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Published on: August 7, 2018
Analysis of Chronic Low Back Pain Caused by Lumbar Microinstability After Percutaneous Endoscopic Transforaminal
Yang Fu1, Ying-Chao Yan1, Xuan-Liang Ru1
1Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Objective:
Chronic low back pain (CLBP) after percutaneous endoscopic transforaminal discectomy (PTED) surgery may be caused by preoperative lumbar microinstability (MI). However, there is a paucity of research on the relationship between lumbar microinstability and chronic low back pain. The purpose of this article is to assess the preoperative radiographic characteristics of patients and evaluate the effects of lumbar microinstability on patient-reported outcomes among single-level lumbar disc herniation (LDH) patients who underwent PTED.
Methods:
This study retrospectively reviewed the radiographic characteristics of a consecutive series of 127 patients with low back pain and leg pain caused by single-level LDH underwent PTED from August 2018 to March 2021. They were divided into three groups according to the radiographic parameters: the stable group (Group S), the dysfunctional group (Group D), and the microinstability group (Group M). The visual analogue scale (VAS) scores for leg and low back pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Logistic regression analysis was used to identify independent risk factors for CLBP.
Results:
Compared with Group D and Group S, Group M had the highest ODI scores (P < 0.01) and VAS scores (low back pain) (P < 0.01) after 1 year, while there were no significant differences in the VAS scores for leg pain at different time points after surgery (P > 0.05). In addition, the logistic regression analysis results regarding CLBP revealed that muscle fatty degeneration on MRI (95% CI, 1.20-8.51, P = 0.02), and facet tropism (95% CI, 1.39 -11.37, P = 0.01) may be independent risk factors.
Conclusion:
Patients with lumbar microinstability may have CLBP after PTED, so patients with lumbar microinstability may need to take internal fixation surgery to solve their symptoms.
Insights
Lumbar microinstability may cause chronic low back pain after percutaneous endoscopic transforaminal discectomy. Patients with microinstability showed worse outcomes, suggesting potential need for internal fixation surgery.
Area of Science:
- Spine surgery
- Orthopedics
- Radiology
Background:
- Chronic low back pain (CLBP) can occur after percutaneous endoscopic transforaminal discectomy (PTED).
- Preoperative lumbar microinstability (MI) is a potential, understudied cause of CLBP post-PTED.
- Understanding MI's impact is crucial for optimizing surgical outcomes in lumbar disc herniation (LDH).
Purpose of the Study:
- To assess preoperative radiographic characteristics in patients undergoing PTED for single-level LDH.
- To evaluate the effect of lumbar microinstability on patient-reported outcomes after PTED.
- To identify risk factors for chronic low back pain following PTED.
Main Methods:
- Retrospective review of 127 patients with single-level LDH who underwent PTED.
- Classification into stable, dysfunctional, and microinstability groups based on radiographic parameters.
- Evaluation of visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores pre- and post-surgery; logistic regression for risk factor identification.
Main Results:
- The microinstability group exhibited significantly higher ODI and low back pain VAS scores at 1 year compared to stable and dysfunctional groups.
- No significant differences in leg pain VAS scores were observed between groups post-surgery.
- Muscle fatty degeneration on MRI and facet tropism were identified as independent risk factors for CLBP.
Conclusions:
- Lumbar microinstability may be associated with chronic low back pain after PTED.
- Patients with MI might benefit from considering internal fixation surgery to address persistent symptoms.
- Radiographic assessment for MI pre-PTED is important for patient selection and outcome prediction.
