ohmori K, Miyasaka K, Hosoe H (1999) Radiographic evaluation of the lumbosacral disc height. Skeletal Radiol 28:638–643. https://doi.org/10.1007/s002560050566

    Article  CAS  PubMed  Google Scholar 

  17. Kim KT, Park SW, Kim YB (2009) Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine Phila Pa 1976 34:2674–2678. https://doi.org/10.1097/BRS.0b013e3181b4aaac

    Article  PubMed  Google Scholar 

  18. Jarman JP, Arpinar VE, Baruah D, Klein AP, Maiman DJ, Muftuler LT (2015) Intervertebral disc height loss demonstrates the threshold of major pathological changes during degeneration. Eur Spine J 24:1944–1950. https://doi.org/10.1007/s00586-014-3564-8

    Article  PubMed  Google Scholar 

  19. Akeda K, Yamada T, Inoue N, Nishimura A, Sudo A (2015) Risk factors for lumbar intervertebral disc height narrowing: a population-based longitudinal study in the elderly. BMC Musculoskelet Disord 16:344. https://doi.org/10.1186/s12891-015-0798-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  21. Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, Bronfort G, van Tulder MW (2015) 2015 Updated method guideline for systematic reviews in the cochrane back and neck group. Spine 40:1660–1673. https://doi.org/10.1097/brs.0000000000001061

    Article  PubMed  Google Scholar 

  22. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P (2011) The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

  23. Lipsey MW, Wilson DB (2001) Practical meta-analysis. Sage publications, Thousand Oaks, CA, p 49

    Google Scholar 

  24. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900. https://doi.org/10.1016/s0140-6736(99)04149-5

    Article  CAS  PubMed  Google Scholar 

  25. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012. https://doi.org/10.1001/jama.283.15.2008

    Article  CAS  PubMed  Google Scholar 

  26. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406. https://doi.org/10.1016/j.jclinepi.2010.07.015

    Article  PubMed  Google Scholar 

  27. Lee SH, Bae JS (2015) Comparison of clinical and radiological outcomes after automated open lumbar discectomy and conventional microdiscectomy: a prospective randomized trial. Int J Clin Exp Med 8:12135–12148

    PubMed  PubMed Central  Google Scholar 

  28. Vodicar M, Kosak R, Gorensek M, Korez R, Vrtovec T, Koder J, Antolic V, Vengust R (2017) Vertebral end-plate perforation for intervertebral disc height preservation after single-level lumbar discectomy: a randomized-controlled trial. Clin Spine Surg 30:E707–E712. https://doi.org/10.1097/BSD.0000000000000305

    Article  PubMed  Google Scholar 

  29. Saruhashi Y, Mori K, Katsuura A, Takahashi S, Matsusue Y, Hukuda S (2004) Evaluation of standard nucleotomy for lumbar disc herniation using the love method: results of follow-up studies after more than 10 years. Eur Spine J 13:626–630. https://doi.org/10.1007/s00586-004-0690-8

    Article  PubMed  PubMed Central  Google Scholar 

  30. Parker SL, Grahovac G, Vukas D, Vilendecic M, Ledic D, McGirt MJ, Carragee EJ (2013) Effect of an annular closure device (barricaid) on same level recurrent disc herniation and disc height loss after primary lumbar discectomy: 2-year results of a multi-center prospective cohort study. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e3182956ec5

    Article  PubMed  Google Scholar 

  31. Son S, Lee SG, Kim WK, Ahn Y (2018) Advantages of a microsurgical translaminar approach (keyhole laminotomy) for upper lumbar disc herniation. World Neurosurg 119:e16–e22. https://doi.org/10.1016/j.wneu.2018.06.004

    Article  PubMed  Google Scholar 

  32. McGirt MJ, Eustacchio S, Varga P, Vilendecic M, Trummer M, Gorensek M, Ledic D, Carragee EJ (2009) A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine 34:2044–2051. https://doi.org/10.1097/BRS.0b013e3181b34a9a

    Article  PubMed  Google Scholar 

  33. Lee DY, Shim CS, Ahn Y, Choi YG, Kim HJ, Lee SH (2009) Comparison of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for recurrent disc herniation. J Korean Neurosurg Soc 46:515–521. https://doi.org/10.3340/jkns.2009.46.6.515

    Article  PubMed  PubMed Central  Google Scholar 

  34. Eun SS, Lee SH, Sabal LA (2016) Long-term follow-up results of percutaneous endoscopic lumbar discectomy. Pain Phys 19:E1161–E1166

    Google Scholar 

  35. Choi KC, Kim JS, Park CK (2016) Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation. Pain Phys 19:E291–E300

    Article  Google Scholar 

  36. Qiao P, Xu T, Zhang W, Fang Z, Ding W, Tian R (2020) Foraminoplasty affects the clinical outcomes of discectomy during percutaneous transforaminal endoscopy: a 2-year follow-up retrospective study on 64 patients. Int J Neurosci. https://doi.org/10.1080/00207454.2020.1732968

    Article  PubMed  Google Scholar 

  37. Tsuji H, Hirano N, Ohshima H, Matsui H, Ishihara H, Imada K (1992) Extraperitoneal anterolateral discectomy for lumbar disc herniation: indications, techniques, and time-related clinical results. J Spinal Disord 5:424–432

    Article  CAS  PubMed  Google Scholar 

  38. Ishihara H, Matsui H, Hirano N, Tsuji H (1997) Lumbar intervertebral disc herniation in children less than 16 years of age. Long-term follow-up study of surgically managed cases. Spine 22:2044–2049

    Article  CAS  PubMed  Google Scholar 

  39. Sayyahmelli S, Lotfinia I, Miabi Z (2012) Magnetic resonance image findings in the early period after lumbar discectomy with satisfactory results. Neurosurg Q 22:113–118. https://doi.org/10.1097/WNQ.0b013e318246368a

    Article  Google Scholar 

  40. Son IN, Kim YH, Ha KY (2015) Long-term clinical outcomes and radiological findings and their correlation with each other after standard open discectomy for lumbar disc herniation. J Neurosurg Spine 22:179–184. https://doi.org/10.3171/2014.10.SPINE131126

    Article  PubMed  Google Scholar 

  41. Luo K, Cai K, Jiang G, Lu B, Yue B, Lu J, Zhang K (2020) Needle-guided suture technique for lumbar annular fiber closure in microendoscopic discectomy: a technical note and case series. Med Sci Monit 26:e918619–e918611. https://doi.org/10.12659/MSM.918619

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sharma SB, Lin GX, Jabri H, Sidappa ND, Song MS, Choi KC, Kim JS (2019) Radiographic and clinical outcomes of huge lumbar disc herniations treated by transforaminal endoscopic discectomy. Clin Neurol Neurosurg 185:105485. https://doi.org/10.1016/j.clineuro.2019.105485

    Article  PubMed  Google Scholar 

  43. Mahatthanatrakul A, Kotheeranurak V, Lin GX, Hur JW, Chung HJ, Kim JS (2019) Comparative analysis of the intervertebral disc signal and annulus changes between immediate and 1-year postoperative MRI after transforaminal endoscopic lumbar discectomy and annuloplasty. Neuroradiology 61:411–419. https://doi.org/10.1007/s00234-019-02174-4

    Article  PubMed  Google Scholar 

  44. Parker SL, Grahovac G, Vukas D, Vilendecic M, Ledic D, McGirt MJ, Carragee EJ (2016) Effect of an annular closure device (barricaid) on same-level recurrent disk herniation and disk height loss after primary lumbar discectomy: 2-year results of a multicenter prospective cohort study. Clin Spine Surg 29:454–460

    Article  PubMed  Google Scholar 

  45. Lequin MB, Barth M, Thome C, Bouma GJ (2012) Primary limited lumbar discectomy with an annulus closure device: 1-year clinical and radiographic results from a prospective, multi-center study. Korean J Spine 9:340–347. https://doi.org/10.14245/kjs.2012.9.4.340

    Article  PubMed  PubMed Central  Google Scholar 

  46. Strömqvist F, Strömqvist B, Jönsson B, Gerdhem P, Karlsson MK (2015) Outcomes of surgical treatment of lumbar disk herniation using an annular closure device. Bone Jt J 97-B:1675–1682. https://doi.org/10.1302/0301-620X.97B12.36258

    Article  Google Scholar 

  47. Smith LJ, Nerurkar NL, Choi KS, Harfe BD, Elliott DM (2011) Degeneration and regeneration of the intervertebral disc: lessons from development. Dis Model Mech 4:31–41. https://doi.org/10.1242/dmm.006403

    Article  CAS  PubMed  Google Scholar 

  48. Frobin W, Brinckmann P, Kramer M, Hartwig E (2001) Height of lumbar discs measured from radiographs compared with degeneration and height classified from MR images. Eur Radiol 11:263–269. https://doi.org/10.1007/s003300000556

    Article  CAS  PubMed  Google Scholar 

  49. Bostelmann R, Steiger HJ, Cornelius JF (2017) Effect of annular defects on intradiscal pressures in the lumbar spine: an in vitro biomechanical study of diskectomy and annular repair. J Neurol Surg A Cent Eur Neurosurg 78:46–52. https://doi.org/10.1055/s-0035-1570344

    Article  PubMed  Google Scholar 

  50. Brinckmann P, Grootenboer H (1991) Change of disc height, radial disc bulge, and intradiscal pressure from discectomy. An in vitro investigation on human lumbar discs. Spine Phila Pa 1976 16:641–646. https://doi.org/10.1097/00007632-199106000-00008

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Vivek A.S. Ramakrishna (PhD Candidate, Spine Labs in St. George & Sutherland Clinical School and School of Mechanical and Manufacturing Engineering, University of New South Wales (UNSW)) for drawing the Figure 2 in this manuscript.

Funding

This work was supported by a Research Training Program scholarship and a University Postgraduate Award from the Australian Government and the UNSW to XLC; an unrestricted education and research donation form Nuvasive Australia to UNSW Spine Labs; fellowship training support from Globus Medical to JVC.

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Authors and Affiliations

  1. Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Sydney, NSW, 2217, Australia

    Xiaolong Chen & Ashish D. Diwan

  2. Spinal Surgical Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA

    Harvinder S. Sandhu

  3. Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, 2217, Australia

    Jose Vargas Castillo & Ashish D. Diwan

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  1. Xiaolong Chen
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Correspondence to Ashish D. Diwan.

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All authors declare that they have no conflict of interest related to this work. ADD is a Nuvasive Consultant and receives possible royalties related to device for replacing nucleus and regenerating nucleus.

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Chen, X., Sandhu, H.S., Vargas Castillo, J. et al. The association between pain scores and disc height change following discectomy surgery in lumbar disc herniation patients: a systematic review and meta-analysis. Eur Spine J 30, 3265–3277 (2021). https://doi.org/10.1007/s00586-021-06891-4

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