Low Back Pain and Radicular Pain by Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) Score in Radiological Outcome in between Baseline Status to Postoperative Status

Abstract

Background: Recurrent lumbar disc herniation (RLDH) is one of the most common spinal disorders following dise surgery. It is a major disabling condition as it impairs significantly with daily activities. But the management of recurrent lumbar disc herniation remains still controversial. Aim: To evaluate the low back pain and radicular pain by visual analogue scale (VAS) and japanese orthopedic association (JOA) score in radiological outcome in between baseline status to postoperative status.

Methods: This prospective interventional study was conducted in department of Orthopaedic Surgery, BSMMU, Dhaka from October 2017 to September 2019. A total of 22 cases of RLDH having the inclusion criteria were taken as sample after diagnosing clinically, radiologically and with MRI. Outcome of low back pain (LBP) and radicular pain was measured by visual analogue score (VAS) and overall clinical outcome by Japanese Orthopaedic Association (JOA) score. Statistical analysis was done by using statistical package for social science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Level of significance was calculated at confidence interval of 95% and p< 0.05.

Results: Follow up period was at least 06 months. Age of patients ranges from 35-70 years with mean age 51.1±19.7 years; 68.2% were male and 31.8% were female. Heavy workers were 54.5%, light workers 18.2% and house wives 27.3% with L4-L5 level involvement in 54.5% patients and L5-S1 in 45.5% patients. 77.3% subjects had BMI >30 kg/m² and 22.7% had ≤30 kg/m² with mean BMI 31.2±1.5 kg/m².  Pre and postoperative mean VAS score for LBP was 7.86±1.36 and 2.77±1.86 and that for radicular pain was 7.59±1.64 and 1.95 ±1.65 respectively. The pre and post operative mean JOA score was 9.36±2.25 and 24.95±2.06 respectively. 02 patient developed wound infection, 01 with dural tear and neurological deficit and 01 postoperative instability and all were treated accordingly. The outcome was measured following Hirabayashi et al. and graded following Fu et al as excellent in 06(27.2%), good in 14(63.7%) and fair in 02 (9.1%) patients. 20 (90.9%) patients were in the satisfactory group and 2(9.1%) patients were in the unsatisfactory group.

Conclusions: Revision discectomy is effective in patients with recurrent lumbar disc herniation with satisfactory rate up to 90.9%. Fusion with revision discectomy improves the postoperative low back pain, decreases the intraoperative risk of dural tear or neural damage and decreases the postoperative incidence of mechanical instability or re recurrence. In concluded that revision discectomy is an effective procedure with very satisfactory functional results for management of patients with recurrent lumbar disc herniation.