Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.
AuthorsHickey, Oonagh T
Burke, Siun M
Mudrakouski, Alexander L
Hayes, Ivan D
Butler, Mark A
Shorten, George D
AffiliationDepartment of Anaesthesia, Cork University Hospital, Cork City, Ireland. firstname.lastname@example.org
Low Back Pain
MetadataShow full item record
CitationDeterminants of outcome for patients undergoing lumbar discectomy: a pilot study. 2010, 27 (8):696-701 Eur J Anaesthesiol
JournalEuropean journal of anaesthesiology
AbstractOne-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus.
A prospective observational pilot study of patients (n = 39) was performed. Quantitative sensory testing, visual analogue scales for anxiety and pain, the Hospital Anxiety and Depression (HADS) Scale and the McGill Pain Questionnaire were completed, and serum nitric oxide metabolites were measured perioperatively. Excised disc tissue was examined histologically, and immunohistochemistry for phospholipase A2 was performed.
Ten patients (26%) had an unsatisfactory outcome. Those with a satisfactory outcome had greater preoperative pain perception thresholds over the affected dermatome, which decreased by 2 months postoperatively. These patients also demonstrated a decrease in nitric oxide metabolites from preoperatively to 18 h postoperatively. Greater preoperative HADS scores, and greater pain intensity 4 h and 24 h postoperatively were associated with an unsatisfactory outcome.
Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study.
- Multivariate prognostic modeling of persistent pain following lumbar discectomy.
- Authors: Hegarty D, Shorten G
- Issue date: 2012 Sep-Oct
- Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain.
- Authors: Aminmansour B, Khalili HA, Ahmadi J, Nourian M
- Issue date: 2006 Oct 1
- Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery: a randomized double-blinded placebo-controlled trial.
- Authors: Jirarattanaphochai K, Jung S, Thienthong S, Krisanaprakornkit W, Sumananont C
- Issue date: 2007 Mar 15
- Prevention of postoperative pain and of epidural fibrosis after lumbar microdiscectomy: pilot study in a series of forty cases treated with epidural vaseline-sterile-oil-morphine compound.
- Authors: Mastronardi L, Pappagallo M, Tatta C, Roperto R, Elsawaf A, Ferrante L
- Issue date: 2008 Jun 15
- Outcomes and presurgery correlates of lumbar discectomy in Utah Workers' Compensation patients.
- Authors: DeBerard MS, LaCaille RA, Spielmans G, Colledge A, Parlin MA
- Issue date: 2009 Mar