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The Journal of Bone and Joint Surgery (American) 86:893-896 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Low-Back Pain Following Surgery for Lumbar Disc Herniation

A Prospective Study

Tomoaki Toyone, MD1, Tadashi Tanaka, MD1, Daisuke Kato, MD1 and Ryutaku Kaneyama, MD1

1 Division of Orthopaedic Surgery, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu-city, Chiba 292-8535, Japan. E-mail address for T. Toyone: tomotomot2001{at}aol.com

Investigation performed at the Division of Orthopaedic Surgery, Kimitsu Chuo Hospital, Kisarazu-city, Chiba, Japan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Lumbar disc herniation often causes sciatica. Although surgery may provide relief of sciatic pain, it is uncertain how surgery affects the relief of low-back pain. The purpose of the present prospective study was to assess the efficacy of discectomy in the treatment of low-back pain associated with lumbar disc herniation.

Methods: Between 1998 and 2001, forty consecutive patients with single-level, unilateral lumbar disc herniation were treated surgically. The first twenty patients (Group 1) underwent standard discectomy, and the second twenty (Group 2) underwent microendoscopic discectomy. Curettage of the disc space was not performed. All forty patients were prospectively followed, and clinical outcomes were evaluated with use of a questionnaire. The mean duration of follow-up was forty months.

Results: All forty patients were satisfied with the outcome. Leg pain decreased rapidly (within one month) in all patients and continued to decrease at the time of the latest follow-up. There was no significant difference between the two groups in terms of leg pain, with the numbers available (p = 0.39). A significant decrease in the mean low-back pain score was noted at the time of the latest follow-up (p = 0.0007).

Conclusions: Excision of a herniated disc for relief of sciatica provided rapid relief of sciatica and low-back pain. The findings of the present small study suggest that lumbar disc herniation might be a possible cause of low-back pain.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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