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Koh, Kim, Kim, Wang, Bae, and Chang: Clinical and Radiologic Factors Predicting the Low Back Pain after Discectomy
Original Article

Journal of Korean Spine Surg 2002;9(3):178-183.

Published online: 21 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.3.178

Clinical and Radiologic Factors Predicting the Low Back Pain after Discectomy

Young-Do Koh, M.D., Dong-Jun Kim, M.D., Jong-Oh Kim, M.D., Jin-Man Wang, M.D., Su-Young Bae, M.D.∗, Sang-Yeol Chang, M.D.

Department of Orthopaedic Surgery, College of Medicine, Ewha Womams University, Seoul, Korea

∗Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea

Address reprint requests to Young-Do Koh, M.D. Department of Orthopaedic Surgery, College of Medicine, Ewha womans University #911-1 Mok-dong, Yangcheon-gu, Seoul 158-050, Korea Tel : 82-2-650-5564, Fax : 82-2-644-0128, E-mail : ydkoh@mm.ewha.ac.kr

Copyright © 2002 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study design

Retrospective analysis to evaluate predictive factors of low back pain after discectomy in lumbar disc herniation.

Objective

We analysed clinical and radiological predictive factors which possibly contribute to postoperative low back pain in herniated lumbar disc disease.

Summary of literature review

There was no statistically significant factors which contribute to postoperative low back pain.

Materials and Methods

Ninety two patients with herniated lumbar disc who were treated by one level simple discectomy from June 1995 to June 2000 were included in this study. They were divided into two groups by severity of postoperative low back pain, back pain group and no back pain group. We analyzed clinical and radiological factors retrospectively in each group by medical records, preoperative radiographs and telephone interview. Then statistical analysis was performed with Chi- square test and logistic regression analysis. Confidence interval was 95%.

Results

Eighteen patients (19.6%) were in back pain group and seventy four patients (80.4%) were in no back pain group. A mong patients over 50 years old and below 50 years old, the ratio of low back pain after discectomy was 33% and 13.8% respectively (Odds ratio=3.1, confidence interval 1.07~9.03). It was proved statistically that except age factor, such factors as follows did not affect postoperative lower back pain. Sex, smoking, preceeding low back pain before discectomy, level of discectomy, disc space narrowing, bony spur, grade of disc degeneration, presence of high intensity zone of disc.

Conclusions

There was no other significant predictive factors of post- discectomy low back pain than the age over 50 years old.

Keywords: Lumbar spine, Herniated disc disease, Discectomy, Low back pain, Predictive factor

REFERENCES

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Figures and Tables%

Fig. 1.
age distribution characteristics in each group
jkss-9-178f1.tif
Table 1.
Sociodemographic characteristics associated with increased risk of postoperative back pain
Risk factors number of subjects number of postoperative back pain (percents) Odds ratio 95% confidence interval∗
Age
< 50 yrs old 65 09 (13.8) 1.00†
> 50 yrs old 27 09 (33.3) 3.11† 1.07~9.03
Sex
Male 56 14 (25.0) 1.00†
Female 36 04 (11.1) 0.38† 0.11~9.03
Smoking
Nonsmoking 47 08 (17.0) 1.00†
Smoking 45 10 (22.2) 1.40† 0.49~3.92

∗ confidence interval was calculated by logistic regression analysis method.

† Statistically meaningful factor

Table 2.
Preoperative low back pain (LBP) associated with increased risk of postoperative back pain
LBP‡ Number of subjects Number of postoperative back pain (percents) Odds ratio 95% confidence interval∗
Preoperative LBP
None 9 03 (33.3) 1.00
Mild§ 45 06 (13.3) 0.31 0.06~1.57
Moderate|| 17 05 (29.4) 0.80 0.14~4.72
Severe 21 04 (19.0) 0.47 0.08~2.74
LBP previous to RP∗∗
No definite LBP 39 06 (15.4) 1.00
definite LBP 41 12 (22.6) 1.61 0.54~4.74

∗ confidence interval was calculated by logistic regression analysis method.

‡ LBP: lower back pain

§ mild: lower back pain milder than radiating pain

|| moderate: lower back pain with severity similar to radiating pain

severe: lower back pain more severe than radiating pain

Table 3.
Radiologic characteristics associated with increased risk of postoperative back pain
Radiologic findings Number of subjects Number of postoperative back pain (percents) Odds ratio 95% confidence interval∗
Disc space narrowing (discectomy level)
No 41‡‡ 09 (21.9) 1.00
Yes 53‡‡ 09 (17.0) 0.76 0.27~2.13
Disc space narrowing (other level)
No 79‡‡ 17 (21.5) 1.00
Yes 13‡‡ 1 (7.7) 0.30 0.03~2.50
Bony spur (discectomy level)
No 56‡‡ 08 (14.3) 1.00
Yes 36‡‡ 10 (27.7) 2.30 0.81~6.56
Bony spur (other level)
No 58‡‡ 09 (15.5) 1.00
Yes 34‡‡ 09 (26.5) 1.96 0.69~5.55
HIZ‡‡
No 74‡‡ 12 (16.2) 1.00
Yes 11‡‡ 04 (36.4) 2.76 0.69~10.94

∗ confidence interval was calculated by logistic regression analysis method.

†† HIZ : finding of high intensity zone on MRI

‡‡ 11 cases were excluded (9 cases from no back pain group and 2 from back pain group) because they have no MRI.

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