Patient-reported outcomes post-discectomy for lumbar disc herniation at hospitals in Eldoret Town, Kenya

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.