PURPOSE To conduct a meta-analysis to describe clinical course of pain and disability in adult patients post-lumbar discectomy (PROSPERO: CRD42015020806). METHODS Sensitive topic-based search strategy designed for individual databases was conducted. Patients (> 16 years) following first-time lumbar discectomy for sciatica/radiculopathy with no complications, investigated in inception (point of surgery) prospective cohort studies, were included. Studies including revision surgery or not published in English were excluded. Two reviewers independently searched information sources, assessed eligibility at title/abstract and full-text stages, extracted data, assessed risk of bias (modified QUIPs) and assessed GRADE. Authors were contacted to request raw data where data/variance data were missing. Meta-analyses evaluated outcomes at all available time points using the variance-weighted mean in random-effect meta-analyses. Means and 95% CIs were plotted over time for measurements reported on outcomes of leg pain, back pain and disability. RESULTS A total of 87 studies (n = 31,034) at risk of bias (49 moderate, 38 high) were included. Clinically relevant improvements immediately following surgery (> MCID) for leg pain (0-10, mean before surgery 7.04, 50 studies, n = 14,910 participants) and disability were identified (0-100, mean before surgery 53.33, 48 studies, n = 15,037). Back pain also improved (0-10, mean before surgery 4.72, 53 studies, n = 14,877). Improvement in all outcomes was maintained (to 7 years). Meta-regression analyses to assess the relationship between outcome data and a priori potential covariates found preoperative back pain and disability predictive for outcome. CONCLUSION Moderate-level evidence supports clinically relevant immediate improvement in leg pain and disability following lumbar discectomy with accompanying improvements in back pain. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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原发性腰椎间盘切除术后疼痛和残疾的临床过程：系统评价和荟萃分析。

目的进行荟萃分析，描述腰椎间盘切除术后成年患者疼痛和残疾的临床过程（PROSPERO：CRD42015020806）。方法进行了针对个人数据库的基于主题的敏感搜索策略。纳入了首次坐骨神经痛/神经根病未发生并发症的首次腰椎间盘切除术后（> 16岁）的患者，该患者在开始时（手术点）进行了前瞻性队列研究。排除了包括翻修手术或未发表英语的研究。两名审稿人独立搜索信息源，评估标题/摘要和全文阶段的资格，提取数据，评估偏见风险（修改后的QUIP）和GRADE。与作者联系以请求缺少数据/方差数据的原始数据。荟萃分析使用随机效应荟萃分析中的方差加权平均值在所有可用时间点评估结果。随时间绘制平均值和95％CI，用于测量腿痛，背痛和残疾的结果。结果共纳入了87项偏倚风险研究（n = 31,034）（中度49项，高38项）。腿部疼痛（0-10，术前平均7.04，50项研究，n = 14,910名参与者）术后立即进行临床相关改善（> MCID），并鉴定出残疾（0-100，术前平均53.33，48项研究，n = 15,037）。背痛也有所改善（0-10，平均术前4.72，53研究，n = 14,877）。所有结果均得到改善（至7年）。荟萃回归分析评估结局数据与先验潜在协变量之间的关系，发现术前背痛和残疾可预测结局。结论中等水平的证据支持腰椎间盘切除术后腿痛和残疾的临床相关立即改善以及伴随的腰痛改善。这些幻灯片可以在电子补充材料下找到。