Abstract:
Background: Lumbar disc herniation can be managed operatively by
discectomy, which significantly reduces the pain in these patients. The outcomes of
these surgeries have been measured using physician based scores but it is important to
understand patients‟ own perspective using a patient-reported outcome score thus
enabling physicians to better manage patient expectations.
Objective: To describe patient-reported outcome scores following discectomy for
lumbar disc herniation using the Oswetry disability index (ODI) and Visual analogue
scale (VAS) tools at hospitals in Eldoret town.
Methods: A descriptive prospective study was carried out on patients treated at
Moi Teaching and Referral hospital, Reale Hospital and St. Luke Orthopedic Hospital
in Eldoret town for lumbar disc herniation with discectomy. Fifty-eight patients were
recruited in the study. Data was collected between January 2016 and March 2017
using patient administered questionnaire. A baseline ODI and VAS scores were taken
pre-operatively and then at 6 and 12 weeks post operatively, and then compared with
the score at first contact. At 12 weeks, patients were to state if they were satisfied or
not with their outcome. Data was analyzed using STATA version 13 at 95%
confidence level.
Results: The mean age of 42 ±8.6 years with a range of 18-58 years. There were
30 males and 28 females. Up to 86.2% of the herniation were classified as
posterolateral herniation by site while the extruded type was diagnosed in 48.3% of
the patients. The most common level of surgery was L4/L5 disc (25.9%) for single
level while for two level surgery was L4/L5 and L5/S1 discs (44.8%). The baseline
mean ODI score was 69.2(±11.1) while at 6 and 12 weeks it was at 39.4(±13.1) and
23.9(±10.4) respectively. The change in mean ODI (-45.1) at 12 weeks was
statistically significant (p <0.001). The baseline mean VAS score for back and leg
pain were 7.3(±1.5) and 5.3(±2.1) respectively. At 6 weeks, the VAS score for back
and leg pain was 3.8(±1.3) and 2.6(±1.7), while at 12 weeks it was 2.3 (±1.1) and
1.3(±1.1) respectively. The change in back pain and leg pain mean at 12 weeks of -
59.7 and -41.8 respectively was significant (p <0.001). There was no association
between age, gender, type of herniation and surgery level to the change in ODI score
or VAS scores for back and leg. Eighty-six percent of patients were satisfied with the
outcome of their surgery despite residual pain.
Conclusion: There was significant change (reduction) in the ODI score and the
VAS score for back and leg pains after discectomy for patients with lumbar disc
herniation.
Recommendation: Discectomy should be encouraged as it is effective in
reduction of pain in patients despite residual pain. Further studies with longer duration
of follow up for these patients.