title: Pain Recurrence After Discectomy for Symptomatic Lumbar Disc Herniation.
abstract: METHODS
  Secondary analysis of data from a concurrent randomized trial and cohort study.
  
  
  OBJECTIVE
  The aim of this study was to determine risks and predictors of recurrent pain following standard open discectomy for subacute/chronic symptomatic lumbar disc herniation (SLDH).
  
  
  BACKGROUND
  Most previous studies of recurrence after discectomy do not explicitly define pain resolution and recurrence, and do not account for variable durations of time at risk for recurrence.
  
  
  METHODS
  We used survival analysis methods to examine predictors of leg pain recurrence. For individuals with initial resolution of leg pain, we defined recurrent leg pain as having leg pain, receiving lumbar epidural steroid injections, or undergoing lumbar surgery subsequent to initial leg pain resolution. We calculated cumulative risks of leg pain recurrence using Kaplan-Meier survival curves, and examined predictors of recurrence using Cox proportional hazards models. We used similar methods to examine LBP recurrence.
  
  
  RESULTS
  One- and three-year cumulative risks of leg pain recurrence were 20% and 45%, respectively. One- and three- year leg pain recurrence risks were substantially lower in participants with complete initial resolution of leg pain (17% and 41%, respectively) than in those without (27% and 54%, respectively). In multivariate analyses, complete leg pain resolution (adjusted hazard ratio [aHR] 0.69; 95% confidence interval [CI] 0.52-0.90), smoking (aHR 1.68 [95% CI 1.22-2.33]), and depression (aHR 1.74 [95% CI 1.18-2.56]) predicted leg pain recurrence. The 1- and 3-year risk of LBP recurrence was 29% and 65%, respectively. LBP recurrence risk at 3 years was substantially lower in participants with complete initial resolution of LBP than in those without, but not at 1 year.
  
  
  CONCLUSIONS
  Recurrence of leg pain and LBP is common after discectomy for SLDH. Cumulative risks of both leg pain and LBP recurrence were generally lower in participants achieving complete initial resolution of pain post-discectomy.
  
  
  METHODS
  2.
authors: Seattle Epidemiologic Research and Information Center and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA.|Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors: Pradeep
authors: P
authors: Suri
authors: Department of Orthopaedics, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.
authors: Adam M
authors: AM
authors: Pearson
authors: Department of Orthopaedics, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.
authors: Wenyan
authors: W
authors: Zhao
authors: Department of Medicine, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.|The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.
authors: Jon D
authors: JD
authors: Lurie
authors: Department of Medicine, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.
authors: Emily A
authors: EA
authors: Scherer
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.
authors: Tamara S
authors: TS
authors: Morgan
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, The Dartmouth-Hitchcock Medical Center, Hanover/Lebanon, NH.
authors: James N
authors: JN
authors: Weinstein
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome