The immediate answer is yes. Measuring leg pain intensity in the leg 4-6 weeks after and operation for lumbar disc herniation can help identify patients who are in danger of experiencing clinically relevant physical disability 1 and 2 years after the operation. There is a need for more research of whether patients with moderate/severe leg pain intensity at early postoperative follow-up could benefit from additional or more intensive postoperative interventions, concludes Dorthe Schoeler Ziegler in a paper in Global Spine Journal.
28 % of the 556 patients participating in the study behind the paper reported moderate to severe leg pain defined as ≥30 on a 0-100 scale, 100 identifying maximal pain 4-6 weeks after their lumbar disc herniation operation. A large part of these were smokers, prone to receive social benefits and prone to be suffering from chronic back pain.
Non-surgical treatment of lumbar disc herniation can relieve pain and improve physical function but approximately 14 – 30 % of all patients undergo discectomy because of serious or persistent symptoms such as intractable leg pain. 8 – 21 % of these patients experience a poor outcome in terms of continued pain or disability for 1 – 5 years after their operation.
It is important to identify the patients who are at risk of continued severe disability early in the post-operative course, since it can have serious health related and social consequences for the patient and have high societal costs. Were it possible to identify patients at risk of a bad outcome shortly after an operation, it could optimize the planning of postoperative interventions.
Previous studies have shown that high pain intensity in the leg both before an operation and within 2 months after lumbar discectomy have been related to a patient’s disability and problems with taking care of a job at a later follow-up on the outcome of the operation. Being able to identify a cut-off point in leg pain intensity for when patients are at risk of experiencing consequent disability would give the surgeon a useful tool for the management of an operation.
In order to examine such a cut-off point, Dorthe Schoeler Ziegler and her research colleagues carried out a longitudinal cohort study based on data from DaneSpine, Statistics Denmark and clinical data from the participating patient’s medical journals to see if measuring pain intensity in the leg at a cut-off point before or shortly after a discectomy could help identify patients at risk of a bad outcome in terms of disability 1 and 2 years after the operation. The cut point of 30 on a 0-100 scale was examined. The researchers found no evidence of preoperative leg pain being able to identify outcome at 1 or 2 years, which could be because the group with mild leg pain pre-operation was very small
The participants in the study completed a baseline questionnaire with questions regarding age, sex, self-reported leg and back pain and health related quality of life. Subsequently data was analysed, and the researchers reached their conclusion.
Dorthe Schoeler Ziegler, Rikke Krüger Jensen, Lisbeth Storm, Leah Carreon, Mikkel Østerheden Andersen. The Association Between Early Postoperative Leg Pain Intensity and Disability at 1-Year and 2-Year Follow-Up After First-Time Lumbar Discectomy. Global spine journal 2019. https://doi.org/10.1177/2192568219893296