Clinical outcomes of lumbar diseases specific test in patients who undergo endoscopy-assisted tubular surgery with lumbar herniated nucleus pulposus: an analysis using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ)

Jun Komatsu,Keita Sato,Kazuo Kaneko,Osamu Shirado,Takuya Miura,Tatsuya Endo,Masumi Iwabuchi,Hironari Fukuda,Keigo Kusano

doi:10.1007/s00590-019-02574-5

Abstract

PurposeThis study was to evaluate clinical outcomes using a patient-oriented test that scores health-related quality of life (HRQOL) for patients after minimally invasive surgery using microendoscopic discectomy (MED) for lumbar disc hernia. Few studies regarding MED in terms of disease-specific quality of life measures using Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) have been published.MethodsRetrospective analysis of the surgical and clinical outcomes with regard to reducing pain and improving the functional status for 31 patients who underwent MED for lumbar disc hernia was conducted. These patients were evaluated at 3-year follow-up. The evaluations were based on a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the JOABPEQ, which is an objective, patient-oriented test that assesses HRQOL in patients with lumbar disorders.ResultsA low rate of improvement was seen only in mental health until 1 year, the low rate of improvement in mental health and was independently correlated with body mass index (BMI), pre-operative scores on the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP), and scores on the BS-POP at 12 months post-operatively.ConclusionsAll categories of VAS, JOA scores, and all domains of JOABPEQ were significantly higher over 3 years than those obtained pre-operatively. But only mental health domain showed mild improvement until 1 year. Moreover, BMI showed a negative correlation with improvements in the mental health domain post-operatively. As patients may be mentally exhausted from lumbar disc herniation, pre-operative mental health may be improved by surgical treatment.

Highlights

Reducing muscle damage is important, for the multifidus muscle, which helps maintain partial stability [1]
The purpose of the present study was to evaluate clinical outcomes at more than 3-year follow-up of patients who underwent microendoscopic discectomy (MED) for lumbar disc hernia based on visual analogue scale (VAS) scores, the Japanese Orthopaedic Association (JOA) scoring system [5] (Table 1), and the JOA Back Pain Evaluation Questionnaire (JOABPEQ), which is an objective, patientoriented test that scores health-related quality of life (QOL) (HRQOL) for patients with lumbar disorders [6]
The analysis showed that the low rate of improvement in mental health was independently correlated with age(odds ratio [OR]: 4.17; 95% confidence interval [CI]: 1.71–10.17; P = 0.0017), body mass index (BMI) (OR: 0.58; 95% CI: 0.34–0.987; P = 0.044), pre-operative BS-POP (OR: 2.03; 95%CI: 1.05–3.92; P = 0.034) and BS-POP scores at 12 months post-operatively (OR: 0.49; 95%CI: 0.27–0.84; P = 0.015) (Table 4)

Summary

Introduction

Reducing muscle damage is important, for the multifidus muscle, which helps maintain partial stability [1]. Invasive decompressive surgical techniques such as microendoscopic discectomy (MED), a technique that uses a tubular retractor and spinal endoscopy for patients with lumbar herniated nucleus pulposus through a unilateral paramedian approach, could lead to better and more aggressive treatment, as well as less muscle and local damage, decreased pain, and faster recovery after surgery [2]. As MED utilizes smaller incisions with the aim of reducing pain and blood loss, it reduces the duration of hospitalization compared with conventional open laminectomy procedures. These advantages have been reported in the literature [4], few studies regarding the superiority of MED in terms of disease-specific quality of life (QOL) measures have been published. The purpose of the present study was to evaluate clinical outcomes at more than 3-year follow-up of patients who underwent MED for lumbar disc hernia based on visual analogue scale (VAS) scores, the Japanese Orthopaedic Association (JOA) scoring system (maximum score, 29 points) [5] (Table 1), and the JOA Back Pain Evaluation Questionnaire (JOABPEQ), which is an objective, patientoriented test that scores health-related QOL (HRQOL) for patients with lumbar disorders [6]

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Results

Discussion

Conclusion