Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy
Hui Wang,1,* Xiaonan Zhou,2,* Xingyu Li,1,* Zeng Xu,1,* Qingbing Meng,3 Jianxi Wang,1 Xiaolong Shen,1 Huajiang Chen,1 Wen Yuan,1 Xiaodong Wu1 1Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 2Dep...
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2023-10-01
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| Series: | Journal of Pain Research |
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| Online Access: | https://www.dovepress.com/risk-factors-for-short-term-and-long-term-low-back-pain-after-transfor-peer-reviewed-fulltext-article-JPR |
| _version_ | 1797653481059778560 |
|---|---|
| author | Wang H Zhou X Li X Xu Z Meng Q Wang J Shen X Chen H Yuan W Wu X |
| author_facet | Wang H Zhou X Li X Xu Z Meng Q Wang J Shen X Chen H Yuan W Wu X |
| author_sort | Wang H |
| collection | DOAJ |
| description | Hui Wang,1,* Xiaonan Zhou,2,* Xingyu Li,1,* Zeng Xu,1,* Qingbing Meng,3 Jianxi Wang,1 Xiaolong Shen,1 Huajiang Chen,1 Wen Yuan,1 Xiaodong Wu1 1Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 2Department of Anesthesiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 3Department of Orthopedics, Shanghai Zhongshan Hospital, Fudan University Shanghai School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huajiang Chen; Xiaodong Wu, Email chenhuajspine@163.com; wuxiaodongspine@163.comIntroduction: Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15– 25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain.Methods: A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain.Results: Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain.Discussion: This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.Keywords: spine, endoscopy, radiology, minimally invasive surgical procedure, postoperative low back pain |
| first_indexed | 2024-03-11T16:45:12Z |
| format | Article |
| id | doaj.art-50c240b79f3141dd9cd2d7ccfbb31084 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-03-11T16:45:12Z |
| publishDate | 2023-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-50c240b79f3141dd9cd2d7ccfbb310842023-10-22T19:32:43ZengDove Medical PressJournal of Pain Research1178-70902023-10-01Volume 163505351787523Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar DiscectomyWang HZhou XLi XXu ZMeng QWang JShen XChen HYuan WWu XHui Wang,1,* Xiaonan Zhou,2,* Xingyu Li,1,* Zeng Xu,1,* Qingbing Meng,3 Jianxi Wang,1 Xiaolong Shen,1 Huajiang Chen,1 Wen Yuan,1 Xiaodong Wu1 1Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 2Department of Anesthesiology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People’s Republic of China; 3Department of Orthopedics, Shanghai Zhongshan Hospital, Fudan University Shanghai School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huajiang Chen; Xiaodong Wu, Email chenhuajspine@163.com; wuxiaodongspine@163.comIntroduction: Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15– 25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain.Methods: A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain.Results: Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain.Discussion: This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.Keywords: spine, endoscopy, radiology, minimally invasive surgical procedure, postoperative low back painhttps://www.dovepress.com/risk-factors-for-short-term-and-long-term-low-back-pain-after-transfor-peer-reviewed-fulltext-article-JPRspineendoscopyradiologyminimally invasive surgical procedurepostoperative low back pain |
| spellingShingle | Wang H Zhou X Li X Xu Z Meng Q Wang J Shen X Chen H Yuan W Wu X Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy Journal of Pain Research spine endoscopy radiology minimally invasive surgical procedure postoperative low back pain |
| title | Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy |
| title_full | Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy |
| title_fullStr | Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy |
| title_full_unstemmed | Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy |
| title_short | Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy |
| title_sort | risk factors for short term and long term low back pain after transforaminal endoscopic lumbar discectomy |
| topic | spine endoscopy radiology minimally invasive surgical procedure postoperative low back pain |
| url | https://www.dovepress.com/risk-factors-for-short-term-and-long-term-low-back-pain-after-transfor-peer-reviewed-fulltext-article-JPR |
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