Relationship between herniated intervertebral disc fragment weight and pain in lumbar microdiscectomy patients
PainSci commentary on Mariajoseph 2022: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This study of disc herniations in 122 middle-aged patients took an unusual approach to measuring the size of the herniation: they weighed whatever they cut off! (The usual method is to use pictures taken with an MRI scan.)
Fun fact: the average fragment weight they removed from peoples' spines was just half a gram. (Anatomy is very tightly packed; most things are smaller than you think.) If it seems hard to believe that such a tiny amount of material could be the cause of so much discomfort, the results of this investigation will back you up on that: it didn’t really matter how big it was, because “disc fragment weight no effect on the severity of pain at presentation or after microdiscectomy.”
They looked at other factors as well — canal compromise, herniation classification, and vertebral level — and none of those were linked to symptom severity either.
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
OBJECTIVE: The relationship between lumbar disc herniation (LDH) size and the severity of preoperative pain and its impact on postoperative recovery is incompletely understood. This study was conducted to investigate the association between herniated disc fragment weight and pain before and after microdiscectomy.
METHODS: A consecutive series of patients from an ongoing randomised controlled trial (ACTRN12616001360404) were included in this study. Included patients were aged between 18 and 75, had a clinical diagnosis of radiculopathy, and MRI evidence of a concordant single-level lumbar disc herniation. All patients underwent standard microdiscectomy without aggressive discectomy or curettage of the endplates. Disc fragment weight was measured intraoperatively.
RESULTS: A total of *122 patients with a mean age of 49.5 ± 12.8 years*, were included. The median weight of disc fragment was 0.545 g (95% CI 0.364 - 0.654 g). There was no relationship between disc weight and the duration of symptoms (p = 0.409) severity of preoperative leg pain (p = 0.070) or preoperative back pain (p = 0.884). Disc fragment weight was demonstrated to have no correlation with clinically significant postoperative leg pain improvement (p = 0.535) or back pain (p = 0.991). Additional LDH factors, including radiological percentage of canal compromise (p = 0.714), herniation classification (p = 0.462), and vertebral level (p = 0.788) were also shown to have no effect on leg pain outcomes.
CONCLUSIONS: Disc fragment weight had no effect on the severity of pain at presentation or after microdiscectomy. Patients benefit from surgery equally, regardless of the size of LDH.
- “Clinical aspects of sciatica and their relation to the type of lumbar disc herniation,” Reihani-Kermani, Archives of Iranian Medicine, 2005.
- “No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain,” Dunsmuir et al, Bone Joint J, 2022.
- “Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients,” Karppinen et al, Spine (Phila Pa 1976), 2001.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.