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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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Hao J, Cheng J, Xue H, Zhang F. Clinical comparison of unilateral biportal endoscopic discectomy with percutaneous endoscopic lumbar discectomy for single l4/5-level lumbar disk herniation. Pain Pract 2021; 22:191-199. [PMID: 34529888 DOI: 10.1111/papr.13078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/28/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this research was to investigate the outcomes between unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the single L4/5-level lumbar disk herniation (sLDH). METHODS From January 2018 to January 2021, a total of 40 patients with sLDH were retrospectively analyzed in this study. All the patients had received spinal surgeries in Affiliated Hospital of Nantong University and Affiliated Nantong Hospital 3 of Nantong University. Among them, 20 patients were treated with PELD (PELD group), and 20 patients were treated with UBE discectomy (UBE group). Postoperative length of hospital stay, estimated blood loss, operation time, and clinical complications of the patients were compared between the two groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were measured before surgeries and 3 days, 1, and 6 months after surgeries. RESULTS Compared with the UBE group, the PELD group had obviously less intraoperative blood loss, shorter operative time, and shorter hospital stay. The differences in the rate of complications were not statistically significant between the two groups. The VAS score and the ODI score of the two groups had a great reduction after operation. In addition, both the groups had satisfactory clinical outcome; the VAS score and ODI of the PELD group decreased more obviously. CONCLUSION The UBE for sLDH yielded similar clinical outcomes to PELD as minimally invasive surgeries; however, PELD is superior to UBE in terms of intraoperative blood loss, operative time, postoperative hospitalization, and short-term postoperative pain relief. The advantages and disadvantages of the two surgeries should be circumspectly balanced when evaluating a patient for a minimally invasive surgery for sLDH, selecting the most appropriate surgical method for patients.
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Affiliation(s)
- Jie Hao
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China
| | - Jiaqi Cheng
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China.,Medical School of Nantong University, Nantong, China
| | - Huawei Xue
- Department of Orthopedics, Third Affiliated Hospital of Nantong University, Nantong, China
| | - Feng Zhang
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China
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