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Neurospine > Volume 19(1); 2022 > Article |
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Funding/Support
This study was supported by “Sun YatSen University Clinical Research 5010 Program” (trial number: 2013006).
Author Contribution
ZC, PX, LR; Data curation: ZC, LH, LH, ZL; Formal analysis: ZC, LH, LH, ZL, RC, LZ; Funding acquisition: LR; Methodology: ZC, LH, RC, LZ, PX; Project administration: PX, LR; Visualization: PX, LR; Writing - original draft: ZC, LH, LH, ZL, JD, BL, LR; Writing - review & editing: ZC, LH, JD, BL, PX, LR.
Variable | All patients (n=226) |
Functional improvement (n = 226) |
Relief of back pain |
Relief of leg pain |
|||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Satisfied (n=158) | Dissatisfied (n=68) | p-value | Satisfied (n=202) | Dissatisfied (n=24) | p-value | Satisfied (n=199) | Dissatisfied (n=27) | p-value | |||
ODI score | |||||||||||
Baseline | 45.3 ± 20.1 | 49.6 ± 21.0 | 35.6 ± 13.6 | < 0.001** | 45.6 ± 20.1 | 43.4 ± 20.5 | 0.615 | 46.1 ± 20.0 | 40.1 ± 20.6 | 0.148 | |
At 3 months | 12.3 ± 12.6 | 7.1 ± 6.7 | 24.2 ± 14.8 | < 0.001** | 10.3 ± 10.4 | 28.7 ± 17.1 | < 0.001** | 9.8 ± 9.6 | 30.6 ± 16.1 | < 0.001** | |
SF-36 PF score | |||||||||||
Baseline | 51.7 ± 23.8 | 47.8 ± 24.8 | 60.7 ± 18.5 | < 0.001** | 51.7 ± 23.6 | 51.5 ± 26.3 | 0.967 | 50.6 ± 23.4 | 59.3 ± 25.5 | 0.077* | |
At 3 months | 90.3 ± 12.6 | 93.8 ± 6.4 | 82.1 ± 18.3 | < 0.001** | 92.2 ± 7.7 | 73.8 ± 26.5 | 0.002** | 92.7 ± 6.7 | 72.6 ± 25.7 | < 0.001** | |
SF-36 BP score | |||||||||||
Baseline | 46.5 ± 19.3 | 43.9 ± 20.3 | 52.5 ± 15.3 | 0.002** | 46.0 ± 19.6 | 50.5 ± 16.5 | 0.286 | 45.6 ± 19.5 | 53.1 ± 16.7 | 0.058* | |
At 3 months | 87.1 ± 14.0 | 91.9 ± 8.7 | 75.9 ± 17.4 | < 0.001** | 89.8 ± 10.3 | 63.8 ± 19.0 | < 0.001** | 90.2 ± 9.2 | 64.2 ± 20.8 | < 0.001** | |
EQ-5D score | |||||||||||
Baseline | 0.52 ± 0.23 | 0.48 ± 0.25 | 0.62 ± 0.14 | < 0.001** | 0.52 ± 0.24 | 0.56 ± 0.15 | 0.365 | 0.51 ± 0.23 | 0.58 ± 0.19 | 0.137 | |
At 3 months | 0.90 ± 0.13 | 0.94 ± 0.09 | 0.82 ± 0.18 | < 0.001** | 0.93 ± 0.10 | 0.72 ± 0.22 | < 0.001** | 0.93 ± 0.09 | 0.71 ± 0.22 | < 0.001** | |
VAS-back score | |||||||||||
Baseline | 3.96 ± 2.47 | 3.99 ± 2.55 | 3.90 ± 2.31 | 0.815 | 3.80 ± 2.51 | 5.30 ± 1.60 | < 0.001** | 3.85 ± 2.49 | 4.82 ± 2.24 | 0.056* | |
At 3 months | 0.95 ± 1.29 | 0.66 ± 0.92 | 1.63 ± 1.71 | < 0.001** | 0.60 ± 0.70 | 3.96 ± 1.20 | < 0.001** | 0.68 ± 0.84 | 2.96 ± 2.07 | < 0.001** | |
VAS-leg score | |||||||||||
Baseline | 5.43 ± 2.00 | 5.67 ± 2.03 | 4.86 ± 1.81 | 0.005** | 5.42 ± 2.00 | 5.50 ± 2.04 | 0.856 | 5.46 ± 2.04 | 5.19 ± 1.69 | 0.500 | |
At 3 months | 0.96 ± 1.43 | 0.51 ± 0.83 | 2.02 ± 1.91 | < 0.001** | 0.68 ± 1.04 | 3.29 ± 2.07 | < 0.001** | 0.52 ± 0.70 | 4.19 ± 1.33 | < 0.001** |
Variable |
Functional improvement |
Relief of back pain |
Relief of leg pain |
|||||||
---|---|---|---|---|---|---|---|---|---|---|
Satisfied (n=158) | Dissatisfied (n=68) | p-value | Satisfied (n=202) | Dissatisfied (n=24) | p-value | Satisfied (n=199) | Dissatisfied (n=27) | p-value | ||
Surgery group, PTED:MED | 84:74 | 29:39 | 0.147 | 100:102 | 13:11 | 0.666 | 97:102 | 16:11 | 0.305 | |
Age (yr) | 39.7 ± 11.5 | 43.2 ± 10.7 | 0.035** | 40.4 ± 11.6 | 43.6 ± 19.6 | 0.194 | 40.3 ± 11.3 | 44.0 ± 11.3 | 0.116 | |
Female sex | 62 (39.2) | 29 (42.6) | 0.632 | 80 (39.6) | 11 (45.8) | 0.556 | 79 (39.7) | 12 (44.4) | 0.637 | |
BMI (kg/m2) | 23.2 ± 3.4 | 23.2 ± 3.1 | 0.927 | 23.1 ± 3.1 | 24.2 ± 3.2 | 0.108 | 23.0 ± 3.4 | 24.3 ± 2.9 | 0.064* | |
Symptom duration ≥ 12 months | 33 (20.9) | 22 (32.4) | 0.065* | 45 (22.3) | 10 (41.7) | 0.036** | 45 (22.6) | 10 (37.0) | 0.101 | |
Dominant back pain | 70 (44.3) | 38 (55.9) | 0.110 | 92 (45.5) | 16 (66.7) | 0.050* | 89 (44.7) | 19 (70.4) | 0.012** | |
Heavy labor worker | 28 (17.7) | 18 (26.5) | 0.134 | 42 (20.8) | 4 (16.7) | 0.635 | 39 (19.6) | 7 (25.9) | 0.443 | |
Sedentary lifestyle | 44 (27.8) | 18 (26.5) | 0.831 | 53 (26.2) | 9 (37.5) | 0.242 | 56 (28.1) | 6 (22.2) | 0.518 | |
History of Smoking | 34 (21.5) | 13 (19.1) | 0.683 | 44 (21.8) | 3 (12.5) | 0.426 | 41 (20.6) | 6 (22.2) | 0.846 | |
History of hypertension | 16 (10.1) | 6 (8.8) | 0.762 | 19 (9.4) | 3 (12.5) | 0.713 | 19 (9.5) | 3 (11.1) | 0.733 | |
History of diabetes | 6 (3.8) | 3 (4.4) | 0.829 | 8 (4.0) | 1 (4.2) | 0.961 | 8 (4.0) | 1 (3.7) | 0.937 | |
Positive nerve root tension test | 125 (79.1) | 43 (63.2) | 0.012** | 151 (74.8) | 17 (70.8) | 0.678 | 152 (76.4) | 16 (59.3) | 0.056* | |
Decreased sensation | 64 (40.5) | 22 (32.4) | 0.247 | 81 (40.1) | 5 (20.8) | 0.066* | 83 (41.7) | 3 (11.1) | 0.001** | |
Myotomal weakness | 46 (29.1) | 19 (27.9) | 0.858 | 62 (30.7) | 3 (12.5) | 0.093* | 62 (31.2) | 3 (11.1) | 0.040** | |
Depressed reflex | 49 (31.0) | 21 (30.9) | 0.984 | 61 (30.2) | 9 (37.5) | 0.984 | 63 (31.7) | 7 (25.9) | 0.546 | |
Surgical segment | 0.283 | 0.714 | 0.743 | |||||||
L3/4 or above | 4 (2.5) | 0 (0) | 4 (2.0) | 0 (0) | 4 (2.0) | 0 (0) | ||||
L4/5 | 74 (46.8) | 37 (54.4) | 100 (49.5) | 11 (45.8) | 97 (48.7) | 14 (51.9) | ||||
L5/S1 | 80 (50.6) | 31 (45.6) | 98 (48.5) | 13 (54.2) | 98 (49.2) | 13 (48.1) | ||||
Location of disc herniation | 0.036** | 0.304 | < 0.001** | |||||||
Median | 31 (19.6) | 20 (29.4) | 46 (22.8) | 5 (20.8) | 45 (22.6) | 6 (22.2) | ||||
Paramedian | 117 (74.1) | 39 (57.4) | 141 (69.8) | 15 (62.5) | 143 (71.9) | 13 (48.1) | ||||
Far lateral | 10 (6.3) | 9 (13.2) | 15 (7.4) | 4 (16.7) | 11 (5.5) | 8 (29.6) | ||||
Type of disc herniation | 0.086* | 0.909 | 0.496 | |||||||
Bulge | 21 (13.5) | 15 (22.7) | 33 (16.6) | 3 (13.0) | 31 (15.8) | 5 (19.2) | ||||
Protrusion | 77 (49.4) | 35 (53.0) | 100 (50.3) | 12 (52.2) | 97 (49.5) | 15 (57.7) | ||||
Extrusion | 58 (37.2) | 16 (24.2) | 66 (33.2) | 8 (34.8) | 68 (34.7) | 6 (23.1) | ||||
Disc degeneration (Pfirrman grade ≥ 3) | 115 (85.8) | 45 (83.3) | 0.665 | 146 (85.4) | 14 (82.4) | 0.665 | 146 (86.4) | 14 (73.7) | 0.140 | |
Modic change | 9 (6.7) | 6 (11.1) | 0.314 | 14 (8.2) | 1 (5.9) | 0.314 | 15 (8.9) | 0 (0) | 0.371 | |
LFJOA | 17 (10.9) | 9 (13.6) | 0.562 | 23 (11.6) | 3 (13.0) | 0.834 | 22 (11.2) | 4 (15.4) | 0.519 | |
Proximal ASD | 53 (39.6) | 29 (53.7) | 0.077* | 73 (42.7) | 9 (52.9) | 0.416 | 72 (42.6) | 10 (52.6) | 0.403 | |
Distal ASD | 41 (56.9) | 17 (53.1) | 0.717 | 54 (55.7) | 4 (57.1) | 0.940 | 54 (56.8) | 4 (44.4) | 0.504 | |
Lateral recess stenosis | 1 (0.6) | 5 (7.6) | 0.010** | 5 (2.5) | 1 (4.3) | 0.485 | 5 (2.6) | 1 (3.8) | 0.531 | |
Residue of herniation | 3 (1.9) | 2 (2.9) | 0.638 | 5 (2.5) | 0 (0) | 0.964 | 5 (2.5) | 0 (0) | 0.892 | |
Recurrence of herniation | 4 (2.5) | 7 (7.4) | 0.133 | 7 (3.5) | 2 (8.3) | 0.245 | 7 (3.5) | 2 (7.4) | 0.293 | |
Reoperation | 7 (4.4) | 7 (10.3) | 0.130 | 12 (5.9) | 2 (8.3) | 0.649 | 12 (6.0) | 2 (7.4) | 0.677 |
Variable | All patients (n=222) |
Functional improvement |
Relief of back pain |
|||||
---|---|---|---|---|---|---|---|---|
Satisfied (n=206) | Dissatisfied (n=16) | p-value | Satisfied (n = 213) | Dissatisfied (n = 9) | p-value | |||
ODI score | ||||||||
Baseline | 44.8 ± 19.9 | 45.6 ± 19.8 | 34.4 ± 18.8 | 0.030** | 45.1 ± 19.8 | 34.4 ± 22.5 | 0.329 | |
At 2 years | 3.2 ± 7.4 | 1.5 ± 3.2 | 24.8 ± 11.5 | < 0.001** | 2.2 ± 5.0 | 26.4 ± 14.5 | 0.005** | |
SF-36 PF score | ||||||||
Baseline | 52.1 ± 23.5 | 51.2 ± 23.1 | 64.7 ± 25.1 | 0.026** | 51.7 ± 23.4 | 62.2 ± 24.5 | 0.189 | |
At 2 years | 97.5 ± 5.1 | 98.5 ± 2.7 | 84.4 ± 9.6 | < 0.001** | 98.1 ± 3.7 | 82.8 ± 10.9 | 0.003** | |
SF-36 BP score | ||||||||
Baseline | 46.5 ± 19.0 | 45.7 ± 19.1 | 57.4 ± 14.7 | 0.017** | 46.0 ± 19.1 | 59.6 ± 13.1 | 0.035** | |
At 2 years | 96.0 ± 9.3 | 98.0 ± 5.0 | 70.1 ± 12.7 | < 0.001** | 97.2 ± 7.1 | 68.0 ± 11.8 | < 0.001** | |
EQ-5D score | ||||||||
Baseline | 0.53 ± 0.22 | 0.52 ± 0.23 | 0.63 ± 0.15 | 0.063* | 0.52 ± 0.22 | 0.66 ± 0.13 | 0.070* | |
At 2 years | 0.97 ± 0.07 | 0.99 ± 0.04 | 0.80 ± 0.12 | < 0.001** | 0.98 ± 0.05 | 0.77 ± 0.12 | < 0.001** | |
VAS-back score | ||||||||
Baseline | 3.94 ± 2.42 | 3.96 ± 2.42 | 3.69 ± 2.50 | 0.668 | 3.94 ± 2.42 | 3.89 ± 2.47 | 0.950 | |
At 2 years | 0.37 ± 0.86 | 0.20 ± 0.50 | 2.56 ± 1.41 | < 0.001** | 0.23 ± 0.51 | 3.67 ± 0.87 | < 0.001** | |
VAS-leg score | ||||||||
Baseline | 5.40 ± 1.92 | 5.40 ± 1.96 | 5.38 ± 1.41 | 0.963 | 5.42 ± 1.92 | 4.78 ± 2.12 | 0.326 | |
At 2 years | 0.19 ± 0.56 | 0.09 ± 0.31 | 1.44 ± 1.21 | < 0.001** | 0.15 ± 0.49 | 1.11 ± 1.17 | 0.038** |
Variable |
Functional improvement |
Relief of back pain |
|||||
---|---|---|---|---|---|---|---|
Satisfied (n = 206) | Dissatisfied (n = 16) | p-value | Satisfied (n = 213) | Dissatisfied (n = 9) | p-value | ||
Surgery group, PTED:MED | 105:101 | 6:10 | 0.299 | 107:106 | 4:5 | 0.734 | |
Age (yr) | 40.4 ± 11.5 | 44.3 ± 9.7 | 0.191 | 40.6 ± 11.4 | 41.0 ± 12.5 | 0.926 | |
Female sex | 77 (37.4) | 12 (75.0) | 0.006** | 82 (38.5) | 7 (77.8) | 0.019** | |
BMI (kg/m2) | 23.2 ± 3.3 | 23.6 ± 2.9 | 0.927 | 23.1 ± 3.3 | 25.0 ± 3.7 | 0.106 | |
Symptom duration ≥ 12 months | 48 (23.3) | 5 (31.3) | 0.472 | 49 (23.0) | 4 (44.4) | 0.139 | |
Dominant back pain | 97 (47.1) | 9 (56.3) | 0.480 | 100 (46.9) | 6 (66.7) | 0.246 | |
Heavy labor worker | 35 (17.0) | 5 (31.3) | 0.153 | 38 (17.8) | 2 (22.2) | 0.666 | |
Sedentary lifestyle | 57 (27.7) | 3 (18.8) | 0.567 | 58 (27.2) | 2 (22.2) | 0.740 | |
History of smoking | 47 (22.8) | 1 (6.3) | 0.204 | 47 (22.1) | 1 (11.1) | 0.688 | |
History of hypertension | 18 (8.7) | 1 (6.3) | 0.732 | 18 (8.5) | 1 (11.1) | 0.560 | |
History of diabetes | 8 (3.9) | 1 (6.3) | 0.496 | 9 (4.2) | 0 (0) | 0.529 | |
Positive nerve root tension test | 154 (74.8) | 10 (62.5) | 0.282 | 158 (74.2) | 6 (66.7) | 0.700 | |
Decreased sensation | 79 (38.3) | 5 (31.3) | 0.573 | 82 (38.5) | 2 (22.2) | 0.324 | |
Myotomal weakness | 61 (29.6) | 5 (31.3) | 0.890 | 64 (30.0) | 2 (22.2) | 0.615 | |
Depressed reflex | 66 (32.0) | 4 (25.0) | 0.761 | 69 (32.4) | 1 (11.1) | 0.279 | |
Surgical segment | 0.513 | 0.555 | |||||
L3/4 or above segment | 4 (1.9) | 0 (0) | 4 (1.9) | 0 (0) | |||
L4/5 | 100 (48.5) | 10 (62.5) | 104 (48.8) | 6 (66.7) | |||
L5/S1 | 102 (19.5) | 6 (37.5) | 105 (49.3) | 3 (33.3) | |||
Location of disc herniation | 0.772 | 0.017** | |||||
Median | 48 (23.3) | 4 (25.0) | 51 (23.9) | 1 (11.1) | |||
Paramedian | 142 (68.9) | 10 (62.5) | 147 (69.0) | 5 (55.6) | |||
Far lateral | 16 (8.1) | 2 (12.5) | 15 (7.0) | 3 (33.3) | |||
Type of disc herniation | 0.756 | 0.091* | |||||
Bulge | 33 (16.3) | 3 (18.8) | 36 (17.1) | 0 (0) | |||
Protrusion | 100 (49.5) | 9 (56.3) | 102 (48.6) | 7 (87.5) | |||
Extrusion | 69 (34.2) | 4 (25.0) | 72 (34.3) | 1 (12.5) | |||
Disc degeneration (Pfirrman grade ≥ 3) | 145 (84.8) | 13 (92.9) | 0.697 | 153 (85.5) | 5 (83.3) | 0.884 | |
Modic change | 13 (7.6) | 2 (14.3) | 0.316 | 14 (7.8) | 1 (16.7) | 0.402 | |
LFJOA | 17 (8.4) | 7 (43.8) | < 0.001** | 20 (9.5) | 4 (50.0) | 0.003** | |
Proximal ASD | 73 (42.7) | 7 (50.0) | 0.596 | 75 (41.9) | 5 (83.3) | 0.110 | |
Distal ASD | 54 (58.1) | 5 (55.6) | 0.884 | 57 (58.8) | 2 (40.0) | 0.407 | |
Lateral recess stenosis | 7 (3.5) | 0 (0) | 0.984 | 7 (3.3) | 0 (0) | 1.000 | |
Residue of herniation | 6 (2.9) | 0 (0) | 1.000 | 6 (2.8) | 0 (0) | 1.000 | |
Recurrence of herniation | 8 (3.9) | 1 (6.3) | 0.496 | 9 (4.2) | 0 (0) | 1.000 | |
Reoperation | 14 (6.8) | 1 (6.3) | 1.000 | 15 (7.0) | 0 (0) | 0.883 |
Factor | OR | 95% CI | p-value | |
---|---|---|---|---|
Multivariate modeling for dissatisfied functional improvement | ||||
Age | 1.05 | 1.01–1.09 | 0.026** | |
Symptom duration ≥ 12 months | 1.42 | 0.60–3.39 | 0.425 | |
Absence of positive nerve root tension test | 1.11 | 0.46–2.68 | 0.822 | |
Location of disc herniation (paramedian vs. median & far-lateral) | 1.20 | 0.54–2.70 | 0.652 | |
Type of disc herniation (extrusion vs. bulge & protrusion) | 1.11 | 0.50–2.49 | 0.802 | |
Proximal ASD | 1.57 | 0.72–3.46 | 0.259 | |
Lateral recess stenosis | 15.54 | 1.05–333.33 | 0.046** | |
Preoperative ODI score | 0.96 | 0.93–0.99 | 0.027** | |
Preoperative SF-36 PF score | 1.00 | 0.97–1.03 | 0.925 | |
Preoperative SF-36 BP score | 1.00 | 0.98–1.03 | 0.775 | |
Preoperative EQ-5D score | 10.00 | 0.68–142.85 | 0.093 | |
Preoperative VAS-leg score | 0.97 | 0.76–1.24 | 0.814 | |
Multivariate modeling for dissatisfied relief of back pain | ||||
Symptom duration ≥ 12 months | 2.08 | 0.83–5.21 | 0.117 | |
Dominant back pain | 1.09 | 0.37–3.24 | 0.878 | |
Absence of decreased sensation | 1.97 | 0.67–5.77 | 0.217 | |
Absence of myotomal weakness | 2.57 | 0.71–9.34 | 0.150 | |
Preoperative VAS-back score | 1.25 | 1.00–1.57 | 0.048** | |
Multivariate modeling for dissatisfied relief of leg pain | ||||
BMI | 1.06 | 0.92–1.22 | 0.393 | |
Dominant back pain | 1.36 | 0.43–4.29 | 0.600 | |
Absence of positive nerve root tension test | 2.04 | 0.74–5.63 | 0.168 | |
Absence of decreased sensation | 5.13 | 1.31–20.1 | 0.019** | |
Absence of myotomal weakness | 2.35 | 0.59–9.27 | 0.224 | |
Location of disc herniation (far-lateral vs. median & paramedian) | 6.06 | 1.78–20.6 | 0.004** | |
Preoperative SF-36 PF score | 1.01 | 0.98–1.03 | 0.635 | |
Preoperative SF-36 BP score | 1.02 | 0.99–1.05 | 0.213 | |
Preoperative VAS-back score | 1.21 | 0.93–1.58 | 0.156 |
OR, odds ratio; CI, confidence interval; ASD, adjacent segment degeneration; ODI, Oswestry Disability Index; SF-36 PF; 36-item Short Form Health Survey physical function; SF-36 BP, 36-item Short Form Health Survey bodily pain; EQ-5D, European quality of life-5 dimensions; VAS, visual analogue scale; BMI, body mass index.
Factor | OR | 95% CI | p-value | |
---|---|---|---|---|
Multivariate modeling for dissatisfied functional improvement | ||||
Female sex | 3.41 | 0.97–12.05 | 0.057 | |
LFJOA | 8.13 | 2.05–32.26 | 0.003** | |
Preoperative ODI score | 0.98 | 0.93–1.03 | 0.394 | |
Preoperative SF-36 PF score | 1.01 | 0.97–1.06 | 0.625 | |
Preoperative SF-36 BP score | 1.03 | 0.99–1.06 | 0.171 | |
Preoperative EQ-5D score | 6.06 | 0.08–500.0 | 0.421 | |
Multivariate modeling for dissatisfied relief of back pain | ||||
Female sex | 9.35 | 0.97–90.91 | 0.053 | |
Location of disc herniation (far-lateral vs. median & paramedian) | 3.07 | 0.34–27.58 | 0.316 | |
Type of disc herniation (protrusion vs. bulge & extrusion) | 12.7 | 1.19–136.3 | 0.036** | |
LFJOA | 7.87 | 1.21–52.63 | 0.031** | |
Preoperative SF-36 BP score | 1.02 | 0.96–1.07 | 0.567 | |
Preoperative EQ-5D score | 35.7 | 0.06–1000 | 0.269 |
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