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Santos A, Silva MF, Dos Santos EH, Tassiana Silva C, Obara K, Bonilha Oda S, Carrasco AC, Cardoso JR. Gait analysis of individuals with specific low back pain undergoing surgery: case series report with one and six-month follow-up. Physiother Theory Pract 2024; 40:1635-1645. [PMID: 36892481 DOI: 10.1080/09593985.2023.2187267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION In addition to pain, specific low back pain is frequently accompanied by restricted range of motion (ROM) during gait. PURPOSE To compare the behavior of kinematic and spatiotemporal gait parameters, pain, functional status, and self-efficacy, in patients with a diagnosis of herniated disk or lumbar stenosis undergoing surgery, in the pre- and postoperative periods of 1 and 6 months (PO6). METHODS Seven participants and 11 control subjects were assessed. A kinematics system comprising 10 optoelectronic cameras was used to assess gait. The Roland-Morris questionnaire, pain intensity, and self-efficacy, over three periods, were used. RESULTS The ROM of the pelvis, hip, and knee of the hernia group presented an increase after surgery and the stenosis group presented a reduction of values in the hip. During the stance phase, the pelvis and hip ROM of both groups remained smaller than the control group. There was improvement in pain in individuals with hernia and stenosis (effect size = 0.6 and 0.8, respectively) in the three analyzed moments; for functional status there was improvement in the first postoperative period (ES = 0.4) compared to the preoperative in those individuals with hernia; and those with stenosis had improvement at PO6 when compared to the time before the surgery (ES = 0.2). CONCLUSION Surgical intervention modifies the spatiotemporal parameters, the ROM of the pelvis, hip, and knee in the total gait cycle, primarily in the sagittal plane, and causes alterations, particularly in the hip joint, in these individuals during the support phase.
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Affiliation(s)
- Amanda Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Mariana Felipe Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Eduarda Hirle Dos Santos
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Carla Tassiana Silva
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Karen Obara
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Shigueo Bonilha Oda
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Aline Cristina Carrasco
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
- PT Department, Universidade Estadual do Centro-Oeste, Guarapuava, PR, Brazil
| | - Jefferson Rosa Cardoso
- Laboratory of Biomechanics and Clinical Epidemiology, PAIFIT Research Group, Universidade Estadual de Londrina, Londrina, PR, Brazil
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Shi L, Ji X, Tian F, Shi Y, Lou P. Risk factor of residual leg numbness after lumbar microdiscectomy for lumbar disc herniation. Medicine (Baltimore) 2023; 102:e35733. [PMID: 37904414 PMCID: PMC10615446 DOI: 10.1097/md.0000000000035733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Although patients with lumbar disc herniation (LDH) can achieve significant relief from lower back and leg pain after lumbar microdiscectomy, a few patients complain of discomfort due to residual leg numbness (RLN). This study aimed to identify potential risk factors for RLN after lumbar microdiscectomy. We prospectively collected and analyzed patients with LDH who underwent microdiscectomy between September 2016 and December 2020. All included patients had preoperative LN symptoms. Patients with RLN were defined as those with LN at the last follow-up. The relationships between RLN and sex, age, body mass index (BMI), current smoking status, diabetes mellitus, revision surgery, preoperative LN Numeric Rating Scale (NRS) score, duration of preoperative LN, RLN at discharge, sagittal range of motion (SROM), Modic change, disc Pfirrmann grade were analyzed. The RLN was observed in 33.5% (112/334) of patients at the last follow-up. No significant differences were observed in age, sex, BMI, current smoking status, or diabetes between the RLN and non-RLN groups. The preoperative LN NRS score, preoperative LN duration, rate of RLN at discharge, and revision surgery were significantly higher in the RLN group than those in the non-RLN group. Multivariate logistic regression analysis identified the preoperative LN NRS score, duration of preoperative LN, RLN at discharge, revision surgery, and SROM as risk factors for RLN in the long-term follow-up. Patients with higher preoperative LN NRS scores and SROM, longer preoperative LN duration, RLN at discharge, and revision surgery were more likely to experience RNL after lumbar microdiscectomy.
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Affiliation(s)
- Liang Shi
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Xianqun Ji
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Fangtao Tian
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Yihua Shi
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Pan Lou
- Department of Spine Surgery, Jingmen Central Hospital (Formerly The First People’s Hospital of Jingmen), Hubei province, China
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Koivunen K, Pernaa KI, Saltychev M. Back pain and radicular pain after lumbar microdiscectomy. BMC Surg 2023; 23:210. [PMID: 37496020 PMCID: PMC10369687 DOI: 10.1186/s12893-023-02114-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023] Open
Abstract
PURPOSE It is generally expected that lumbar microdiscectomy affects radicular leg pain, but not so much local back pain. The primary objective was to evaluate if the trajectories of changes in pain severity follow similar patterns for back and radicular leg pain after lumbar microdiscectomy. The secondary objective was to investigate the associations between some preoperative parameters and the patterns of these trajectories. METHODS Register-based retrospective study of 353 patients undergoing microdiscectomy in the lumbar spine. Linear mixed modelling was applied. RESULTS The average age of the participants was 46 years and 44% were women. The developmental trajectories were similar for both back and leg pain. Pain level decrease during the first year after the surgery, slightly worsening later. No statistically significant interactions were detected of preoperative pain duration or severity, sex or age on the shapes of the trajectories. For every analyzed grouping factor, the 95% confidence intervals overlapped at every postoperative time point with one exception - worse preoperative back pain was statistically significantly associated with worse pain at three months and at the end of the two-year follow-up. CONCLUSION After microsurgical discectomy, developmental curves for both back and radicular leg pain demonstrated similar patterns. Pain intensity decreased during the first year after the surgery. and slightly increased after that remaining, however, below the preoperative level. Age, sex, preoperative pain duration or preoperative intensity of leg pain were not associated with significant differences in the trajectories of pain severity after the surgery. In this study, severe preoperative back pain was the only factor, which was significantly associated with worse postoperative trajectory of pain intensity.
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Affiliation(s)
| | - Katri I Pernaa
- Department of Orthopedics, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, PO Box 528, Turku, FI-20701, Finland.
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Rehman Y, Bala M, Rehman N, Agarwal A, Koperny M, Crandon H, Abdullah R, Hull A, Makhdami N, Grodecki S, Wrzosek A, Lesniak W, Evaniew N, Ashoorion V, Wang L, Couban R, Drew B, Busse JW. Predictors of Recovery Following Lumbar Microdiscectomy for Sciatica: A Systematic Review and Meta-Analysis of Observational Studies. Cureus 2023; 15:e39664. [PMID: 37388594 PMCID: PMC10307033 DOI: 10.7759/cureus.39664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Chronic post-surgical pain is reported by up to 40% of patients after lumbar microdiscectomy for sciatica, a complaint associated with disability and loss of productivity. We conducted a systematic review of observational studies to explore factors associated with persistent leg pain and impairments after microdiscectomy for sciatica. We searched eligible studies in MEDLINE, Embase, and CINAHL that explored, in an adjusted model, predictors of persistent leg pain, physical impairment, or failure to return to work after microdiscectomy for sciatica. When possible, we pooled estimates of association using random-effects models using the Grading of Recommendations Assessment, Development, and Evaluation approach. Moderate-certainty evidence showed that the female sex probably has a small association with persistent post-surgical leg pain (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 0.63 to 2.08; absolute risk increase (ARI) = 1.8%, 95% CI = -4.7% to 11.3%), large association with failure to return to work (OR = 2.79, 95% CI = 1.27 to 6.17; ARI = 10.6%, 95% CI = 1.8% to 25.2%), and older age is probably associated with greater postoperative disability (β = 1.47 points on the 100-point Oswestry Disability Index for every 10-year increase from age (>/=18 years), 95% CI = -4.14 to 7.28). Among factors that were not possible to pool, two factors showed promise for future study, namely, legal representation and preoperative opioid use, which showed large associations with worse outcomes after surgery. The moderate-certainty evidence showed female sex is probably associated with persistent leg pain and failure to return to work and that older age is probably associated with greater post-surgical impairment after a microdiscectomy. Future research should explore the association between legal representation and preoperative opioid use with persistent pain and impairment after microdiscectomy for sciatica.
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Affiliation(s)
- Yasir Rehman
- Health Research Methodology, McMaster University, Hamilton, CAN
| | - Malgorzata Bala
- Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Nadia Rehman
- Health Research Methods, Impact and Evidence, McMaster University, Hamilton, CAN
| | | | - Magdalena Koperny
- Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Holly Crandon
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, CAN
| | - Ream Abdullah
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, CAN
| | - Alexandra Hull
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, CAN
| | | | | | - Anna Wrzosek
- Interdisciplinary Intensive Care, Jagiellonian University, Krakow, POL
| | | | | | - Vahid Ashoorion
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, CAN
| | - Li Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, CAN
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, CAN
| | - Brian Drew
- Neurosurgery, McMaster University, Hamilton, CAN
| | - Jason W Busse
- Health Research Methodology, McMaster University, Hamilton, CAN
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Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:408-413. [PMID: 34704128 DOI: 10.1007/s00586-021-07033-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/09/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Most patients with lumbar disc herniations requiring surgery have concomitant back pain. The purpose of the current study was to evaluate the outcome of surgery for lumbar disc herniations in patients with no preoperative back pain (NBP) compared to those reporting low back pain (LBP). METHODS 15,418 patients surgically treated due to LDH with primary discectomy from 1998 until 2020 were included in the study. Self-reported low back pain assessed with a numerical rating scale (NRS) was used to dichotomize the patients in two groups, patients without preoperative back pain (NBP, NRS = 0, n = 1333, 9%) and patients with preoperative low back pain (LBP, NRS > 0, n = 14,085, 91%). Patient reported outcome measures (PROMs) collected preoperatively and one-year postoperatively were used to evaluate differences in outcomes between the groups. RESULTS At the one-year follow-up, 89% of the patients in the NBP group were completely pain free or much better compared with 76% in the LBP group. Significant improvement regarding leg pain was seen in all measured PROMs in both groups oneyear after surgery. In the NBP group, 13% reported clinically significant back pain (NRS difference greater than Minimally Clinical Important Difference (MICD)) at the one-year follow-up. CONCLUSIONS Patients without preoperative back pain are good candidates for LDH surgery. 13% of patients without preoperative back pain develop clinically significant back pain one-year after surgery.
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